后方经皮微创切开加塑形锁定钢板治疗骨盆后环损伤的临床研究  

Clinical research on posterior percutaneous mini-incision with a moulding locking plate for treat- ment of posterior pelvic ring injury

作　　者：周海燕[1] 季英[1] 吴良浩[1] 施继飞[1] 禹宝庆[1] 叶秀章[1] 周建华[1] 顾龙殿[1] 苏佳灿[2] 姜新华[1] 李承[1] 黄建明[1] 朱雅龙[1] 张东华[2] 黄淦[2] 潘思华[2] 

机构地区：[1]上海市浦东医院,复旦大学附属浦东医院骨科,201399 [2]第二军医大学附属上海医院骨科

出　　处：《中华创伤杂志》2014年第1期20-24,共5页Chinese Journal of Trauma

摘　　要：目的探讨后方经皮微创切开结合塑形锁定钢板治疗骨盆后环损伤的手术方式及其疗效。方法选择2008年1月—2012年12月入院的46例骨盆后环损伤的骨盆骨折患者，其中男27例，女19例；平均年龄34．8岁。骨折均为TileC型：C1．1型18例，C1．2型8例，C1．3型9例，C2型11例。所有患者均采取后方经皮微创切开结合塑形锁定钢板进行治疗。合并骨盆前环损伤32例患者，其中30例联合骨盆前方有限切开手术入路复位内固定治疗，2例因尿道损伤行膀胱造瘘术只单纯应用后方经皮微创切开内固定骨盆后环。合并髋臼骨折14例，其中8例联合骨盆前方有限切开复位内固定治疗，6例联合Kocher—Langenbeck入路切开复位内固定治疗。结果所有患者术中未发生大出血，术后未出现腰骶丛神经卡压征，未出现感染、复位丢失、深静脉血栓形成等。46例均获平均19个月（8—35个月）随访。骨盆骨折前后环损伤复位均为优。所有患者术后6～10周患侧下肢部分负重行走，术后12—16周完全负重行走。X线片示骨痂生长通过骨折线，骨折部位均获得骨性愈合。结论采取后方经皮微创切开结合塑形锁定钢板治疗骨盆后环损伤具有固定牢靠、手术创伤小、出血少、手术时间短、术后患者可早期下地活动等优点，值得临床推广。Objective To investigate the surgical approach and result of minimally invasive per- cutaneous plate osteosynthesis with a moulding locking plate for treatment of patients with posterior pelvic ring injury. Methods Forty-six patients （27 men, 19 women; at mean age of 34.8 years） with poste- rior pelvic ring injury treated from January 2008 to December 2012 were enrolled in the study. There were 18 patients with type-C1.1, 8 with type-C1.2, 9 with type-C/. 3, and 11 with type-C2 fractures accord- ing to Tile classification system. Treatments were all minimally invasive percutaneous plate osteosynthesis with a moulding locking plate. For the combined anterior pelvic ring injuries in 32 patients, additional surgical interventions included limited open reduction and internal fixation via the anterior approach （n = 30） and cystostomy for urethral injury （n = 2） ; for the combined acetabular fractures in 14 patients, ad- ditional surgical interventions included limited open reduction and internal fixation via the anterior ap- proach （ n = 8 ） and open reduction and internal fixation via the Kocher-Langenbeck approach （ n = 6）. Results There was no massive bleeding in operation and no lumbrosacral nerve entrapment syndrome, infection, reduction loss or deep vein thrombosis after operation. Reduction of the anterior-posterior pelvic ring injury was excellent for all patients at a mean follow-up of 19 months （range, 8-35 months）. Partial weight-bearing was permitted for all patients at postoperative 6-10 weeks and full weight-bearing at postop- erative 12-16 weeks. Besides, X-ray films revealed bone callus formation through fracture line and bony healing in all patients. Conclusion Minimally invasive percutaneous plate osteosynthesis with a moulding locking plate gains advantages of rigid fixation, minor trauma, less bleeding, short operation time, and early ambulation and hence deserves wild attention in clinical practice.

关 键 词：骨盆 骨折固定术 内 塑形锁定钢板 

分 类 号：R687.3[医药卫生—骨科学]