切开复位内固定治疗耻骨联合浮动伤  

Open reduction and internal fixation for floating symphysis pubis

作　　者：李连欣[1] 王永会[1] 郝振海[1] 周东生[1] 刘健安[1] 

机构地区：[1]山东大学附属省立医院创伤骨科,济南250021

出　　处：《中华骨科杂志》2014年第4期436-440,共5页Chinese Journal of Orthopaedics

基　　金：东省优秀中青年科学家科研奖励基金（2008BS03054）

摘　　要：目的探讨耻骨联合浮动损伤的临床特点及采用切开复位内同定治疗的效果。方法回顾性分析2008年1月至2013年1月采用切开复位内同定治疗48例耻骨联合浮动损伤患者资料，男31例，女17例；年龄20-61岁，平均36．5岁；车祸伤35例，坠落伤8例，挤压伤5例。骨盆骨折AO分型：B型13例，C型35例。其中45例合并骨盆后环骨折，14例合并髋臼骨折，17例合并四肢骨折，11例合并胸腹部损伤，6例合并泌尿生殖系统损伤。受伤至手术时间3-25d，平均7d。骨盆前环同定方法：重建钛板同定双侧耻骨支骨折41例，微创空心钉同定7例。同时同定后环损伤4l例，其中12例采用骶髂前钢板同定，5例采用骶髂螺钉同定，18例采用髂骨后“M”型板同定，6例采用髂腰同定。结果44例获得随访，随访时间12-36个月，平均16个月，骨折全部临床愈合，愈合时间10-16周，平均12．6周。采，}=}jMatta标准评价骨折复位情况，其中优21例，良16例，可7例，优良率为84．1％（37／44）。末次随访时Majeed评分为65-100分，平均81．5分，其中优30例，良10例，可4例，优良率为90．9％（40／44）。术后3天，2例患者发生脂肪液化，经换药2-3周后治愈；术后5-15d，平均10d，8例发生下肢深静脉血栓，经给予低分子肝素等保守治疗1-6个月，平均3．5个月后血栓治愈；术后5-7d，平均6t1，3例l叶I现耻骨疼痛，给予抗炎止痛药物、理疗等治疗1年后疼痛解除。无一例发生钢板断裂脱m、感染及医原性神经、m管损伤等并发症。结论耻骨联合浮动伤是一类严重的骨盆’目’折，多数合并后环损伤，影响骨盆稳定性，切开复位内同定可以稳定骨盆，有助于早期活动及功能锻炼，从而获得良好临床效果。Objective To explore the clinical characteristics of the floating injury of symphysis pubis and clinical out-come of open reduction and internal fixation. Methods A retrospective study was conducted to analyze the 48 patients who had been treated in our department with open reduction and internal fixation for the floating injury of Symphysis pubis from January 2008 to January 2013. There were 31 males and 17 females, with an average age of 36.5 years （range, 20 to 61 years）. Thirty-five patients were injured in traffic accidents and 8 were injured by talling injuries, and the other 5 were crushed by mac, hine. Forty- five cases were complicated with fractures of the posterior pelvis ring; 14 cases were complicated with acetabular fractures; 17 cas-es were complicated with extremity fractures; 11 cases were complicated with thoracic and abdominal injuries and 6 cases were as-sociated with urogenital system injury. The average period from trauma to operation was 7 days （range, 3 to 25 days）. Operation was performed under general anesthesia. The bilateral pubic ramus fractures were fixed with reconstruction plate in 41 eases, and 7 cases were fixed with cannulated screw through minimally invasive method. Forty-one cases with posterior ring fractures were fixed simultaneously. Results There were 44 patients being followed up with an average period of 16 months （range, 12 to 30 months）. All the fractures of the pelvis were clinically healed with an average period of 12.6 weeks （range, 10 to 16 weeks）. Accord- ing to the Majeed score system, the functional results were excellent in 30 cases, good in 10 cases, and fair in 4 cases; The average score was 81.5 （range, 60 to 100） . Two patients who had wound fat liquefaction at 3 days after operation were healed by dressing changing; 8 patients got deep vein thrombosis at I0 days （range, 5 to 15 days） after operation were cured by conservative treat- ment; 3 patients got supra pubic pain at 6 days （range, 5 to 7 days） after operation were healed

关 键 词：骨盆 耻骨联合 骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]