采用内外固定联合技术分阶段治疗陈旧性CⅠ、Ⅱ型骨盆骨折  

Staged treatment with combined internal and external fixation for type CⅠand Ⅱ pelvic fracture

作　　者：陈辉[1] 郭庆山[1] 刘华渝[1] 宗兆文[1] 沈岳[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所全军战创伤中心，创伤,烧伤与复合伤国家重点实验室,重庆400042

出　　处：《创伤外科杂志》2014年第4期328-332,共5页Journal of Traumatic Surgery

基　　金：国家科技支撑计划"创伤救治新技术研究集成示范"(2012BAI 11B01)

摘　　要：目的总结联合应用骨盆外固定和内固定术分期分阶段治疗陈旧性CⅠ、Ⅱ型骨盆骨折的疗效。方法 2011年3月-2013年7月共收治6例陈旧性CⅠ、Ⅱ型骨盆骨折患者,男性4例,女性2例;年龄24-62岁,平均55岁。道路交通伤4例,高处坠落伤2例。受伤时间3周-2个月,均合并有不同程度其他组织脏器损伤。X线及CT检查示耻骨联合分离,其中2例分离间距＆gt;2.5cm,骶骨骨折未有骶髂关节分离脱位CⅠ型4例;骶骨骨折伴骶髂关节分离脱位CⅡ型2例。一期先采用外固定支架逐渐加压复位前环,纠正旋转不稳定,同时配合骨牵引纠正垂直不稳定,二期再行前后环内固定治疗。结果术后切口均Ⅰ期愈合,6例均获随访,随访时间5-26个月,平均15.5个月。术后患者主观感觉均较术前好转,骨折骨性愈合。术后对复位情况按Matta评分：优4例,良1例,中1例;对功能恢复情况按Majeed评分：优4例,良1例,中1例。结论联合应用骨盆外固定分阶段加压复位前环以及纠正垂直移位和切开复位重建钢板以及髂腰间椎弓根螺钉内固定治疗陈旧性CⅠ、Ⅱ型骨盆骨折,具有创伤小,出血少,术后恢复快等优点,取得了良好的治疗效果。Objective To summarize the curative effect of staged treatment with combined internal and external fixation for type CⅠ and H pelvic fracture. Methods From Mar. 2013 to Jul. 2011 ,there were 6 cases of type CI, Ipelvic fracture, including 4 males and 2 females （ age ranged from 24 to 62 years, mean 55 years ）. There were 4 cases of traffic accident injury,and 2 cases of falling injury. The injury time ranged from 3 weeks to 2 months. All cases were complicated with other organ injuries. X-ray and CT examination showed 2 cases of pubic symphysis separation, with the separation distance 〉 2. 5cm. There were 4 cases of type C I（ sacral fracture without sacroiliac joint dislocation） and 2 cases of C Ⅱ（ sacral fracture with sacroiliac joint dislocation）. In the first stage, external fixator was gradually pressurized to reset the anterior ring,correct the rotational instability, and simultaneously correct the vertical instability. In the second stage we used internal fixation for final treatment for both anterior and posterior pelvic ring. Results All incisions healed in the primary stage. Six cases were followed up,ranging from 5 to 26 months,with an average of 15.5 months. The Matta score indicated excellent in 4 cases,good in 1 case,and fair in 1 case. The Majeed score for functional recovery indicated excellent in 4 cases,good in 1 case, and fair in 1 case. Conclusion The combined use of external and internal fixation for type CⅠ,Ⅱ pelvic fracture has advantages of minimal trauma, less bleeding,and fast postoperative recovery. It can obtain a good treatment effect.

关 键 词：骨盆骨折 内固定 外固定 

分 类 号：R683.3[医药卫生—骨科学]