骨盆前方皮下内固定架治疗不稳定骨盆骨折  

Anterior subcutaneous internal fixation of unstable pelvic ring fracture

作　　者：张彦龙[1] 吴春生[1] 宋连新[1] 任栋[1] 张英泽[1] 彭阿钦[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心,石家庄050051

出　　处：《中华创伤杂志》2015年第9期828-832,共5页Chinese Journal of Trauma

摘　　要：目的评价经皮椎弓根钉棒系统即皮下内固定架（INFIX）治疗骨盆前环骨折的疗效。方法选择2013年7月—2014年6月应用INFIX经皮下固定骨盆前环骨折15例，其中男11例，女4例；年龄23～65岁，平均38．5岁。致伤原因：交通伤8例，坠落伤4例，砸伤3例。骨折按Young—Burgess和AO／OTA分型：APC2型，即61-B1型1例；LC1型，即61-B2．1型4例；LC2型，即61-B2．2／61-B2．3型6例；VS型，即61-C1／61-C2型4例。前环固定的基本方法：先在双侧髂前上、下棘之间分别拧入1枚椎弓根螺钉，再将预弯的连接杆经皮下固定在两螺钉之间。对于后环稳定者，仅用INFIX固定前环；对于前、后环均不稳定者，在后环固定后，再用INFIX固定前环。随访期间了解患者对INFIX的耐受程度，观察伤口感染、骨化性肌炎、内固定松动及股外侧皮神经损伤等情况。结果随访6～12个月，平均7．5个月。所有患者对INFIX耐受良好，无不适感。无切口感染、骨化性肌炎和内固定松动。所有患者3个月内骨折愈合，无复位丢失。4例出现双侧、2例出现单侧股外侧皮神经损伤，均于术后3个月内恢复。结论INFIX技术创伤小、并发症少、效果可靠，是治疗骨盆前环骨折的理想方法。Objective To determine the curative effect of stabilizing unstable pelvic ring fracture using the anterior subcutaneous internal fixator （INFIX）. Methods From July 2013 to June 2014, 15 cases who suffered from anterior pelvic ring fracture were treated with the device. There were 11 males and 4 females, with mean age of 38. 5 years （range, 23-65 years）. Eight cases sustained fracture in traffic accidents, 4 in high falls, and 3 in crush injury. According to the Young-Burgess and AO/OTA classification systems, type APC2 or 61-B1 was noted in one case, LC1 or 61-B2.1 in 4 cases, LC2 or 61-B2. 2/61-B2. 3 in 6 cases, and VS or 61-C1/61-C2 in 4 cases. Basic method in anterior ring fixation was one pedicle screw was respectively inserted into the area between the anterior superior iliac spine and anterior inferior iliac spine of both sides. The precontoured rod was then tunneled subcutaneously from one screw to the other. For the stable posterior injury in pelvic ring fracture, the anterior pelvic ring was stabilized only using the technique. For the unstable posterior injury in pelvic ring fracture, the anterior and posterior ring were both fixed using the technique. During follow-up visits, patients＂ tolerance to the device, wound infection, myositis ossificans, internal fixation lessening, and lateral femoral cutaneous nerve injury were evaluated. Results Follow-up ranged from 6-12 months （mean, 7. 5 months）. The device was well tolerated by the patients for comfort. None had surgical site infection and internal fixation loosening. Injuries healed without loss of reduction at the 3-month follow-up. Injury of the lateral femoral cutaneous nerve at the both side was reported in 4 cases and at one side in 2 cases, but all restored 3 month after operation. Conclusion The reported technique is minimally invasive with few complica- tions and reliable results, hinting an ideal method to stabilize the anterior pelvic ring fracture.

关 键 词：骨盆 骨折固定术 内 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]