微创腰椎骨盆三角固定技术在不稳定型骶骨骨折治疗中的应用  

Minimally invasive lumbopelvic stabilization with triangular osteosynthesis for unstable sacral fractures

作　　者：李辉[1] 易成腊[1] 白祥军[1] 宋先舟[1] 胡耑[1] 李占飞[1] 冯振中[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,湖北武汉430030

出　　处：《创伤外科杂志》2015年第6期518-521,共4页Journal of Traumatic Surgery

摘　　要：目的探讨微创腰椎骨盆三角固定治疗不稳定型骶骨骨折手术方法和临床疗效。方法2011年1月-2014年3月采用微创入路对14例不稳定型骶骨骨折患者进行腰椎骨盆三角固定,其中男性11例,女性3例;年龄19-49岁,平均40.5岁。骨盆骨折按Tile分型：C1型10例,C2型3例,C3型1例。受伤至手术时间为7-45d,平均23.1d。纵向内固定系统为通用脊柱内固定系统（USS系统）联合髂骨螺钉及CDHTMLEGACY CMAS骶髂内固定系统,术后对骨折愈合及伤口并发症发生情况进行记录、随访。结果手术时间87-150min,术中出血量200-400m L。9例采用CMAS系统,5例采用USS系统联合髂骨螺钉;横向骶髂螺钉固定8例,跨骶骨钢板固定6例。9例进行骶神经根减压,部分患者神经功能显著改善。本组患者平均获得6.5个月的随访,未出现伤口渗液、皮缘坏死或伤口感染等伤口并发症;2例患者诉髂后上棘螺钉突出不适;无内固定断裂、复位丢失及骨折延迟愈合等并发症。全部患者骨折基本愈合,6例患者已取出内固定物。结论采用微创方法治疗不稳定型骶骨骨折不仅能够完成牢固的内固定,而且可降低术中对软组织的损伤,减少术中出血,降低术后伤口并发症的发生率,具有较大应用价值。Objective To analyze the operative technique and clinical effectiveness of minimally invasive lumbopelvic stabilization with triangular osteosynthesis for vertically unstable sacral fractures. Methods From Jan.2011 to Mar. 2014,14 cases of unstable sacral fractures were treated with minimally invasive technique by USS or CDHTMLEGACY CMAS iliosacral system. They were 11 males and 3 females with an average age of 40. 5（ 19-49）years. According to Tile classification,there were 10 cases of type C1,3 cases of type C2 and 1 case of type C3.The definitive operations were performed 7-45 days（ average 23. 1 days） after injury. Vertical fixation system was universal spine system（ USS） and CDHTMLEGACY CMAS. The sacral healing and wound complications were recorded and evaluated after operation. Results The duration of operation ranged from 87 to 150 minutes. The blood loss during the operation ranged from 200-400 m L. Nine cases were treated by using CMAS system,5 cases by using USS combined with iliac screws. The transverse fixation was achieved by iliosacral screws in 8 cases and transsacral plates in 6 cases. Decompression was performed in 9 cases,some of whom obtained significant recovery of neurological function. All the patients were followed up for an average of 6. 5 months. No wound-healing disorders or infections,and no rupture of implants or loss of reduction were observed. Fractures healed in all cases. Removal of implants was performed in 6 cases. Conclusion This minimally invasive technique for unstable sacral fractures is worth application for it can not only provide stable internal fixation,but also decrease or even prevent further soft tissues injuries,bleeding and postoperative wound complications.

关 键 词：骶骨骨折 骨盆 微创 内固定 

分 类 号：R683.6[医药卫生—骨科学]