骨盆骨折手术失败原因分析及处理  

Reasons and Management of Failed Pelvic Fractures Surgery

作　　者：王钧 周炎[2] 

机构地区：[1]武汉市十一医院骨科,湖北武汉430015 [2]武汉大学人民医院骨Ⅲ科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2016年第2期300-304,共5页Medical Journal of Wuhan University

摘　　要：目的:探讨导致骨盆骨折手术失败的原因及处理措施。方法:回顾性分析2006年3月至2013年6月收治的16例骨盆骨折手术失败患者的临床病例资料,男12例,女4例;年龄为35-55岁,平均45.5岁;骨折按Tile分型,B1型2例,B2型3例,B3型2例,C1型5例,C2型4例。4例采用外固定支架固定,12例行开放复位内固定术。根据Matta和Tornetta复位评定标准及Majeed功能评价标准,术后骨折复位质量及临床评价为"差",或固定失效、骨折复位丢失评定为治疗失败,分析手术失败的原因,并及时采取手术翻修治疗。结果:手术失败原因:2例因多发伤延误手术时机而未能予以骨折有效复位;4例骨盆骨折选择外固定支架作为终末固定导致复位丢失;4例仅行骨盆前环固定而未予以后环的稳定;6例骨盆骨折未予以有效复位及内固定。其中14例行骨盆翻修手术,2例骨盆骨折畸形愈合患者放弃翻修手术。14例翻修病例随访12-30个月,平均18个月。末次随访时根据Matta和Tornetta复位评定标准,优4例,良6例,可3例,差1例,优良率为71.4%;按Majeed临床疗效评价标准,优4例,良7例,可3例,优良率为78.6%。结论:手术时机把握不当、固定方式选择错误、骨折复位质量及内固定稳定性欠佳是骨盆骨折手术失败的主要原因。尽早手术翻修可明显降低患者术后功能障碍的发生。Objective： To investigate the cause and treatment of failed pelvic fractures surgery. Methods： The clinical data of 16 cases with failed pelvic fractures surgery were retrospectively analyzed fi＇om March 2006 to June 2013. There were 12 males and 6 females with an average age of 45.5 years （ranged from 35 to 55 years）. According to Tile classification, 2 cases were with type B1 fractures,3 cases with type B2,2 cases with type B3,5 cases with type Cl,and 4 cases with type C2. Four cases were treated with external fixation, and 12 cases underwent open reduction and internal fixation operation. According to the Matta and Tornetta reset evaluation criteria and Ma- jeed function evaluation standard, treatment failures were defined as the quality and performance for postoperative fracture clinical evaluation for ＂bad＂ ,or fixed failure and loss of fracture reset. The cause of operation failure was analyzed and revision surgery treatment was taken timely. Results： Two cases of multiple injury could not be effectively reset because of delayed operation time, 4 cases of pelvic fractures were treated with external fixator as terminal fixation led to reset lost,4 case of anterior ring stability without posterior ring fixation and 6 cases had no effective re- duction and internal fixation. Among them, 14 cases underwent pelvic revision operation, and 2 patients with pelvic fracture malunion abandoned revision surgery. Revision cases were followed up for 12-30 months （average 18 months）. According to Matta and Tornetta criteria at latest fol- low-up, it was excellence in 4 eases, good in 6 cases,fair in 3 cases,poor in 1 case,and the excel- lent and good rate was 71.4%. According to Majeed criteria, it was excellence in 4 cases,good in 7 cases,fair in 3 cases,and the excellent and good rate was 78.6%. Conclusion. Improper surgical timing,incorrect fixed way, and poor quality of fracture reduction and internal fixation are the main causes of failed pelvic fractures surgery. Early surgical revision can signi

关 键 词：骨盆 骨折固定术 内 治疗失败 回顾性分析 

分 类 号：R683.3[医药卫生—骨科学]