联合入路治疗陈旧性TileB型和C型骨盆骨折的疗效  

Combined approach to treatment of Tile type B and C old pelvis fracture

作　　者：朱福良[1] 贾健[2] 郑道明[1] 张银光[2] 刘兆杰[2] 时宇博[1] 王云国[1] 李立军[1] 

机构地区：[1]天津医科大学第二医院骨科,300211 [2]天津医院创伤骨科

出　　处：《中华创伤杂志》2016年第3期196-202,共7页Chinese Journal of Trauma

摘　　要：目的探讨应用联合人路处理TileB型和C型陈旧性骨盆骨折的手术方法。方法2009年7月-2014年7月收治19例TileB型和C型陈旧性骨盆骨折患者，其中男13例，女6例；年龄25～66岁，平均53．4岁。致伤原因：交通伤14例，高处坠落伤3例，重物砸伤2例。受伤至手术时间1．5-0．3个月。根据Tile分型方法，B2型5例，B3型5例，C1型3例，C2型4例，C3型2例；4例B型和2例C型合并髋臼骨折。B型骨折畸形采取前路髂腹股沟入路，骨折畸形愈合处骨刀截骨重建钢板固定；C型骨折采取前路髂腹股沟入路截骨，后路骶骨截骨或骶髂关节截骨后髂腰固定术。如合并髋臼后壁或后柱骨折，采用附加Kocher—Langenbeck后方入路，漂浮体位双侧窗口复位骨折同时固定治疗。根据Mears和Velyvis影像学评定标准对复位进行评价。根据M^eed评分标准对术前、术后功能评分进行比较。结果19例患者随访时间平均11．4个月（3～24个月），骨折愈合时间平均5．2个月（3—7个月），骨折均I期愈合。Mears和Velyvis影像学评定标准：解剖复位10例，满意6例，不满意3例。Majeed评分标准：优6例，良10例，可3例。术后2例存在伤时骶神经损伤残留致小便控制不佳；1例髋臼陈旧性骨折致髋关节疼痛，但口服非甾体抗炎药物能控制疼痛；2例存在骶髂关节酸痛症状。无发生断钉及内固定失效病例。结论通过骨盆联合入路对TileB型和C型骨盆前后环陈旧性畸形愈合骨折处截骨矫形并坚强固定，恢复完整闭合骨盆环结构，是提高复位质量、纠正患侧肢体短缩、改善术后功能的有效方法。Objective To investigate the operative methods in treatment of Tile type B and C old pelvis fracture. Methods The study enrolled 19 cases （ 13 males and 6 females） with a mean age of 53.4 years （range, 25-66 years） treated from July 2009 to July 2014. Injury resulted from traffic accidents in 14 cases, high falls in 3 cases and hit by heavy objects in 2 cases. Time from injury to operation was 1.5-10.3 months. According to the Tile classification, the type of fracture was 5 B2, 5 B3, 3 C1, 4 C2 and 2 C3. Four cases of type B and two cases of type C were combined with acetabulum fracture. Type B fracture deformity was operated through the anterior letournel approach, during which the malunion had osteotomy and reconstruction plate fixation. When posterior wall or column acetabular fracture existed, additional posterior Kocher-Langenbeck incision was used to achieve fracture reduction and stabilization through bilateral fenestration in the floating position. Type C fracture undergone osteotomy through anterior letournel approach and posterior sacral osteotomy or ilio-lumbar fixation following sacroiliac osteotomy. With regard to the combined posterior wall or column acetabular fracture in type C fracture, thesurgical method was the same as type B. Radiological and functional results were respectively evaluated using the Mears-Velyvis system and Majeed criteria. Results Mean duration of follow-up was 11.4 months （range, 3-24 months ）. All fracture united in the one-stage, with mean union time of 5.2 months （range, 3-7 months）. According to the Mears and Velyvis system, 10 cases obtained anatomical reduction, 6 were satisfied, and 3 were unsatisfied. According to the Majeed criteria, the results were excellent in 6 cases, good in 10 and fair in 3. After operation, 2 cases sustained poor control of urination caused by sacral nerve injury ; 1 case still had hip pain caused by old acetabular fracture, but the symptom could be controlled by non-steroidal anti-inflammatory drugs; 2 cases had sacroiliac joi

关 键 词：骨盆 髋臼 骨折固定术 内 髂腰固定 

分 类 号：R687.3[医药卫生—骨科学]