髂腰固定治疗合并骶骨骨折的垂直不稳定型骨盆骨折  

Iliolumbar Fixation in the Treatment of Vertically Unstable Pelvic Fracture Combined with Sacral Fracture

作　　者：李宗原[1] 王陶[1] 石波[1] 王军[1] 唐诗添[1] 谢明锐 

机构地区：[1]绵阳市中心医院骨科,四川绵阳621000

出　　处：《四川医学》2016年第4期433-437,共5页Sichuan Medical Journal

摘　　要：目的探讨应用髂腰固定系统治疗合并骶骨骨折的垂直不稳定型骨盆骨折的临床效果。方法对2011年7月至2014年12月收治的13例合并骶骨骨折的垂直不稳定型骨盆骨折患者进行髂腰固定手术治疗。采用后路下腰椎后正中切口入路,垂直移位复位后,椎弓根钉棒系统固定双侧L5椎体,髂骨钉固定髂后上棘;前路采用stoppa入路钢板螺钉固定6例,髂腹股沟入路钢板螺钉固定4例,双侧髂前上棘组合式外固定支架固定3例。结果 13例患者术后获得4~36个月随访,平均20.3个月。术后X线片均示骨盆骨折复位满意,后环形态恢复良好;根据Matta骨盆骨折复位评定标准,优8例,良5例。术后5例患者骶丛损伤压迫症状解除,未出现医原性神经、血管损伤。所有下肢行走及屈、伸髋功能恢复满意。术后12个月Majeed评分：优9例,良4例。结论髂腰固定系统治疗合并骶骨骨折的垂直不稳定型骨盆骨折疗效满意,且具有利于解除神经压迫,操作不复杂、并发症少的特点。Objective To evaluate the clinical effect of the application of iliolumbar fixation system in the treatment of vertically unstable pelvic fracture combined with sacral fracture. Methods From July 2011 to December 2014,13 patients with a vertically unstable pelvic fracture combined with sacral fracture were treated with iliolumbar fixation surgery. Using posterior midline incision approach from the lower lumbar spine. After vertically resetting and shifting,pedicle screw system was used to fix bilateral L5 vertebral body,iliac screw was used for fixing posterior superior iliac spine. For the anterior,6 cases were used stoppa approach and were fixed with plate and screw; 4 cases were used ilioinguinal approach and were fixed with plate and screw; 3 cases were fixed with external fixation combined with bilateral anterior superior iliac spine. Results 13 cases of patients were foI lowed up 4-36 months after surgery,an average of 20. 3 months. The postoperative X-ray films showed satisfactory reduction of the pelvic fracture and good recovery of the posterior ring shape. After being evaluated according to Matta pelvic fractures assessment standards,the outcomes of reduation were excellent in 8case,good in 5 cases. After the operation,5 cases of patients with symptoms of sacral plexus injury and compression relieved with no symptoms of the original nerve and vascular injury. All patients had a satisfactory function recovery in terms of lower limb walking and hip flexion and extension. 12 months after operation,accoding to Majeed functional scoring,9 patients were excellent,4 were good. Conclusion The application of iliolumbar fixation system in the treatment of vertically unstable pelvic fracture combined with sacral fracture has a satisfactory effect,and has such characteristics as the relief of nerve compression,simple operation,less complications of surgery at the same time.

关 键 词：骨盆 骨折 垂直 不稳定 髂腰 骶骨 固定 

分 类 号：R687.3[医药卫生—骨科学]