椎弓根钉棒系统皮下内固定治疗骨盆前环不稳定骨折的系统评价  

Anterior Subcutaneous Internal Fixation( ASIF) using Pedicle Rod- screw System for Unstable Pelvic Anterior Ring Fractures: a Systematic Assessment

作　　者：熊为[1] 赵猛[1] 张劲松[1] 徐圣康[1] 刘家国[1] 

机构地区：[1]十堰市太和医院.湖北医药学院附属医院创伤骨科,湖北十堰442000

出　　处：《湖北医药学院学报》2016年第2期165-169,181,F0003,共7页Journal of Hubei University of Medicine

基　　金：湖北医药学院附属太和医院2014年循证医学"苗圃基金"项目(EBM2014020)

摘　　要：目的：系统评价椎弓根钉棒系统皮下内固定治疗骨盆前环不稳定骨折的疗效和安全性。方法：计算机检索Pub Med、The Cochrane Library、Embase、CNKI、维普和万方数据库有关椎弓根钉棒系统皮下内固定治疗骨盆前环不稳定骨折的文献,检索时限均从建库至2015年9月。提取有效数据资料后进行系统评价。结果：检索到15篇文献,其中描述性临床研究9篇,生物力学研究4篇,解剖学研究2篇。纳入不稳定骨盆骨折228例。术后并发症有：股外侧皮神经损伤及异位骨化[单组率Meta分析显示其发生率分别为22.45%（95%CI=14.42%~33.22%）和31.97%（95%CI=24.87%~40.02%）],伤口感染7例,股神经损伤6例,皮肤刺激3例,骨折不愈合3例,术后复位丢失4例,内固定松动1例,内固定调整9例。生物力学研究显示该技术生物力学性能优于外固定架。解剖学研究显示该技术安全可行。结论：椎弓根钉棒系统皮下内固定治疗骨盆前环不稳定骨折有效、微创、患者舒适,但术后并发症较多,术中应仔细操作避免损伤及压迫周围神经。该技术还处于早期阶段,还需改进技术,开展高质量研究。Objective To systematically review the effectiveness and safety of anterior subcutaneous internal fixation（ASIF） using pedicle rod-screw system for unstable pelvic anterior ring fractures.Mothods The literatures about ASIF using pedicle rod-screw system for unstable pelvic anterior ring fractures were searched within the databases of PubMed, The Cochrane Library,EMbase, CNKI,VIP and WanFang Data from inception to September 2015.The quality of the included studies was critically evaluated and data were extracted and analyzed. Results A total of 15 literatures including 9 descriptive clinical studies, 2 anatomic studies and 4 biomechanical studies were included.Finally, 228 patients incurred unstable pelvic anterior ring fractures were included in the clinical studieS.The postoperative complications included irritation of the lateral femoral cutaneous nerve and heterotopic ossification.Meta-analysis for single rate showed that the incidence was 22.45%（95%CI= 14.42% - 33.22% ） and 31.97% （95%CI = 24.87% ~ 40.02% ）, respectively.Wound infection happened in 7 cases, femoral norve palsy in 6 cases, skin irritation in 3 cases, nonunion in 3 cases,loss of reduction in 4 cases, screw loosening in 1 case and revision in 9 cases.Biomechanical studies showed that this technique was superior to external fixation.Anatomic studies showed that this technique was safe and feasible.Conclusion The current evidence shows that ASIF for unstable pelvic anterior ring fractures is effective, mini-invasive and comfortable.But there were many complications after operation.It is important to avoid lesion and pressure of surrounding nerves by careful operation. This technology research is still in the early stage.It needs to be improved to carry out high quality research.

关 键 词：骨盆前环骨折 不稳定 皮下内固定 钉棒系统 系统评价 

分 类 号：R687.3[医药卫生—骨科学]