骨盆环不稳定性骨盆骨折的手术入路和内固定选择  

Choices of the internal fixation and approaches on unstable pelvic ring fractures

作　　者：毕大卫[1] 祖罡[1] 韩雷[1] 陈亿民[1] 马海涛[1] 胡钢锋[1] 朱元[1] 

机构地区：[1]杭州市萧山区第一人民医院,浙江杭州311200

出　　处：《中国骨伤》2017年第3期213-216,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的 :探讨在骨盆环不稳定骨盆骨折中手术入路与内固定的选择。方法 :2010年5月至2015年5月,45例骨盆前后环不稳定患者分别采取不同的固定方法及手术入路治疗,男38例,女7例;年龄21~61岁,平均45岁;病程在2周内。按照Young-Burg分型,其中LC型23例,VS型6例,APC型16例。术前患者髋部疼痛,活动受限,摄片示骨盆环断裂骨折移位。结果:术后患者伤口愈合佳,无相关并发症。45例患者术后获得随访,时间9~21个月,平均13个月。术后患者髋部疼痛缓解,X线片示骨盆复位满意,骨盆环形态恢复良好。Majeed功能评分(93.5±11.6)分;结果优35例,良8例,可2例。结论:伴有骨盆环不稳定的骨盆髋臼骨折,往往并发复合伤,手术原则既要考虑减少手术创伤,又要顾及骨折复位,特别要考虑关节内骨折复位和骨盆环的稳定性,所以往往需要切开手术入路和微创手术相结合,才能达到满意的疗效。Objective：To discuss the suitable surgical approach and the internal fixation of unstable pelvic pelvic fractures. Methods：From May 2010 to May 2015,45 patients with unstable pelvic fractures were treated with different approaches and fixations,including 38 males and 7 females with an average age of 45 years ranging from 21 to 61 years. The course was within 2 weeks. According to Young Burg classification,23 patients were lateral compression injuries,6 patients were vertical shearing injuries,16 patients were anterior posterior compression injuries. All patients had hip pain and limitation of motion,the X rays showed the pelvic ring fracture. Results：All wounds healed well without complications,45 cases were followed up for a mean period of 13 months（ranged 9 to 21 months）. Patients with hip pain had a good postoperative pain relief. The post operative X rays showed the reduction was satisfied and the pelvic ring shaped well. According to Majeed standards,the final follow up score was 93.5±11.6,35 cases got excellent results,8 were good,2 were fare. Conclusion：The unstable pelvic and acetabular fractures are always with compound injury. Beside the reduction,to decrease the second surgery trauma should take into consideration as well,the intra articular reduction and the stability of the pelvic were especially valued,so combined the different approach with minimal invasive technique can get good clinical result.

关 键 词：骨盆 骨折 手术入路 骨折固定术 内 

分 类 号：R683.3[医药卫生—骨科学]