三种外固定置钉方法治疗骨盆骨折  

Comparison of three pin placements of external fixation for treatment of pelvic fractures

作　　者：夏羿凡 陈路[2] 朱天亮 刘显宏 

机构地区：[1]重庆市人民医院三院院区骨科,重庆400010 [2]川北医学院附属医院骨科,四川南充637000

出　　处：《中国矫形外科杂志》2017年第10期879-883,共5页Orthopedic Journal of China

基　　金：重庆市卫生和计划生育委员会资助项目(编号:2015ZBXM092)

摘　　要：[目的]通过回顾性分析,对比骨盆骨折后使用3种不同外固定支架置钉方法间的并发症发生率,为临床置钉提供理论依据。[方法]选择2006年1月~2016年5月两医院骨盆骨折患者232例,Tile A型119例,Tile B型55例,Tile C型58例,随机分为髂嵴上置钉组,髋臼上置钉组和髂嵴下置钉组进行治疗并随访18个月,对比平均手术时间、平均出血量、术后功能恢复情况、神经损伤、钉道感染率、置钉在骨内的体积及松动情况。[结果]3组患者平均手术时间差异具有统计学意义(P<0.001),且每两组间平均手术时间差异也具有统计学意义(P<0.001),嵴下组手术时间最短为(15±5)min,髋臼组最长为(66±10 min)。3组平均出血量差异具有统计学意义(P<0.001),其中嵴下组平均出血量为(20±5)ml,而髋臼组(100±35 ml)和嵴上组(90±50 ml)间出血量差异无统计学意义(P=0.443)。3组患者术后功能恢复Majeed评分优良率,嵴上组61.33%,嵴下组82.5%,髋臼组95.65%,组间比较差异具有统计学意义(P<0.001),髋臼组术后功能恢复情况好于其他2组。神经损伤率:嵴上组0%,嵴下组17.5%,髋臼组4.35%,3组间比较差异具有统计学意义(P<0.05)。髋臼组虽有较低的钉道感染率(8.69%),但与嵴上组(26.67%)及嵴下组(32.5%)组间比较差异无统计学意义。在所把持的骨量方面,3组间差异无统计学意义(P=0.059),而松动率差异具有统计学意义(P<0.05),组间比较髋臼组(2.61%)明显低于其他两组,嵴上组(20.00%)和嵴下组(33.33%)比较差异无统计学意义。[结论]嵴下固定作为急救的处理时较为合适,髋臼上固定适合于可能将外固定支架作为终极治疗的人群,嵴上固定在综合对比中无显著优势。[Objective] To compare outcomes of three pin placements of external fixation for treatment of pelvic fracture. [Methods] A total of 232 patients with pelvic fracture, including 119 cases of Tile type A, 55 cases of type B and 58 cases of type C, received surgical treatment with external fixation in two hospitals from January 2006 to May 2016. Three pin placements of external fixation were used, such as placement at superior iliac crest, inferior iliac crest and superior acetabulum. Comparisons of the three groups were conducted in perioperative and follow-up parameters. [Results] Operation time was shortest in the inferior iliac crest group （15~5 rain）, while the longest in the superior acetabulum group （66~10 min）, with significant differences among three groups （P〈0.O01）, and between each two groups of them as well （P〈0.O01） . Blood loss in average was 90~50 ml in superior iliac crest group, 20~5 ml in the inferior iliac crest group, and 100~35 ml in superior ac- etabulum group, associated with significant differences among the 3 groups （P〈0.001）, however, no significant difference be- tween the superior iliac crest group and the superior acetabulum group （P=0.443） . The nerve injury rates were 0%, 17.5% and 4.35% respectively, with significant differences among three groups （P〈0.001） . Pin tract infection rate was the lowest in the superior acetabulum group （8.69%）, however no significantly statistical differences compared with 26.67% in the superior iliac crest group and 32.5% in the inferior iliac crest group. According to Majeed score, excellent and good rate of outcomes achieved 61.33% in the superior iliac crest group, 82.5% in the inferior iliac crest group, and 95.65% in the superi- or acetabulum group, with significant differences among groups （P〈0.001） . Although no significant difference was found in terms of pin purchase （P=0.059）, loosening rate of pin in the acetabulum group （2.61%） was significantly lower than that of the superior lilac crest

关 键 词：骨盆骨折 外固定架 髋臼上置钉 髂嵴下置钉 

分 类 号：R687.3[医药卫生—骨科学]