经皮内固定治疗复合创伤骨盆前环骨折  

Percutaneous Internal Fixation for Anterior Ring Pelvic Fractures in Complex Injury

作　　者：史风雷 王琨 吕夫新 孙正考 

机构地区：[1]山东大学齐鲁医院(青岛)创伤骨科,青岛266035

出　　处：《中国现代手术学杂志》2017年第6期428-431,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨经皮内固定治疗复杂创伤中骨盆前环骨折的效果。方法回顾性分析2012年1月~2015年5月我科收治的复合伤骨盆环骨折患者17例,骨盆骨折按Tile分型:Tile B1型7例(7侧),Tile B2型5例(6侧),Tile C1型2例(3侧),Tile C2型2例(4侧),双侧髋臼横行骨折1例,均为闭合性损伤。所有患者前环骨折均采用经皮内固定治疗,前方显露耻骨联合并间接牵引复位,C臂透视骨折位置好,髂前上嵴处切口,通过皮下隧道,安放钢板固定。3个月后骨折愈合取出内固定物。结果本组17例22侧骨盆骨折患者均顺利完成经皮内固定治疗,前环复位固定手术时间平均23(20~50)min,术中出血平均38(20~120)ml。17例患者均获随访,随访时间平均11(6~24)个月。复位质量按Matta标准评定:优13侧,良8侧,可1侧。骨折愈合时间平均10(8~12)周。无骨折不愈合或延迟愈合发生,无内固定失败及血管神经的医源性损伤等并发症发生,仅2例出现股外侧皮神经的刺激症状,均于4周内恢复。5例患者出现钢板置放区不适,皮下有异物感,取出钢板后不适症状消失。结论经皮内固定治疗骨盆前环骨折,切口小,不暴露神经、血管等结构,安全、稳定,疗效良好。Objective To explore the effect of percutaneous anterior pelvic internal fixation（APIF） in the treatment of complex injuries. Methods A total of 17 complex injury cases with unstable anterior ring pelvic fractures admitted from January 2012 to May 2015 were analyzed retrospectively. According to Tile classification,there were 7 cases（7 laterals） of type B1,5 cases（6 laterals） of B2,2 cases（3 laterals） of C1,2 cases（4 laterals） of C2 and 1 case of bilateral transverse acetabular fracture. All anterior ring pelvic fractures were treated by APIF. The symphysis pubis was exposed and consensual traction reduction was performed,the internal fixation of plate was carried out by the subcutaneous tunnel via the incision of anterior superior iliac spine. Results All 17 cases accomplished the surgery of APIF with 23 minutes of the average operative time（ranged from 20 to 50） and 38 ml of intraoperative blood loss（ranged from 20 to 120）. All17 cases were followed up for 6 to 24 months with an average of 11 months. The outcomes revealed excellent in 13 fractures,good in 8 fractures and fair in 1 fracture according to Matta ＇s criteria. The fracture healing time was 8 to 12 weeks with an average of 10 weeks. There was no complication as fracture nonunion,delayed union,internal fixation failure and iatrogenic neurovascular injury. The irritation of lateral femoral cutaneous nerve occurred in 2 cases and recovered spontaneously in 4 weeks. Subcutaneous foreign body sensation was found in 5 cases and disappeared after removal of internal fixators. Conclusion Percutaneous APIF issafe,mini-traumatic and reliable for unstable anterior ring pelvic fractures in complex injury without the necessity of neurovascular structures dissection.

关 键 词：骨盆骨折 骨盆环 骨折固定术 内 经皮内固定术 

分 类 号：R687.3[医药卫生—骨科学]