不稳定型骨盆骨折前环固定失效的原因分析与处理  

Causes and solutions for failed anterior ring fixation for unstable pelvic fractures

作　　者：莫华贵[1] 黄远翘[1] 陈元庄[1] 马滚韶[1] 徐勤[1] 罗裕强 陈家辉 Mo Huagui;Huang Yuanqiao;Chen Yuanzhuang;Ma Gunshao;Xu Qin;Luo Yuqiang;Chen Jiahui(Department of Orthopedics and Joint Surgery,Jiangmen Central Hospital,Jiangmen 529030,Guangdong,China)

机构地区：[1]广东省江门市中心医院四肢关节骨科,529030

出　　处：《中华创伤骨科杂志》2020年第6期495-500,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的分析不稳定型骨盆骨折前环固定失效的原因,探讨其处理方案的选择。方法回顾性分析2009年1月至2019年3月期间广东省江门市中心医院四肢关节骨科收治的84例不稳定型骨盆骨折患者资料。男56例,女28例;年龄为19~64岁,平均42.5岁;骨折按Tile分型:B1型22例,B2型16例,B3型10例;C1型22例,C2型6例,C3型8例。单纯前环固定21例,前、后环联合固定63例。术后根据Matta评分标准评定骨折复位质量,统计术后前环固定失效患者,并分析其失效原因及处理方案的选择。结果84例患者术后获6~36个月(平均13.5个月)随访。7例(8.3%)患者术后发生骨盆骨折前环固定失效。前环固定失效时间为术后3~75 d,平均29.1 d。失效原因:手术时机选择不当及前环固定稳定性欠佳2例,单纯前环固定稳定性欠佳1例,前环固定物选择错误及康复措施不当2例,术中复位不良1例,后环固定不稳1例。2例患者前环采用外固定支架固定失效,1例翻修,1例保守治疗;5例前环采用钢板内固定失效,4例翻修,1例保守治疗。5例翻修患者翻修术后获11~24个月(平均17.2个月)随访。末次随访时根据Majeed评分系统评定骨盆功能:优2例,良2例,可1例。2例保守治疗患者最终畸形愈合。结论手术时机选择不当、前环固定物选择错误、术中复位不良、前环固定稳定性欠佳、后环固定不稳及康复措施不当是不稳定型骨盆骨折前环固定失效的主要原因。对于不稳定型骨盆骨折前环固定失效,关键是明确失效原因,采用钢板固定翻修可取得良好疗效.Objective To discuss the causes and solutions for failed anterior ring fixation for unstable pelvic fractures.Methods A retrospective analysis was conducted of the 84 patients who had been admitted to Department of Orthopedics and Joint Surgery,Jiangmen Central Hospital for unstable pelvic fractures from January 2009 to March 2019.They were 56 males and 28 females,aged from 19 to 64 years(mean,42.5 years).By the Tile classification,22 cases were type B1,16 type B2,10 type B3,22 type C1,6 type C2 and 8 type C3.Simple anterior ring fixation was performed for 21 cases and combined anterior and posterior ring fixation for 63 ones.The Matta's criteria were applied for the evaluation of fracture reduction.The cases of failed anterior ring fixation and their solutions were recorded and analyzed.Results All patients were followed up for 6 to 36 months(average,13.5 months).Failed anterior ring fixation was observed in 7 cases(8.3%)at 3 to 75 days after operation(average,29.1 days).The failure was attributed to improper operation timing and unstable anterior ring fixation in 2 cases,mere unstable anterior ring fixation in one,wrong choice of anterior ring fixators and improper rehabilitation in 2 cases,poor intraoperative reduction in one and unstable posterior ring fixation in one.In the 2 failed cases that had been treated by external fixators,one underwent revision and the other conservative treatment.In the 5 cases that had been treated by plating,4 underwent revision and one conservative treatment.By the Majeed criteria,the pelvic function was evaluated at the final follow-up as excellent in 2,good in 2 and fair in one in the 5 cases of revision who obtained follow-up from 11 to 24 months(average,17.2 months)after revision;malunion was observed in the 2 cases of conservative treatment.Conclusions Failed anterior ring fixation for unstable pelvic fracture may be caused by improper operation timing,wrong choice of anterior ring fixators,intraoperative malreduction,unstable pelvic ring fixation and improper rehabilitatio

关 键 词：骨盆 骨折 骨折固定术 治疗失败 前环 

分 类 号：R687.3[医药卫生—骨科学]