空心开路器辅助下经皮逆行耻骨螺钉植入技术在耻骨支骨折中的应用研究  

The application of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in treatment of pubic branch fracture

作　　者：王海[1] 叶君健[1] 林章雄[1] 吴贵[1] 谢昀[1] WANG Hai;YE Junjian;LIN Zhangxiong;WU Gui;XIE Yun(Department of Orthopedic Trauma&Ankle Surgery,Fujian Trauma Medical Center,First Affiliated Hospital of Fujian Medical University,Fuzhou Fujian,350004,P.R.China)

机构地区：[1]福建医科大学附属第一医院创伤骨科、足踝外科福建省创伤医学中心,福州350004

出　　处：《中国修复重建外科杂志》2020年第9期1106-1113,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：福建医科大学启航基金项目(2017XQ1082)。

摘　　要：目的探讨空心开路器辅助下经皮逆行耻骨螺钉植入技术治疗耻骨支骨折的疗效。方法回顾分析2008年3月—2019年3月采用空心螺钉固定治疗的42例耻骨支骨折患者临床资料。根据手术方式将其分为传统手术组(A组20例,采用传统逆行耻骨螺钉植入固定)与改良手术组(B组22例,采用空心开路器辅助下经皮逆行耻骨螺钉植入固定)。两组患者性别、年龄、致伤原因、骨折分型、合并症及受伤至手术时间等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、出血量、切口长度、植入螺钉长度及并发症发生情况。术后次日根据Matta标准评估骨折复位情况,术后12个月采用Majeed评分评价功能。结果两组患者均顺利完成手术,B组手术时间、出血量及切口长度均显著小于A组(P<0.05);两组植入螺钉长度比较差异无统计学意义(t=0.793,P=0.437)。所有患者均获随访,随访时间8~24个月,平均16.8个月。两组均未出现血管、神经损伤,内固定物断裂,螺钉进入关节腔,骨折不愈合等并发症;两组患者骨折愈合时间比较差异无统计学意义(t=-1.068,P=0.299)。A组出现切口感染2例,切口脂肪液化1例,下肢深静脉血栓形成2例,并发症发生率为25.0%;B组仅出现1例下肢深静脉血栓形成,并发症发生率为4.5%,低于A组,但差异无统计学意义(χ~2=2.104,P=0.147)。A组发现1例骨折再移位,B组无骨折再移位发生。术后次日Matta影像学评价及术后12个月Majeed功能评价两组间比较差异均无统计学意义(P>0.05)。结论空心开路器辅助下经皮逆行耻骨支螺钉植入技术治疗耻骨支骨折疗效确切,具有切口小、手术时间短、出血量少、并发症发生率低的优点。Objective To evaluate the effectiveness of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in pubic branch fractures.Methods The clinical data of 42 patients with pubic branch fractures treated by hollow screw fixation between March 2008 and March 2019 were analyzed retrospectively.According to the operation method,they were divided into the traditional operation group(20 cases in group A,fixed with traditional retrograde pubic screws)and the modified operation group(22 cases in group B,fixed with percutaneous retrograde pubic screws assisted by hollow pedicle opener).There was no significant difference(P>0.05)between the two groups in terms of gender,age,cause of injury,fracture classification,comorbidity,and time from injury to operation.The operation time,blood loss,incision length,screw length,and complications were recorded and compared between the two groups.The fracture reduction was evaluated according to Matta standard on the next day after operation,and the function was evaluated by Majeed score at 12 months after operation.Results The operation was successfully completed in both groups.The operation time,blood loss,and incision length of group B were significantly less than those of group A(P<0.05);there was no significant difference in screw length between the two groups(t=0.793,P=0.437).All patients were followed up 8-24 months,with an average of 16.8 months.There was no complication in the two groups,such as injury of blood vessels and nerves,fracture of internal fixation,screw entering into joint cavity,and nonunion of fracture.There was no significant difference in the fracture healing time between the two groups(t=−1.068,P=0.299).There were 2 cases of incision infection,1 case of incision fat liquefaction,2 cases of lower extremity deep vein thrombosis in group A,the incidence of complications was 25.0%;there was only 1 case of lower extremity deep vein thrombosis in group B,the incidence of complication was 4.5%,which was lower than that in group A,but the di

关 键 词：骨盆骨折 耻骨支骨折 空心开路器 经皮内固定 微创手术 

分 类 号：R687.3[医药卫生—骨科学]