骶髂关节脱位合并同侧骶骨翼骨折分型的可信度检验及临床应用效果评价  

Classification system of sacroiliac joint dislocation with ipsilateral sacral wing fracture and its validity examination and clinical application evaluation

作　　者：徐康帅 谷城 李嘉成 陈社强 陈煜辉 庄岩[3] 侯志勇[4] 樊仕才 Xu Kangshuai;Gu Cheng;Li Jiacheng;Chen Sheqiang;Chen Yuhui;Zhuang Yan;Hou Zhiyong;Fan Shicai(Department of Traumatic Surgery,Center for Orthopedic Surgery,Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China;Department of Orthopedics,Huadu District People′s Hospital of Guangzhou City,Huadu Hospital,Southern Medical University,Guangzhou 510800,China;Department of Traumatic Orthopedics,Honghui Hospital Affiliated to Xi′an Jiaotong University,Xi′an 710054,China;Trauma Emergency Center,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]南方医科大学第三附属医院骨科医学中心创伤骨科,广州510630 [2]南方医科大学附属花都医院,广州市花都区人民医院骨科,广州510800 [3]西安交通大学附属红会医院创伤骨科,西安710054 [4]河北医科大学第三医院创伤急救中心,石家庄050051

出　　处：《中华创伤杂志》2022年第3期234-239,共6页Chinese Journal of Trauma

基　　金：国家自然科学基金(82072411,81772428)。

摘　　要：目的:建立骶髂关节脱位合并同侧骶骨翼骨折(SJDISWF)分型系统,并进行可信度检验及临床应用效果评价。方法:采用多中心回顾性病例系列研究分析2016年1月至2019年12月南方医科大学第三附属医院、西安交通大学附属红会医院及河北医科大学第三医院收治的20例SJDISWF患者的临床资料,其中男8例,女12例;年龄13~58岁[(34.7±13.2)岁]。根据伤侧骶骨移位的方向将SJDISWF患者进行分型,共分为3型:Ⅰ型骶髂关节脱位,同侧骶骨翼骨折块向前脱出呈漂浮状;Ⅱ型骶髂关节脱位,同侧骶骨翼骨折块压缩粉碎,可波及骶前孔;Ⅲ型骶髂关节脱位,同侧骶骨翼骨折端向骶管内嵌插,造成骶管内占位。依据4名观察者间隔4周的两次分型评估结果对SJDISWF分型系统进行可信度检验。根据Ⅰ、Ⅱ、Ⅲ型骨折,分别对患者行前路切开复位内固定、闭合复位内固定或后路切开复位内固定手术。记录术后骨折愈合情况、骨折复位质量Matta评分、术后3,6个月及末次随访时Majeed功能评分、并发症情况。结果:观察者间可信度Kappa值均值为0.890,观察者内可信度Kappa值均值为0.854。本研究中Ⅰ型患者12例,Ⅱ型患者7例,Ⅲ型患者1例,均顺利完成手术治疗。患者均获随访6~36个月[(20.0±8.7)个月]。骨折均获临床愈合,愈合时间为8~14周[(10.2±1.7)周]。骨折复位质量Matta评分优良率:Ⅰ型83%(10/12),Ⅱ型71%(5/7),Ⅲ型0%(0/1),总优良率达75%。术后3个月Majeed功能评分为(74.6±5.2)分,术后6个月为(84.4±5.8)分( P<0.01);末次随访时Majeed功能评分优良率:Ⅰ型75%(9/12),Ⅱ型100%(7/7),Ⅲ型0%(0/1),总优良率为80%。随访过程中无一例出现股外侧皮神经或坐骨神经损伤、下肢深静脉血栓形成、骶髂关节疼痛、内固定失效或骨折复位丢失等。 结论:SJDISWF分型系统的可信度较高,依据分型对SJDISWF患者采取相应治疗方式均取得较为满意的复位固定及功能恢�Objective To establish the classification system of sacroiliac joint dislocation with ipsilateral sacral wing fracture(SJDISWF),examine its reliability and evaluate the clinical application.Methods A multi-center retrospective case series study was conducted to analyze the clinical data of 20 SJDISWF patients admitted to Third Affiliated Hospital of Southern Medical University,Honghui Hospital Affiliated to Xi′an Jiaotong University and Third Hospital of Hebei Medical University from January 2016 to December 2019.There were 8 males and 12 females,aged from 13-58 years[(34.7±13.2)years].Based on the direction of sacral displacement,SJDISWF was divided into 3 types.Type I:the sacroiliac joint dislocated and the ipsilateral sacral wing fracture fragment was anteriorly prolapsed;Type II:the sacroiliac joint dislocated,the ipsilateral sacral wing fracture fragment was compressed or crushed,the anterior sacral foramen may fractured;Type III:the sacroiliac joint dislocated and the ipsilateral sacral wing fracture end was inserted into the sacral canal,causing an intra-sacral canal occupation.The reliability of the classification was performed based on the assessment results of two phases in four observers at 4-week intervals.Treatments were utilized based on the types I,II,III fractures,including anterior approach for open reduction and internal fixation,closed reduction and internal fixation or posterior approach for open reduction and internal fixation respectively.Postoperative fracture healing time was recorded.Quality of fracture reduction was graded according to Matta′s criteria.Majeed functional score was recorded at postoperative 3 months,6 months and the final follow-up.Complications were detected as well.Results The overall Kappa value of inter-observer reliability was 0.890.The overall Kappa value of intra-observer reliability was 0.854.There were 12 patients with type I,7 with type II and 1 with type III.All patients went through the procedure uneventfully and were followed up for 6-36 months[(20.0±8.7

关 键 词：骶髂关节 骶骨 脱位 骨折分型 

分 类 号：R687.3[医药卫生—骨科学]