经第2骶骨翼髂骨螺钉固定技术在不稳定型骨盆后环损伤治疗中的应用效果分析  

Fixation with S2 alar iliac screws for unstable injury to posterior pelvic ring

作　　者：向杰 范伟杰[2] 唐奕泉[2] 陈文康[2] 郑健雄 陈滨 Xiang Jie;Fan Weijie;Tang Yiquan;Chen Wenkang;Zheng Jianxiong;Chen Bin(Division of Orthopaedics and Traumatology,Department of Orthopaedics,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Orthopaedics and Traumatology,The First Affiliated Hospital to University of South China,Hengyang 421001,China)

机构地区：[1]南方医科大学南方医院骨科-创伤骨科,广州510515 [2]南华大学附属第一医院创伤骨科,衡阳421001

出　　处：《中华创伤骨科杂志》2022年第3期206-212,共7页Chinese Journal of Orthopaedic Trauma

基　　金：广东省教育厅高水平建设经费南方医科大学临床研究启动项目(LC2019ZD001);南华大学医学临床研究4310计划。

摘　　要：目的探讨经第2骶骨翼髂骨螺钉(S2AI)固定技术在不稳定型骨盆后环损伤治疗中的适应证,并评估该技术的可行性及其临床疗效。方法回顾性分析2017年9月至2020年12月期间南方医科大学南方医院骨科-创伤骨科和南华大学附属第一医院创伤骨科应用S2AI固定技术治疗的18例不稳定型骨盆后环损伤患者资料。男8例,女10例;平均年龄为40岁(20~64岁);骨盆骨折根据Tile分型:B2型3例,C1型10例,C2型5例。合并骶神经损伤3例,根据Gibbons神经损伤分级:Ⅱ级2例,Ⅲ级1例。受伤至手术时间平均为11 d(4~21 d)。6例患者采用短节段S1-S2AI固定,1例患者行对侧S1-S2AI固定,5例患者采用腰椎骨盆固定,6例患者采用骶髂三角固定。术后应用CT根据Shillingford法评价S2AI置入的精确性,记录患者的骨折复位质量及并发症发生情况等。结果18例患者术后获平均19.8个月(12~36个月)随访。术后所有患者骨折均获骨性愈合。18例患者共置入21枚S2AI,术中未发生神经、血管损伤等并发症,术后CT发现2枚S2AI穿破髂骨皮质。根据Matta评分标准评定骨折复位质量:优10例,良7例,可1例。术前3例合并骶神经损伤患者术后2例Ⅱ级损伤恢复为Ⅰ级,1例Ⅲ级损伤恢复为Ⅱ级。术后2例患者出现切口部位浅表感染,无一例患者出现内固定物突出、断裂或松动等并发症。结论S2AI固定技术能够灵活应用于多种类型骨盆后环损伤,可对骨盆环和腰骶结合部提供坚强固定,并发症发生率较低。Objective To explore the fixation with S2 alar iliac screws(S2AI)for unstable injury to the pelvic posterior ring.Methods The clinical data of 18 patients were analyzed retrospectively who had been treated for unstable injury to the posterior pelvic ring by S2AI screw fixation at Division of Orthopaedics and Traumatology,Department of Orthopaedics,Nanfang Hospital,Southern Medical University and at Department of Orthopaedics and Traumatology,The First Affiliated Hospital to University of South China from September 2017 to December 2020.They were 8 males and 10 females,with an average age of 40 years(from 20 to 64 years).According to Tile classification,there were 3 cases of type B2,10 cases of type C1 and 5 cases of type C2.Sacral nerve injury was complicated in 3 patients(2 cases of Gibbons gradeⅡand one of Gibbons gradeⅢ).Short-segment S1-S2AI fixation was used in 6 cases,contralateral S1-S2AI fixation in one case,lumbar-pelvic fixation in 5 cases,and sacroiliac triangle fixation in 6 cases.The accuracy of S2AI placement was evaluated by CT after operation according to the Shillingford method;the reduction quality of pelvic fractures and complications were documented.Results All the 18 patients were followed up for 19.8 months(from 12 to 36 months).Bony union was achieved in all fractures.A total of 21 S2AI were implanted in the 18 patients without intraoperative neurovascular injury.Postoperative CT found penetration into the iliac cortex by S2AI in 2 cases.According to the Matta criteria,the fracture reduction was excellent in 10 cases,good in 7 and fair in one.Of the 3 patients with preoperative sacral nerve injury,2 with gradeⅡinjury recovered to gradeⅠand one with gradeⅢinjury recovered to gradeⅡafter operation.Superficial infection occurred at the incision site in 2 patients after operation,and complications such as protrusion,rupture or loosening of implants were observed in none of the patients.Conclusion S2AI fixation can be flexibly applied to various types of posterior pelvic ring injury

关 键 词：骨盆 骨折 骶骨骨折 骨折固定术 内 骨钉 骶神经损伤 

分 类 号：R687.3[医药卫生—骨科学]