骨盆解锁复位架辅助复位固定治疗陈旧性DenisⅠ、Ⅱ型骶骨骨折合并骶丛损伤  

The application of pelvic unlocking reduction frame for the treatment of old Denis I or II sacral fractures combined with sacral plexus nerve injury

作　　者：麦奇光 陈煜辉 朱振华 李涛 王华 杨诚 黄海 廖坚文 樊仕才 Mai Qiguang;Chen Yuhui;Zhu Zhenhua;Li Tao;Wang Hua;Yang Cheng;Huang Hai;Liao Jianwen;Fan Shicai(Department of Traumatic Surgery,Center for Orthopaedic Surgery,the Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,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

出　　处：《中华骨科杂志》2022年第10期652-660,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81772428、82072411);广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(LC2016ZD032)。

摘　　要：目的探讨骨盆解锁复位架辅助复位固定治疗陈旧性DenisⅠ、Ⅱ型骶骨骨折合并骶丛损伤的疗效。方法回顾性分析2013年1月至2020年10月治疗37例陈旧性骶骨骨折伴骶丛损伤(GibbonsⅢ级)患者资料,根据是否采用骨盆解锁复位架辅助直视下复位固定分为使用组和未使用组。使用组18例,男11例、女7例,年龄(38±6.4)岁(范围13~56岁);骶骨骨折Denis分型Ⅰ型6例、Ⅱ型12例。未使用组19例,男14例、女5例;年龄(42±10.7)岁(范围19~59岁);DenisⅠ型5例、Ⅱ型14例。术前3D打印1∶1完整骨盆模型。比较两组患者的手术时间、术中出血量、骨折复位Matta评分、术后1年视觉模拟评分(visual analogue scale,VAS)、Majeed功能评分及Gibbons骶神经损伤分级,记录骨折愈合时间及并发症发生情况。结果使用组、未使用组患者手术时间分别为(121.0±16.2)min、(182.6±16.2)min,差异有统计学意义(t=11.54,P<0.001);术中出血量分别为(686±382)ml、(963±348)ml,差异有统计学意义(t=2.38,P=0.003)。骨折复位质量Matta评价优良率,使用组为94%(17/18),未使用组为68%(13/19),差异有统计学意义(P=0.039)。术后1年,使用组、未使用组Majeed评分分别为(88.72±7.03)分和(72.00±9.75)分,差异有统计学意义(t=5.96,P<0.001);VAS评分分别为(0.83±0.71)分和(1.00±0.82)分,差异无统计学意义(t=0.66,P=0.512);Gibbons骶神经损伤分级,使用组Ⅰ、Ⅱ、Ⅲ级分别有15、1、2例,未使用组Ⅰ、Ⅱ、Ⅲ级分别有11、3、5例,两组差异无统计学意义(Z=-1.04,P=0.401)。使用组术后1例患者出现钢板部分螺钉断裂,未予特殊处理。未使用组术后1例出现髂内静脉破裂,予明胶海绵等填塞止血,术后留置引流管观察未见明显出血;4例出现双下肢不等长,有跛行,未予特殊治疗。使用组和未使用组并发症发生率分别为6%(1/18)和26%(5/19),差异有统计学意义(P=0.042)。结论采用骨盆解锁复位架辅助复位固定治疗陈旧性DeObjective To investigate the clinical effect assistant with pelvic unlocking reduction frame for the treatment of old Denis I or II sacral fractures combined with sacral plexus nerve injury.Methods From January 2013 to October 2020,37 patients diagnosed with old sacral fractures with sacral plexus nerve injury which Gibbons classification was grade III were divided into the use group and the non-use group according to whether assisted with pelvic unlocking reduction frame.Eighteen patients(11 males,7 females,mean age 38±6.4,range from 13-56)were selected into the use group and nineteen patients(14 males,5 females,mean age 42±10.7,range 19-59)were selected into the non-use group.The three-dimensional(3D)pelvic model(1∶1)was printed before operation.The operation time,intraoperative bleeding,Matta score,visual analogue scale(VAS),Majeed score and gibbons sacral nerve injury grade of the two groups were compared.The healing time and complications of each group was recorded.Results The average operation time of the use group and the non-use group was 121.0±16.2 min and 182.6±16.2 min,respectively,with significant difference(t=11.54,P<0.001).The mean operative bleeding was 686±382 ml of the use group and 963±348 ml of the non-use group(t=2.38,P=0.003).The quality of fracture reduction was evaluated according to Matta scoring standard:the excellent and good rate of the use group was 94%(17/18),and that of the non-use group was 68%(13/19)(P=0.039).The curative effect was evaluated according to the Majeed score:the use group was 88.72±7.03 points,and that of the non-use group was 72.00±9.75 points(t=5.96,P<0.001)at 1 year post-operative.One year after operation,the VAS scale of the use group was 0.83±0.71 points,and that of the non-use group was 1.00±0.82 points(t=0.66,P=0.512).According to Gibbons classification,15 patients were grade I,1 patient was grade II and 2 patients were grade III in the use group and 11 patients were grade I,3 patients were grade II and 5 patients were grade III in the non-use group

关 键 词：骨盆 骨折 骨折固定术 内 腰骶丛 

分 类 号：R687.3[医药卫生—骨科学]