骶骨截骨结合腰椎-骨盆撑开三角固定治疗纵向移位的骨盆骨折畸形愈合及骨不连  

Sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion or nonunion of vertically displaced pelvic fractures

作　　者：谷美琪 罗杨兴 何立 李悦[1] 解杰[1] 龚嵩 张谦 尹恩志 许喆 白祥军[1] 易成腊[1] 陈华[2] Gu Meiqi;Luo Yangxing;He Li;Li Yue;Xie Jie;Gong Song;Zhang Qian;Yin Enzhi;Xu Zhe;Bai Xiangjun;Yi Chengla;Chen Hua(Department of Traumatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China;Department of Orthopaedics,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,武汉430000 [2]解放军总医院第一医学中心骨科,北京100853

出　　处：《中华骨科杂志》2022年第20期1358-1365,共8页Chinese Journal of Orthopaedics

基　　金：国家骨科与运动康复临床医学研究中心创新基金(2021-NCRC-CXJJ-ZH-24)。

摘　　要：目的探讨骶骨截骨结合腰椎-骨盆撑开三角固定治疗纵向移位的骶骨骨折畸形愈合及骨不连的手术方法和临床疗效。方法回顾性分析2015年4月至2020年1月采用后环骶骨截骨治疗的9例骨盆骨折畸形愈合及骨不连患者资料,男5例、女4例;年龄为(30.67±10.06)岁(范围14~45岁)。骨盆骨折AO/OTA分型C1.3型8例,C3.3型1例。受伤至手术时间(12.8±18.92)个月(范围3~60个月)。一侧骨盆纵向移位(3.8±0.57)cm(范围2.5~4.1 cm)。9例均采用后环骶骨截骨、前环耻骨上下支截骨或不截骨及腰椎-骨盆撑开三角固定矫正一侧骨盆纵向移位。测量骨盆纵向移位矫正情况,末次随访时采用Majeed评分标准及疼痛视觉模拟评分(visual analogue scale,VAS)评估患者疗效。结果9例均顺利完成手术,随访时间(12.00±9.95)个月(范围6~36个月)。1例术后一侧骨盆残留移位1.5 cm(术前较健侧相差3.2 cm)外,8例残留移位0.1~0.7 cm。末次随访时骨盆骨折Majeed评分由术前44.0(33.5,76)分升至91.0(80.5,92.5)分,差异有统计学意义(Z=2.67,P<0.001),步态明显改善;VAS由术前(6.00±1.41)分降至(1.22±0.97)分,差异有统计学意义(t=8.73,P<0.001)。无一例发生感染、钢板断裂、螺钉松动、医源性神经及血管损伤等并发症。结论骶骨截骨结合腰椎-骨盆撑开三角固定治疗骶骨骨折造成的骨盆畸形愈合和骨不连,能矫正骨盆纵向移位、矫正肢体不等长、重建骨盆环的稳定性。Objective To investigate the clinical therapy of sacral osteotomy combined with lumbopelvic distraction triangular osteosynthesis for malunion and nonunion of type C longitudinally displaced sacral fracture.Methods A retrospective study of 9 patients with malunion and nonunion of type C pelvic fractures who had been treated with sacral osteotomy combined with triangular osteosynthesis from April 2015 to January 2020 were analyzed.They were 5 men and 4 women,with an average age of 30.67±10.06(range 14-45 years).AO/OTA classification at initial pelvic fracture,8 cases were type C1.3 and one was type C3.3.The period from injury to surgery was 12.8±18.92 months(range 3-60 months).The cranial displacement of one side of the pelvis was 3.8±0.57 cm(range 2.5-4.1 cm).Sacral osteotomy and triangular osteosynthesis were used in all nine patients,combined with osteotomy or no osteotomy of the superior and inferior branches of the anterior ring pubis.The degree of longitudinal displacement of one side of the pelvis was assessed by making a vertical line gap between the acetabular apex on both sides and the central axis of the sacrum on the X-ray of the pelvis.The Majeed scoring and visual analogue scale(VAS)were evaluated preoperatively and at the last follow-up to assess the therapeutic effect of the patients.Results In all 9 patients,except for 1 case of postoperative pelvic residual displacement 1.5 cm(preoperative 3.2 cm difference compared with the healthy side),the other 8 patients had a postoperative bilateral difference of 0.1-0.7 cm.All the patients were followed up for 12.00±9.95 months.At the last follow-up,the Majeed score of pelvic fracture increased from 44.0(33.5,76.0)points preoperatively to 91.0(80.5,92.5)points.The difference before and after operation was statistically significant(Z=2.67,P<0.001),and the gait was significantly improved.And the VAS score for pain decreased from 6.00±1.41 points preoperatively to 1.22±0.97 points.The difference before and after operation was statistically significant(t

关 键 词：骨盆 骶骨 骨折 骨折固定术 内 修复外科手术 

分 类 号：R687.3[医药卫生—骨科学]