改良内置外固定架联合骶髂螺钉治疗Tile C1.3型骨盆骨折  

Modified internal fixator combined with sacroiliac screws in treatment of Tile C1.3 pelvic fracture

作　　者：叶龙飞 官建中[1] 王晓盼[1] 陈笑天[1] 卢红信 肖玉周[1] 代秀松[1] 吴敏[1] YE Longfei;GUAN Jianzhong;WANG Xiaopan;CHEN Xiaotian;LU Hongxin;XIAO Yuzhou;DAI Xiusong;WU Min(Department of Orthopaedics,the First Affiliated Hospital of Bengbu Medical College,Anhui Key Laboratory of Tissue Transplantation,Bengbu Anhui,233000,P.R.China)

机构地区：[1]蚌埠医学院第一附属医院骨科组织移植安徽省重点实验室,安徽蚌埠233000

出　　处：《中国修复重建外科杂志》2022年第12期1447-1452,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过与传统内置外固定架(internal fixator,INFIX)比较,探讨Tile C1.3型骨盆骨折治疗中采用改良INFIX固定骨盆前环的疗效。方法以2018年4月—2021年6月收治的Tile C1.3型骨盆骨折患者作为研究对象,其中55例符合选择标准纳入研究。术中骨盆前环采用传统INFIX固定30例(对照组)、改良INFIX固定25例(改良组),骨盆后环均采用骶髂螺钉固定。两组患者性别、年龄、致伤原因、受伤至手术时间以及合并伤等一般资料比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间、术中出血量及并发症发生情况。术后复查X线片,评估骨盆前环复位情况,参照Matta评分标准对复位程度分级;观察骨折愈合情况以及愈合时间。随访时参照Majeed评分标准评价关节功能。结果改良组手术时间较对照组延长(Z=–3.837,P<0.001),但两组术中出血量差异无统计学意义(t=–1.831,P=0.076)。两组患者均获随访,随访时间12~18个月,平均14个月。X线片复查示根据Matta评分标准,改良组骨盆前环复位优良率为88.00%,优于对照组的63.33%(χ^(2)=4.373,P=0.037)。改良组及对照组骨折均愈合,愈合时间分别为(12.04±3.59)、(14.83±4.83)周,差异有统计学意义(t=2.401,P=0.020)。末次随访时,改良组Majeed评分优良率为80.00%,对照组为76.67%,差异无统计学意义(χ^(2)=0.089,P=0.766)。改良组2例(8%)发生并发症,均为耻骨联合上方切口感染;对照组9例(30%)发生并发症,其中股外侧皮神经损伤5例、股神经麻痹2例、骨折延迟愈合2例。改良组并发症发生率低于对照组,差异有统计学意义(χ^(2)=4.125,P=0.042)。结论与传统INFIX相比,Tile C1.3型骨盆骨折治疗中采用改良INFIX固定骨盆前环并发症更少,前环稳定性更好,骨折愈合时间更短,神经损伤风险更低。Objective To investigate the effectiveness of modified internal fixator(INFIX)to fix the anterior pelvic ring for Tile C1.3 pelvic fracture by comparing with the traditional INFIX.Methods The patients with Tile C1.3pelvic fractures admitted between April 2018 and June 2021 were taken as the study objects.Of them,55 cases were included in the study according to the selection criteria.During operation,the anterior pelvic ring was fixed with the modified INFIX in 30 cases(modified group)and with the traditional INFIX in 25 cases(control group).The posterior pelvic ring in 55 cases was fixed with sacroiliac screws.There was no significant difference between the two groups in gender,age,cause of injury,time from injury to operation,and combined injury(P>0.05).The operation time,intraoperative blood loss,and complications were recorded and compared between the two groups.The X-ray film was taken to evaluate the reduction of the anterior pelvic ring after operation,grade the reduction according to the Matta scoring standards,and observe the fracture healing and healing time.The function was evaluated according to Majeed scoring standards during follow-up.Results The operation time of the modified group was significantly longer than that of the control group(Z=–3.837,P<0.001),but there was no significant difference in the intraoperative blood loss between the two groups(t=–1.831,P=0.076).All patients were followed up 12-18 months(mean,14 months).X-ray film reexamination showed that the excellent and good rate of Matta scoring for anterior pelvic ring reduction in the modified group was 88.00%,which was significantly better than that in the control group(63.33%)(χ^(2)=4.373,P=0.037).All fractures healed,and the fracture healing time of the modified group and the control group was(12.04±3.59)and(14.83±4.83)weeks respectively,with a significant difference(t=2.401,P=0.020).At last follow-up,the excellent and good rates of Majeed scoring were 80.00%in the modified group and 76.67%in the control group,with no significan

关 键 词：骨盆骨折 内置外固定架 骨盆前环 内固定 

分 类 号：R687.3[医药卫生—骨科学]