成人骶髂关节前脱位的手术方式及疗效  

Surgical methods and treatment effects of the adult anterior dislocation of the sacroiliac joint

作　　者：樊仕才 侯志勇[2] 庄岩[3] 吕刚 郭书权[5] 徐康帅 麦奇光 李涛 陈煜辉 朱振华 张英泽[2] Fan Shicai;Hou Zhiyong;Zhuang Yan;Lyu Gang;Guo Shuquan;Xu Kangshuai;Mai Qiguang;Li Tao;Chen Yuhui;Zhu Zhenhua;Zhang Yingze(Department of Traumatic Surgery,Center for Orthopaedics,Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China;Trauma Emergency Center,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Traumatic Orthopaedics,Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China;Department of Orthopaedics,Xinjiang Medical University the Forth Clinical Hospital,Urumqi 830000,China;Department of Orthopaedics,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,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,上海200433 [2]河北医科大学第三医院创伤急救中心,石家庄050051 [3]西安交通大学附属红会医院创伤骨科,西安710054 [4]新疆维吾尔自治区中医院骨一科,乌鲁木齐830000 [5]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《中华骨科杂志》2023年第8期477-483,共7页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82072411, 81772428);国家骨科与运动康复临床医学研究中心创新基金(2021-NCRC-CXJJ-PY-06);国家重点研发计划(2022YFC2504303)。

摘　　要：目的探讨成人骶髂关节前脱位(adult anterior dislocation of the sacroiliac joint, AADSJ)的手术方式及临床疗效。方法回顾性分析2016年1月至2021年1月, 南方医科大学第三附属医院、河北医科大学第三医院、西安交通大学附属红会医院、新疆维吾尔自治区中医院、重庆医科大学附属第一医院收治的25例骶髂关节前脱位患者资料, 男18例、女7例, 年龄(38.8±15.5)岁(范围18~83岁)。根据骶髂关节前脱位的影像学表现制订骶髂关节前脱位的临床分型:Ⅰ型, 骶髂关节完全前脱位, 整个髂骨耳状面移位至骶骨前方;Ⅱ型, 骶髂关节骨折合并前脱位。Ⅱ型分为三个亚型:Ⅱa型, 髂骨骨折累及骶髂关节前1/3, 髂骨脱位至骶骨正前方;Ⅱb型, 髂骨骨折累及骶髂关节后2/3, 髂骨脱位至骶骨前上方;Ⅱc型, 髂骨骨折累及骶髂关节后2/3, 髂骨脱位至骶骨前内侧。四名观察者分别采用临床分型、Tile分型及Young-Burgess分型评估各分型的可信度及可重复性。分别采用腹直肌外侧入路和髂腹股沟入路实施手术, 记录手术时间及术中出血量;术后行骨盆X线及CT检查, 根据Matta评分评价骨折复位质量, 术后1年随访时按Majeed标准评价术后功能。结果 25例患者的临床分型:Ⅰ型3例、Ⅱa型5例、Ⅱb型9例、Ⅱc型8例。AADSJ的临床分型、Tile分型及Young-Burgess分型的可信度检验Kappa值分别为0.681、0.328、0.383, 可重复性检验Kappa值分别为0.690、0.221、0.395。采用腹直肌外侧入路14例、髂腹股沟入路11例。腹直肌外侧入路术中处理骶髂关节前脱位的时间为(122.0±50.7)min(范围65~148 min), 小于髂腹股沟入路的(178±49.9)min(范围110~270 min), 差异有统计学意义(t=2.76, P=0.011);术中出血量为(680±330)ml(范围350~2 120 ml), 小于髂腹股沟入路的(1 660±968)ml(范围680~3 300 ml), 差异有统计学意义(t=3.55, P=0.002)。全部患者随访1~3年, Matta评分示腹直肌外侧入路�Objective To explore the surgical methods and treatment effects of adult anterior dislocation of the sacroiliac joint(AADSJ).Methods A multi-center retrospective case series study was conducted to analyze the clinical data of 25 cases admitted in 5 clinical centers(affiliations of authors in this article)from January 2016 to January 2021.There were 18 males and 7 females,aged 38.8±15.5 years(range,18-83 years).The AADSJ clinical classification system was formulated based on the radiographic morphology of anterior dislocation of the sacroiliac joint,which includes two types.Type I:complete anterior dislocation of the sacroiliac joint,and displacement of the entire iliac auricular surface to the front of the sacrum.Type II:fracture of the sacroiliac joint combined with anterior dislocation,subdivided into 3 subtypes.Type IIa:iliac fracture involves the anterior 1/3 of the sacroiliac joint,and dislocation of the ilium anterior to the sacrum.Type IIb:iliac fracture involves the posterior 2/3 of the sacroiliac joint,and dislocation of the ilium anterior to the sacrum.Type IIc:iliac fracture involves the posterior 2/3 of the sacroiliac joint,and dislocation of the ilium anteromedial to the sacrum.The reliability and repeatability of the clinical classification,Tile classification and Young-Burgess classification were performed based on the results of two-phase assessments in four observers.The operations were performed by the lateral-rectus approach and the ilioinguinal approach.The operation time and intraoperative bleeding were recorded.Pelvic X-ray and CT scan were rechecked after the operation.The quality of fracture reduction was evaluated according to Matta score.The postoperative functional rehabilitation was evaluated according to the Majeed rehabilitation standard at one-year follow-up.Results Among 25 cases in this study,there were 3 cases of Type I,5 cases of Type IIa,9 cases of Type IIb and 8 cases of Type IIc according to the clinical classification system.The Kappa values of reliability tests for the cli

关 键 词：成年人 骨盆 骨折脱位 骶髂关节 

分 类 号：R687.4[医药卫生—骨科学]