缓慢牵引闭合解锁复位技术治疗陈旧性Tile C型骨盆骨折的疗效分析  

Gradual traction-unlocking closed reduction technique for Tile C old pelvic fractures

作　　者：王金昌 郭浩 汤俊君 陆海波[1] 胡星星[1] 成佳伟 窦美静 李双成[1] 陈华[1] 张群[1] 唐佩福[1] Wang Jinchang;Guo Hao;Tang Junjun;Lu Haibo;Hu Xingxing;Cheng Jiawei;Dou Meijing;Li Shuangcheng;Chen Hua;Zhang Qun;Tang Peifu(Department of Orthopaedics,The Fourth Medical Center,General Hospital of Chinese PLA,Beijing 100048,China;The Second Surgical Department,Hospital of Beijing Municipal Corps,Chinese People's Armed Police Force,Beijing 100027,China)

机构地区：[1]解放军总医院第四医学中心骨科医学部,北京100048 [2]武警北京市总队医院外二科,北京100027

出　　处：《中华创伤骨科杂志》2023年第6期478-484,共7页Chinese Journal of Orthopaedic Trauma

基　　金：军队后勤科技成果扩试项目(145BHQ0003074X);军队医学科技青年培育计划项目(21QNPY131)

摘　　要：目的探讨缓慢牵引闭合解锁复位技术治疗陈旧性Tile C型骨盆骨折的技术要点和疗效。方法回顾性分析2012年8月至2021年6月期间解放军总医院第四医学中心骨科医学部收治的6例陈旧性Tile C型骨盆骨折患者资料。男4例,女2例;年龄(35.8±10.5)岁;骨折Tile分型:C1.2型4例,C1.3型1例,C2型1例。受伤至手术时间为153.8(64.3,204.8)d。6例患者均采用缓慢牵引闭合解锁复位技术治疗。记录患者的缓慢牵引复位时间、手术时间、住院时间、术中出血量、术后骨折复位质量、并发症及末次随访时骨盆功能等。结果6例患者术后获(40.3±22.9)个月(范围值为12~72个月)随访。6例患者的缓慢牵引复位时间为(26.7±4.6)d,手术时间为(199.2±4.6)min,住院时间为(11.5±2.9)d,术中出血量为(533.3±189.6)mL。术后骨盆骨折复位质量根据改良Matta评分标准评定:复位满意5例,不满意1例。6例患者术前双下肢长度差为(6.9±1.6)cm,术后即刻为(1.0±0.4)cm,差异有统计学意义(t=11.135,P<0.001)。术后3个月骨折愈合1例,术后6个月骨折愈合5例。末次随访时6例患者的骨盆Majeed评分为(80.8±9.0)分;优2例,良3例,可1例。并发症:伤口延迟愈合1例,小腿肌间静脉血栓2例,情绪焦虑和睡眠障碍1例。无一例患者出现新的腰骶丛神经损伤。结论缓慢牵引闭合解锁复位技术兼具Ilizarov技术和骨盆闭合解锁复位技术的优点,应用于陈旧性Tile C型骨盆骨折,不仅可以保护腰骶丛神经,而且骨折能获得满意复位,疗效良好。Objective To explore the technical points and efficacy of gradual traction-unlocking closed reduction technique(GT-UCRT)for Tile C old pelvic fractures.Methods From August 2012 to June 2021,6 patients with Tile C old pelvic fracture were treated and followed up at Department of Orthopedics,The Fourth Medical Center,General Hospital of Chinese PLA.They were 4 males and 2 females with an age of(35.8±10.5)years.By Tile classification:4 cases of type C1.2,1 case of type C1.3,and 1 case of type C2;time from injury to surgery:153.8(64.3,204.8)days.The 6 patients were treated with GT-UCRT.The time for gradual traction reduction,operation time,hospital stay,intraoperative blood loss and complications were recorded.The modified Matta score was used to evaluate the reduction quality of pelvic fractures,and the Majeed score was used to evaluate the pelvic function at the last follow-up.Results The 6 patients were followed up for(40.3±22.9)months(from 12 to 72 months)after surgery.The time for gradual traction reduction was(26.7±4.6)days,operation time(119.2±4.6)minutes,hospital stay(11.5±2.9)days,and intraoperative blood loss(533.3±189.6)mL.By the modified Matta score,the pelvic reduction after surgery was rated as satisfactory in 5 cases and as unsatisfactory in 1 case.The length disparity between both lower limbs in the 6 patients was(6.9±1.6)cm before surgery and(1.0±0.4)cm immediately after surgery,showing a statistically significant difference(t=11.135,P<0.001).One fracture healed 3 months after surgery and 5 fractures 6 months after surgery.The Majeed pelvic score at the last follow-up was(80.8±9.0)points for the 6 patients,yielding 2 excellent cases,3 good cases and 1 fair case.Delayed wound healing was reported in 1 patient,calf intermuscular venous thrombosis in 2 cases,and emotional anxiety and sleep disorder in 1 patient.No new lumbosacral plexus injury was found in any patient.Conclusion sIn the treatment of Tile C old pelvic fractures,since our self-designed GT-UCRT combines the advantages of Ilizarov

关 键 词：骨盆 陈旧性骨折 手术中并发症 手术后并发症 缓慢牵引闭合解锁复位技术 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]