逆行耻骨上支髓内钉固定治疗骨盆前环骨折的疗效分析  

Fixation with a retrograde pubic ramus intramedullary nail for anterior pelvic ring fractures

作　　者：尹恩志 罗杨兴 袁雪峰 何立 谷美琪 解杰 龚嵩 王震[1] 许喆 向鹏辉 程瑞祥 易成腊[1] Yin Enzhi;Luo Yangxing;Yuan Xuefeng;He Li;Gu Meiqi;Xie Jie;Gong Song;Wang Zhen;Xu Zhe;Xiang Penghui;Cheng Ruixiang;Yi Chengla(Department of Traumatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,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430030

出　　处：《中华创伤骨科杂志》2023年第6期491-497,共7页Chinese Journal of Orthopaedic Trauma

基　　金：国家骨科与运动康复临床医学研究中心、江苏省中以产业技术研究院创新基金(2021-NCRC-CXJJ-ZH-24);十四五国家重点研发计划项目(2022YFC2504303)。

摘　　要：目的介绍一种逆行耻骨上支髓内钉,探讨其固定治疗骨盆前环骨折的临床疗效。方法回顾性分析2020年6月至2021年2月期间华中科技大学同济医学院附属同济医院创伤外科收治且获得随访的14例骨盆前环骨折患者资料。男10例,女4例;年龄(44.8±12.5)岁;骨盆骨折根据AO/OTA分型:61-A型5例,61-B型4例,61-C型5例;骨盆前环骨折根据Nakatani分型:单侧Ⅰ区骨折1例,单侧Ⅱ区骨折5例,单侧Ⅲ区骨折2例,右侧Ⅱ区、左侧Ⅲ区骨折3例,左、右两侧均为Ⅲ区骨折2例,左、右两侧均为Ⅱ区骨折1例。受伤至手术时间为(7.8±1.8)d。所有患者骨盆前环骨折均采用逆行耻骨上支髓内钉固定。记录患者每枚髓内钉的置入时间、术中X线透视次数、骨折复位质量、末次随访时骨盆功能及并发症发生情况等。结果14例患者共置入18枚逆行耻骨上支髓内钉,术中每枚髓内钉置入时间为(35.9±8.6)min,术中X线透视次数为(22.8±1.9)次。术后所有患者置钉处手术切口均未发生感染。术后骨折复位质量根据Matta评分标准评定:优7例,良5例,可2例。14例患者术后获(18.1±1.5)个月随访。末次随访时骨盆X线片及CT图片示骨折愈合良好,髓内钉在骨盆前环骨皮质内。末次随访时根据骨盆Majeed评分系统评定骨盆功能:优10例,良3例,可1例。1例患者术后2个月出现下蹲不适,未予特殊治疗,3个月后症状缓解;无一例患者出现髓内钉移位或滑脱、置钉口疼痛等并发症。结论逆行耻骨上支髓内钉固定治疗骨盆前环骨折的疗效良好,具有手术切口小、手术时间短及术中透视次数少等优点。Objective To explore the clinical efficacy of a retrograde pubic ramus intramedullary nail(RPRIN)in the treatment of anterior pelvic ring fractures.Methods A retrospective study was conducted to analyze the 14 patients with anterior pelvic ring fracture who had been treated and followed up at Department of Traumatic Surgery,Tongji Hospital From June 2020 to February 2021.There were 10 males and 4 females with an age of(44.8±12.5)years.By the AO/OTA classification for pelvic fractures,5 cases were type 61-A,4 cases 61-B,and 5 cases type 61-C;by the Nakatani classification,1 case belonged to unilateral zoneⅠfracture,5 cases to unilateral zoneⅡfracture,2 cases to unilateral zoneⅢfracture,3 cases to right zoneⅡand left zoneⅢfracture,2 cases to zoneⅢfracture on both left and right sides,and 1 case to zoneⅡfracture on both sides.The time from injury to operation was(7.8±1.8)days.All the anterior pelvic ring fractures were fixated with a RPRIN.The time and fluoroscopic frequency for placement of every single RPRIN,quality of fracture reduction,and pelvic function and incidence of postoperative complications at the last follow-up were recorded.Results A total of 18 RPRINs were placed in the 14 patients.For placement of each RPRIN,the time was(35.9±8.6)min,and the fluoroscopic frequency(22.8±1.9)times.No complications such as infection occurred at any surgical incision after RPRIN placement.According to the Matta scoring,the quality of postoperative fracture reduction was assessed as excellent in 7 cases,as good in 5 cases and as fair in 2 cases.The 14 patients were followed up for(18.1+1.5)months.Their X-ray and CT images of the pelvis at the last follow-up showed that the fractures healed well and the intramedullary nails were placed in the cortical bone of the anterior ring of the pelvis.According to the Majeed scoring at the last follow-up,the pelvic function was assessed as excellent in 10 cases,as good in 3 cases and as fair in 1 case.One patient reported discomfort during squatting 2 months after

关 键 词：骨盆 骨折 骨折固定术 髓内 逆行耻骨上支髓内钉 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]