阻挡钉辅助下经皮微创前柱螺钉固定治疗骨盆与髋臼骨折的疗效分析  

Minimally invasive percutaneous anterior column screwing assisted by blocking screws for pelvic and acetabular fractures

作　　者：熊志刚 黄伟[1] 黄俊武 杨帆[1] 赵立炜 杨二平 Xiong Zhigang;Huang Wei;Huang Junwu;Yang Fan;Zhao Liwei;Yang Erping(Department of Orthopaedics,Huanggang Central Hospital Affiliated to Yangtze University,Huanggang,Hubei 438000,China;Department of Orthopaedics,The First People's Hospital of Wuxue,Wuxue,Hubei 435400,China)

机构地区：[1]长江大学附属黄冈市中心医院骨科,黄冈438000 [2]武穴市第一人民医院骨科,武穴435400

出　　处：《中华创伤骨科杂志》2023年第6期505-511,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨阻挡钉辅助下经皮微创前柱螺钉固定治疗骨盆与髋臼骨折的可行性及临床疗效。方法回顾性分析2019年7月至2022年4月期间黄冈市中心医院骨科收治的13例(14侧)骨盆与髋臼骨折患者资料。男8例,女5例;年龄(49.1±13.3)岁;髋臼骨折7例(单侧6例,双侧1例),骨折Letournel-Judet分型:前柱骨折5例6侧,横形伴后壁骨折2例2侧;骨盆骨折6例(合并骨盆后环骨折5例),骨折按Tile分型:B2型1例,C1型3例,C2型2例。根据前柱通道解剖分区进行统计:Ⅲ区5侧,Ⅳ区3侧,Ⅴ区6侧。受伤至手术时间(8.2±2.9)d,范围值为3~14 d。所有患者均在阻挡钉辅助下完成顺行前柱螺钉固定,5例患者合并的骨盆后环骨折行经皮骶髂关节螺钉固定。记录患者前柱螺钉置入的手术时间、术中透视次数、术中出血量、骨折复位质量及末次随访时髋关节功能等。结果13例患者共经皮置入14枚前柱螺钉。前柱螺钉置入手术时间为(65.0±10.2)min,术中透视次数为(63.5±14.5)次,每枚螺钉失血<30 mL。术后切口均一期愈合,未发生医源性血管神经损伤、切口愈合不良等并发症。13例患者术后均获(11.1±2.2)个月随访。1例双侧髋臼前柱骨折患者置入2枚前柱螺钉,术后1个月左侧前柱螺钉发生移位,之后取出;其余患者未发现内固定物松动或骨折再移位等并发症。骨折均获愈合,愈合时间为(10.2±2.1)个月。术后前柱骨折复位质量根据Matta评分标准评定:优7侧,良5侧,差2侧。末次随访时6例骨盆骨折患者按骨盆Majeed评分系统评定疗效:优4例,良2例;7例(8侧)髋臼骨折患者按改良Merle d'Aubigné&Postel评分系统评定疗效:优4髋,良3髋,可1髋。结论阻挡钉辅助下经皮微创前柱螺钉固定治疗骨盆与髋臼骨折的临床疗效良好,且操作便捷、安全和可靠。Objective To investigate the feasibility and clinical efficacy of percutaneous anterior column screwing assisted by blocking screws for pelvic and acetabular fractures.Methods A retrospective analysis was conducted of the 13 patients who had been admitted from July 2019 to April 2022 for pelvic and acetabular fractures.There were 8 males and 5 females with an age of(49.1±13.3)years,7 acetabular fractures(6 on one side and 1 on both sides;by the Letournel-Judet classification:5 anterior column fractures on 6 sides,and 2 transverse and posterior wall fractures on 2 sides),and 6 pelvic fractures(5 complicated with pelvic posterior ring fracture;by the Tile classification:1 case of type B2,3 cases of type C1,and 2 cases of type C2).According to the anatomic zones of the anterior column,5 fractures were at zoneⅢ,3 ones at zoneⅣ,and 6 ones at zoneⅤ.The time from injury to surgery ranged from 3 to 14 days,averaging(8.2±2.9)days.Anterograde anterior column screwing assisted by blocking screws was performed for all the 13 patients;the posterior ring was fixated with percutaneous sacroiliac joint screws for the 5 patients complicated with pelvic posterior ring fracture.The surgical time,intraoperative fluoroscopy frequency,and intraoperative bleeding volume for insertion of anterior column screws,fracture reduction quality,and hip joint function at the last follow-up were recorded.Results A total of 14 anterior column screws were inserted percutaneously in the 13 patients.For insertion of anterior column screws,the surgical time was(65.0±10.2)min,the intraoperative fluoroscopy frequency(63.5±14.5)times,and the intraoperative bleeding volume for each screw less than 30 mL.All the incisions healed primarily after surgery,without such complications as iatrogenic neurovascular injury or poor wound healing.All the 13 patients were followed up for(11.1±2.2)months after surgery.In the patient with bilateral acetabular anterior column fractures for which 2 anterior column screws had been inserted,one screw had to be rem

关 键 词：髋臼 骨盆 骨折 骨折固定术 内 骨钉 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]