"阶梯复位法"治疗髂骨骨折合并骶髂关节前脱位  

Treatment of iliac fracture combined anterior dislocation of the sacroiliac joint by the"ladder reduction method"

作　　者：温磊 陈戈 侯开宇 季建华 陈长顺 刘琨 邓永成 陈仲 郑常友 Wen Lei;Chen Ge;Hou Kaiyu;Ji Jianhua;Chen Changshun;Liu Kun;Deng Yongcheng;Chen Zhong;Zheng Changyou(Department of Orthopaedic and Trauma Surgery,Affiliated Hospital of Yunnan University,Kunming 650000,China;Department of Anesthesiology,First Affiliated Hospital of Kunming Medical University,Kunming 650000,China)

机构地区：[1]云南大学附属医院骨与创伤外科,昆明650000 [2]昆明医科大学第一附属医院麻醉科,昆明650000

出　　处：《中华骨科杂志》2023年第15期1007-1012,共6页Chinese Journal of Orthopaedics

摘　　要：目的 探讨"阶梯复位法"治疗髂骨骨折合并骶髂关节前脱位的临床疗效.方法 回顾性分析云南大学附属医院2010年2月至2022年1月收治的10例骶髂关节前脱位患者资料,男5例、女5例,年龄22~52岁,平均38.8岁.均为车祸伤,骨盆骨折Tile分型,C1.2型5例、C2型3例、C3型2例.采用"阶梯复位法"复位及钢板螺钉固定.第一步,于髂嵴置入1~2枚Schanz针控制髂骨,向外侧适当牵拉Schanz针;第二步,使用骨膜剥离器在骶骨与髂骨间进行撬拨复位;第三步,对仍无法复位者,在骶骨上紧贴髂骨内缘由前上向后下置入1枚直径2.5 mm的克氏针,并于骶骨与髂骨间插入一把骨膜剥离器,用其尖端顶住克氏针,以髂骨为支点进行撬拨使两者分离;第四步,维持撬拨,再紧贴髂骨内缘在骶骨上置入另1枚直径2.5 mm克氏针,继续使用骨膜剥离器于骶骨与髂骨间撬拨,重复操作,同时结合牵引下肢复位骶髂关节前脱位.术后使用Matta评分评估复位质量,使用Majeed评分评估骨盆骨折后功能恢复程度.结果 4例患者通过第一、二步即完成复位,6例难复性骶髂关节前脱位通过第一至四步操作成功复位.6例难复性骶髂关节前脱位患者的骨折复位时间为(39.67±3.09)min(范围 35~44min),术中失血量为(300.00±141.42)ml(范围 150~600 ml);另 4例骨折复位时间为(36.75± 4.38)min(范围30~42 min),术中失血量为(225.00±44.30)ml(范围200~300 ml).10例患者均获得随访,随访时间为(12.9±3.7)个月(范围9~20个月).所有患者骨盆前后环骨折均获得愈合,骨折愈合时间为(12.77±1.62)周(范围10.71~15.28周).末次随访时6例难复性骶髂关节前脱位患者Matta评价优5例、良1例,另4例均为优.6例Majeed功能评分为(86.50±6.08)分(范围74~92分),其中5例为优、1例为良;另4例为(81.5±9.39)分(范围71~94分),其中优2例、良2例.结论 "阶梯复位法"是一种安全有效、易于操作的治疗髂骨骨折合并骶髂关节前脱位的方�Objective To investigate the clinical effect of"ladder reduction method"in the treatment of iliac fracture combined anterior dislocation of sacroiliac joint.Methods The retrospective analysis was performed on 10 cases of iliac fracture combined anterior sacroiliac joint dislocation admitted to the Affiliated Hospital of Yunnan University from February 2010 to January 2022,among which 5 cases were males and 5 cases were females,aged ranging from 22 to 52 years,with an average age of 38.8 years.All patients were injured in car accidents including 5 cases of C1.2,3 cases of C2,and 2 cases of C3 fractures according to Tile classification.All patients were treated with the"ladder reduction method"with plate and screw fixation.In the first step,1-2 Schanz pins were inserted into the iliac crest to control the ilium,and the Schanz pins were appropriately pulled laterally;in the second step,the periosteal stripper was used to pry the reduction between the sacrum and ilium;in the third step,for the patients who still could not be reduced,a 2.5 mm diameter Kirschner wire was placed on the sacrum close to the iliac crest,and a periosteal stripper was inserted between the sacrum and iliac crest,with its tip against the Kirkner wire,and the iliac crest as the fulcrum for pry pulling to separate the two.In the fourth step,the pry was maintained,and then another 2.5 mm diameter Kirschner wire was placed on the sacrum close to the internal margin of the iliac bone.The periosteal stripper was continued to pry between the sacrum and the iliac bone,and the operation was repeated.At the same time,the anterior dislocation of the sacroiliac joint was reduced with traction of the lower limb.Postoperatively,the quality of reduction was evaluated by the Matta score,and the degree of functional recovery after pelvic fracture was evaluated by the Majeed score.Results Four patients completed the reduction through the first and second steps,and 6 cases of refractory sacroiliac joint anterior dislocation were successfully reduced through the

关 键 词：骶髂关节 关节脱位 骨折切开复位 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]