S2AI半螺纹螺钉骶髂固定治疗骨盆后环损伤疗效观察  

Observation on curative effect of S2AI semi-threaded screw sacroiliac fixation in treatment of posterior pelvic ring injury

作　　者：吴亮[1] 孔德伟 宋超 吴铭 丁志宏[1] 刘粤[1] 唐江安[1] 杨铁毅[1] 张岩[1] WU Liang;KONG Dewei;SONG Chao;WU Ming;DING Zhihong;LIU Yue;TANG Jiangan;YANG Tieyi;ZHANG Yan(Department of Orthopedics,Shanghai Pudong New Area Gongli Hospital,Shanghai 200135,China)

机构地区：[1]上海市浦东新区公利医院骨科,上海200135 [2]宁夏医科大学上海市浦东新区公利医院研究生培养基地,上海200135

出　　处：《中国骨与关节损伤杂志》2023年第10期1009-1013,共5页Chinese Journal of Bone and Joint Injury

基　　金：上海市浦东新区卫生系统重点学科(PWZxk2022-09);上海市浦东新区卫生系统领先人才培养计划(PWRL2019-01);上海市浦东新区卫生健康委员会卫生科技项目(PW2020A-43);上海市浦东新区卫生健康委员会临床特色学科(PWYts2021-05)。

摘　　要：目的观察S2AI半螺纹螺钉骶髂固定治疗骨盆后环损伤的临床疗效。方法回顾性分析自2016-08—2021-03采用S2AI半螺纹螺钉骶髂固定治疗的28例骨盆后环损伤,22例S2AI螺钉进行单边固定,其中4例固定到L_(4)椎弓根,10例固定到L_(5)椎弓根,8例固定到S1椎弓根;6例S2AI螺钉进行双边固定,其中2例固定到L_(4)椎弓根,4例固定到L_(5)椎弓根。结果本组手术时间97~196 min,平均146.1 min;术中出血量125~350 mL,平均225.4 mL。术后X线片及CT显示骨盆后环骨折端复位良好,骨折复位质量按Matta标准评定:优18例,良8例,可2例。总共置入34枚S2AI半螺纹螺钉,螺钉在髂骨内的通道长度为47~78 mm,平均60.2 mm。28例术后均获得随访,随访时间6~30个月,平均16.5个月。术后6个月骨盆Majeed功能评分为50~93分,平均80.2分;优14例,良8例,可4例,差2例。末次随访时骨盆Majeed功能评分为60~96分,平均87.7分;优22例,良4例,可2例。末次随访时影像学检查结果显示骶髂关节复位良好,骨盆前环、后环复位未丢失,螺钉位置准确、固定可靠。结论S2AI半螺纹螺钉骶髂固定系统是治疗骨盆后环损伤的有效方法,具有手术操作相对简单、安全性高、内固定可靠、术后并发症发生率低等优点。Objective To observe the clinical effect of S2AI semi-threaded screw sacroiliac fixation in the treatment of pelvic posterior ring injury.MethodsTwenty-eight patients with posterior pelvic ring injury were treated with S2AI semi-threaded screw sacroiliac fixation from August 2016 to March 2021.Twenty-two cases were fixed unilaterally with S2AI screws,including 4 cases fixed to L_(4)pedicle,10 cases to L_(5)pedicle and 8 cases to S1pedicle.Six cases were fixed bilaterally with S2AI screws,including 2 cases fixed to L_(4)pedicle and 4 cases to L_(5)pedicle.ResultsThe operation time in this group was 97-196min,with an average of 146.1 min.The intraoperative blood loss was 125-350 mL,with an average of 225.4 mL.Postoperative X-ray and CT showed that the fractured end of the posterior pelvic ring was well restored.According to Matta criteria,the quality of fracture reduction was excellent in 18 cases,good in 8 cases and fair in 2 cases.A total of 34 S2AI semi-threaded screws were inserted,and the passage length of the screws in ilium was 47-78 mm,with an average of 60.2 mm.All 28 cases were followed up for 6-30 months,with an average of 16.5 months.Six months after operation,the Majeed function score of pelvis was50-93,with an average of 80.2,excellent in 14 cases,good in 8 cases,fair in 4 cases and poor in 2 cases.At the last follow-up,the pelvic Majeed function score was 60-96,with an average of 87.7,excellent in 22 cases,good in 4 cases and fair in 2 cases.At the last follow-up,the results of imaging examination showed that the sacroiliac joint was well reduced,the anterior and posterior pelvic rings were not lost,and the screw position was accurate and the fixation was reliable.ConclusionS2AI semithreaded screw sacroiliac fixation system is an effective method for the treatment of posterior pelvic ring injury,which has the advantages of relatively simple operation,high safety,reliable internal fixation and low incidence of postoperative complications.

关 键 词：不稳定骨盆骨折 骨盆后环损伤 S2AI螺钉 半螺纹螺钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]