两种固定Tile C型骨盆骨折前环的比较  

Two types of fixation for the anterior ring in Tile type C pelvic fractures

作　　者：丁海波 李鹏 孙培锋 赵金柱 曲良 王连嘉 陶春生 DING Hai-bo;LI Peng;SUN Pei-feng;ZHAO Jin-zhu;QU Liang;WANG Lian-jia;TAO Chun-sheng(Department of Orthopedics,The 971 st Hospital of PLA Navy,Qingdao 266000,China)

机构地区：[1]中国人民解放军海军第九七一医院骨科一病区,山东青岛266000

出　　处：《中国矫形外科杂志》2023年第24期2232-2237,共6页Orthopedic Journal of China

摘　　要：[目的]比较经皮钉棒系统(钉棒)与钢板治疗不稳定性骨盆环骨折的临床疗效。[方法]回顾性分析2016年1月—2020年12月本科手术治疗57例Tile C型骨盆骨折患者。首先行后环复位内固定,依据术前医患沟通结果,30例采取钉棒前环固定,27例采取钢板前环固定。比较两组围手术期、随访及影像结果。[结果]两组患者均顺利完成手术,术中无神经、血管损伤等严重并发症。钉棒组在手术时间[(59.1±12.2) min vs (77.2±18.3) min,P<0.05]、切口总长度[(15.4±3.2) cm vs (27.5±4.3)cm,P<0.05]和术中失血量[(75.2±15.3) ml vs (350.4±50.6) ml,P<0.05]均显著少于钢板组,两组术中透视次数、切口愈合等级、住院时间的差异均无统计学意义(P>0.05)。早期并发症,钉棒组为3.3%(1/30),钢板组为18.5%(5/27),差异无统计学意义(P=0.091)。所有患者随访12个月以上。钉棒组恢复完全负重活动时间显著早于钢板组[(92.6±11.2) d vs (107.4±12.1) d,P<0.05]。随时间推移,两组患者VAS评分显著减少(P<0.05),而Majeed评分显著增加(P<0.05)。术后3个月[(77.5±5.6) vs(71.8±3.6),P<0.05]和6个月[(88.7±3.6) vs (82.5±1.6),P<0.05]钉棒组的Majeed评分显著优于钢板组。影像方面,相应时间点,两组间骨折复位质量、内固定位置的差异均无统计学意义(P>0.05)。钉棒组骨折愈合时间显著早于钢板组(P<0.05)。[结论]经皮钉棒系统固定Tile C型骨盆骨折前环具有手术时间短、手术创伤小、出血量少、骨盆愈合快等诸多微创优点。[Objective] To compare the clinical efficacy of percutaneous screw-rod system versus plate in the treatment of unstable pelvic ring fractures.[Methods] A retrospective study was conducted on 57 patients who underwent open reduction and internal fixation(ORIF) for Tile type C pelvic fractures in our department from January 2016 to December 2020.After the ORIF for the posterior ring had been performed,30 patients had the anterior ring fixed with screw-rod system,while the other 27 patients were with plate.The perioperative,follow-up and imaging documents were compared between the two groups.[Results] All the patients in both groups were operated on successfully without nerve and vascular injury and other serious complications.The screw-rod group proved significantly superior to the plate group in terms of operation time [(59.1±12.2) min vs(77.2±18.3) min,P<0.05],total incision length [(15.4±3.2) cm vs(27.5±4.3) cm,P<0.05] and intraoperative blood loss [(75.2±15.3) ml vs(350.4±50.6) ml,P<0.05],nevertheless there were no significant differences in the number of intraoperative fluoroscopy,incision healing grade and hospitalf stay between the two groups(P>0.05).The early complications were 3.3%(1/30) in the screw-rod group,whereas 18.5%(5/27) in the plate group,which was not statistically significant(P=0.091).All patients were followed up for more than 12 months,and the screw-rod group resumed full weight-bearing activity significantly earlier than the plate group [(92.6±11.2) days vs(107.4±12.1) days,P<0.05].The VAS scores for pain decreased significantly(P<0.05),while the Majeed score increased significantly over time in both groups(P<0.05).The screw-rod group was significantly better than the plate group in term of Majeed score at 3 months [(77.5±5.6) vs(71.8±3.6),P<0.05] and 6 months [(88.7±3.6) vs(82.5±1.6),P<0.05].Radiographically,there were no significant differences in reduction quality according to Matta's criteria and internal fixation position between the two groups at any time points accordingly

关 键 词：骨盆骨折 前环损伤 钉棒系统 经皮内固定 钢板 

分 类 号：R683.3[医药卫生—骨科学]