Starr架辅助复位结合通道螺钉技术治疗Tile C1.3型骨盆骨折的临床疗效观察  

Clinical effects of Starr frame-assisted reduction combined with channel screw technique in the treatment of Tile C1.3 pelvic fractures

作　　者：蒋科[1] 向超 罗月 李毓灵 Jiang Ke;Xiang Chao;Luo Yue;Li Yuling(Department of Orthopedics,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan Province 637000,China)

机构地区：[1]川北医学院附属医院骨科,四川南充637000

出　　处：《创伤外科杂志》2024年第5期364-369,共6页Journal of Traumatic Surgery

基　　金：四川省医学会骨科专项科研课题项目(2020SAT42)。

摘　　要：目的探讨Starr架辅助复位结合微创通道螺钉技术治疗Tile C1.3型骨盆骨折的疗效和安全性。方法回顾性分析川北医学院附属医院骨科2019年1月—2023年1月手术治疗的34例Tile C1.3型骨盆骨折患者资料,男性23例,女性11例;年龄21~68岁,平均42.6岁;道路交通伤19例,高处坠落伤7例,摔伤8例;合并四肢骨折11例,脊柱骨折12例,腹部损伤6例,腓总神经损伤2例。18例采用Starr架辅助复位结合通道螺钉技术为研究组,16例采用传统切开复位内固定患者为对照组。分析两组患者手术时间、术中出血量、术中透视次数及住院时间。通过CT测量比较患者术前术后骶骨垂直移位复位情况。采用Matta影像评分评价骨折复位质量。观察切口感染、血管神经损伤、下肢静脉血栓形成及异位骨化等并发症。比较患者骨折愈合时间,采用Majeed功能评分评价患者功能恢复情况。结果研究组患者手术时间(73.0±13.6)min,术中出血量(25.0±12.5)mL,平均住院时间12.1d,显著少于对照组[手术时间(138.3±47.6)min,术中出血量(226.5±102.4)mL,平均住院时间23.2d],差异有统计学意义(P均<0.001),但研究组术中透视平均31.2次,多于对照组(平均25.0次),差异有统计学意义(P=0.009)。通过CT测量数据分析两组患者术前、术后骨盆垂直移位距离[研究组,术前:(10.2±6.2)mm,术后:(4.7±3.1)mm;对照组,术前:(9.7±5.8)mm,术后:(5.1±3.4)mm],差异无统计学意义(P>0.05)。研究组和对照组患者复位质量优良率分别为88.9%、81.3%,差异无统计学意义(z=-1.116,P=0.265)。两组患者总并发症率分别为11.1%、25.0%,差异无统计学意义(χ^(2)=1.500,P=0.682)。两组患者均获得6~17个月随访,平均11.6个月。研究组患者骨折平均愈合时间16.3周,显著短于对照组22.3周,差异有统计学意义(P=0.005)。末次随访Majeed评分(85.3±6.4)分显著高于对照组(80.6±5.7)分,差异有统计学意义(P=0.032)。结论Starr架辅助复位Objective To investigate the efficacy and safety of Starr frame-assisted reduction combined with minimally invasive channel screw technique in the treatment of Tile C1.3 pelvic fractures.Methods This retrospective analysis was conducted on 34 patients with Tile C1.3 pelvic fractures who underwent surgical treatment at the Department of Orthopedics,Affiliated Hospital of North Sichuan Medical College,between Jan.2019 and Jan.2023.Of these patients,23 were male and 11 were female,aged 21-68(mean 42.6)years.The causes of injuries included road traffic accidents in 19 cases,falls from height in 7 cases,and ground-level falls in 8 cases.Among them,11 cases had concomitant limb fractures,12 spinal fractures,6 abdominal trauma,and 2 peroneal nerve injuries.Eighteen cases were treated with Starr frame-assisted reduction combined with channel screw fixation and included in the study group,while the other 16 cases underwent traditional open reduction and internal fixation and were included in the control group.Perioperative parameters including operation time,intraoperative blood loss,intraoperative fluoroscopy times,and length of hospital stay were analyzed for both groups.Pre-and post-operative sacral vertical displacement was measured via CT scans.Fracture reduction quality was assessed using the Matta score.Complications such as surgical site infection,vascular or nerve injury,lower limb deep vein thrombosis,and heterotopic ossification were recorded.Fracture healing time and functional recovery were compared between the two groups using the Majeed functional score.Results Compared with the control group,the study group revealed significantly shorter operation time(min,73.0±13.6 vs.138.3±47.6),less intraoperative blood loss(mL,25.0±12.5 vs.226.5±102.4),and shorter length of hospital stay(d,median 12.1 vs.median 23.2,all P<0.001).However,the study group required much more numbers of intraoperative fluoroscopy(median 31.2 vs.median 25.0,P=0.009).There was no significant difference in pre-and post-operative sacral ver

关 键 词：骨盆骨折 Starr架 通道螺钉 复位 

分 类 号：R683.3[医药卫生—骨科学]