髂骨间固定与骶髂螺钉治疗B型骨盆骨折疗效比较  

Transiliac internal fixator versus sacroiliac screw for Tile type B pelvic fracturs

作　　者：陈宝[1] 王振山 许田恩 范恒恺 张苍宇[1] 丁明聪[1] 万麟[1] CHEN Bao;WANG Zhen-shan;XU Tian-en;FAN Heng-kai;ZHANG Cang-yu;DING Ming-cong;WAN Lin(Department of Orthopaedics,The Second Hospital,Lanzhou University,Lan-zhou,Gansu 730030,China)

机构地区：[1]兰州大学第二医院骨科,甘肃兰州730030

出　　处：《中国矫形外科杂志》2024年第24期2209-2214,共6页Orthopedic Journal of China

基　　金：甘肃省自然科学基金项目(编号:23JRRA0989)。

摘　　要：[目的]比较髂骨间固定(transiliac internal fixator,TIFI)和骶髂螺钉(sacroiliac screw,SIS)结合前环固定治疗B型骨盆骨折的临床疗效。[方法]回顾性分析2016年10月—2021年7月本院手术治疗47例Tile B型骨盆骨折患者的临床资料。根据医患沟通结果,23例采用TIFI结合微创前环钢板治疗(髂间组),24例采用SIS结合前环钢板固定(骶髂组)。比较两组围手术期、随访和影像学结果。[结果]髂间组手术时间[(262.4±33.2)min vs(316.9±46.9)min,P<0.001]、术中出血量[(107.6±13.0)ml vs(128.8±13.3)ml,P<0.001]、透视次数[(13.0±3.1)次vs(27.9±5.6)次,P<0.001]均显著少于骶髂组,但切口总长度[(13.3±1.1)cm vs(10.7±1.2)cm,P<0.001]显著大于骶髂组。所有患者随访12个月以上。两组患者下地行走时间、完全负重时间的差异无统计学意义(P>0.05)。随时间推移,两组VAS评分、Majeed评分均显著改善(P<0.05)。相同时间点,两组VAS评分、Majeed评分的差异无统计学意义(P>0.05)。影像方面,与术前相比,末次随访时,两组患者Matta评级显著改善(P<0.05),相同时间点,两组间Matta评级的差异无统计学意义(P>0.05)。两组骨折愈合时间的差异无统计学意义(P>0.05)。[结论]TIFI结合微创前环固定治疗B型骨盆骨折具有手术时间短,出血量少,透视次数少及骨折复位满意等优点。[Objective]To compare the clinical efficacy of transiliac internal fixator(TIFI)versus sacroiliac screw(SIS)combined with anterior ring fixation for type B pelvic fracture.[Methods]A retrospective study was conducted on 47 patients who had Tile type B pelvic fracture treated surgically in our hospital from October 2016 to July 2021.According to doctor-patient communication,23 patients were treated with TIFI combined with minimally invasive anterior ring plate(the TIFI group),while other 24 patients had the sacroiliac joint fixed with SIS combined with anterior ring plate(the SIS group).The documents regarding perioperative period,follow-up and images were compared between the two groups.[Results]The TIFI group proved significantly superior to the SIS group in terms of operation time[(262.4±33.2)min vs(316.9±46.9)min,P<0.001],intraoperative blood loss[(107.6±13.0)ml vs(128.8±13.3)ml,P<0.001]and fluoroscopy times[(13.0±3.1)vs(27.9±5.6),P<0.001],but the former consumed significantly longer total incision length than the latter[(13.3±1.1)cm vs(10.7±1.2)cm,P<0.001].All patients in both groups were followed up for more than 12 months,and there was no significant difference in time to regain ambulation and full weight bearing activity between the two groups(P>0.05).The VAS scores and Majeed scores were signifi⁃cantly improved in both groups over time(P<0.05),whereas which were not significantly different between the two groups at any time points accordingly(P>0.05).With respect of imaging,the Matta scale in both groups was significantly improved at the last follow-up compared with that preoperatively(P<0.05),which was not statistically significant between the two groups at any corresponding same time points(P>0.05).There was no significant difference in fracture healing time between the two groups(P>0.05).[Conclusion]TIFI combined with mini⁃mally invasive anterior ring fixation in the treatment of Tile type B pelvic fracture has the advantages of shortening operation time,reducing bleeding,declining fluorosc

关 键 词：骨盆骨折 髂骨间内固定 骶髂螺钉 微创手术 

分 类 号：R683.3[医药卫生—骨科学]