三种外固定置钉方法治疗骨盆骨折

发布时间：2018-05-02 19:38

本文选题：骨盆骨折 + 外固定架　；参考：《中国矫形外科杂志》2017年10期

【摘要】：[目的]通过回顾性分析,对比骨盆骨折后使用3种不同外固定支架置钉方法间的并发症发生率,为临床置钉提供理论依据。[方法]选择2006年1月~2016年5月两医院骨盆骨折患者232例,Tile A型119例,Tile B型55例,Tile C型58例,随机分为髂嵴上置钉组,髋臼上置钉组和髂嵴下置钉组进行治疗并随访18个月,对比平均手术时间、平均出血量、术后功能恢复情况、神经损伤、钉道感染率、置钉在骨内的体积及松动情况。[结果]3组患者平均手术时间差异具有统计学意义(P0.001),且每两组间平均手术时间差异也具有统计学意义(P0.001),嵴下组手术时间最短为(15±5)min,髋臼组最长为(66±10 min)。3组平均出血量差异具有统计学意义(P0.001),其中嵴下组平均出血量为(20±5)ml,而髋臼组(100±35 ml)和嵴上组(90±50 ml)间出血量差异无统计学意义(P=0.443)。3组患者术后功能恢复Majeed评分优良率,嵴上组61.33%,嵴下组82.5%,髋臼组95.65%,组间比较差异具有统计学意义(P0.001),髋臼组术后功能恢复情况好于其他2组。神经损伤率:嵴上组0%,嵴下组17.5%,髋臼组4.35%,3组间比较差异具有统计学意义(P0.05)。髋臼组虽有较低的钉道感染率(8.69%),但与嵴上组(26.67%)及嵴下组(32.5%)组间比较差异无统计学意义。在所把持的骨量方面,3组间差异无统计学意义(P=0.059),而松动率差异具有统计学意义(P0.05),组间比较髋臼组(2.61%)明显低于其他两组,嵴上组(20.00%)和嵴下组(33.33%)比较差异无统计学意义。[结论]嵴下固定作为急救的处理时较为合适,髋臼上固定适合于可能将外固定支架作为终极治疗的人群,嵴上固定在综合对比中无显著优势。
[Abstract]:[objective] to compare the incidence of complications between three different external fixation methods after pelvic fracture, and to provide theoretical basis for clinical nail placement. [methods] from January 2006 to May 2016, 232 patients with pelvic fractures in two hospitals were randomly divided into three groups: upper iliac crest nail group, acetabular superior nail group and inferior iliac crest nail group, and were followed up for 18 months. 55 patients with Tile A type A and 55 patients with Tile B type C were randomly divided into three groups: the iliac crest superior nail group, the acetabular superior nail group and the iliac crest screw group. The mean operative time, blood loss, postoperative functional recovery, nerve injury, infection rate of the nail, the volume and loosening of the nail in the bone were compared. [results] the average operating time of the three groups was significantly different (P 0.001), and the mean operation time between the two groups was also statistically significant. The shortest operation time was 15 卤5 minutes in the subcristal group and the longest in the acetabular group was 66 卤10 min).3. The average bleeding volume of the acetabular group was 66 卤10 min).3. The difference was statistically significant (P 0.001). The average amount of blood loss in the subcristal group was 20 卤5 ml, while that in the acetabular group (100 卤35 ml) and the supracristal group (90 卤50 ml) had no significant difference. There was no significant difference between the two groups in the excellent and good rate of functional recovery after operation. The superior group (61.33), the subcristal group (82.5%) and the acetabular group (95.65%) had significant differences (P 0.001). The recovery of function in the acetabular group was better than that in the other two groups. The rate of nerve injury: superior group 0, subcristal group 17. 5%, acetabular group 4. 35%, the difference was statistically significant (P 0. 05). Although the acetabular group had a low infection rate of 8.69g, there was no significant difference between the acetabular group and the superior group (26.67%) and the subcristal group (32.5%). There was no significant difference in bone mass among the three groups (P 0.059), but there was no significant difference in loosening rate (P 0.05). The difference between the two groups was significantly lower than that in the acetabular group (2.61%), and there was no significant difference between the two groups in the superior group (20.00%) and the subcristal group (3.33%). [conclusion] Superior acetabular fixation is suitable for the treatment of emergency treatment with subcristal fixation, and supraacetabular fixation is suitable for the people who may use external fixator as the ultimate treatment. There is no significant advantage in the comprehensive comparison between supracristal fixation and external fixation.
【作者单位】：重庆市人民医院三院院区骨科;川北医学院附属医院骨科;
【基金】：重庆市卫生和计划生育委员会资助项目(编号:2015ZBXM092)
【分类号】：R687.3

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