骨盆骨折三轴移位方式及复位原则

发布时间：2018-12-18 00:42

【摘要】：目的基于骨盆CT三维重建,建立骨盆三维立体坐标系,分析骨盆骨折的三轴移位方式并建立复位原则。方法纳入2015年6月-2016年5月正常骨盆CT数据21例,建立均值骨盆三维模型,以髂前下棘中点为原点建立骨盆三维立体坐标轴,并基于此坐标系统建立一种骨盆骨折三轴移位方式分类。对临床中2012年1月—2016年5月收治的55例骨盆骨折患者(男29例,女26例;年龄11~66岁,平均35.6岁),根据上述三轴移位方式分类方法,按逆向复位原则行闭合或切开复位,运用空心螺钉、钢板或外固定支架固定治疗,评估骨盆骨折三轴移位方式分类的临床指导价值。结果根据三轴原理,将骨盆骨折移位分为x轴正移位/负移位、旋正/旋负移位,y轴正移位/负移位、旋正/旋负移位,z轴正移位/负移位、旋正/旋负移位。纳入骨盆骨折患者的手术切口平均7.1 cm;复位时间平均12.2 min;受辐射时间平均55.3 s;螺钉植入时间平均27.2 min,术后骨盆X线片或三维CT显示所有骨盆骨折复位良好,螺钉钢板植入无误;术中失血量平均96.5 mL;手术时间平均2.1 h;住院时间平均18.7 d。患者均获随访,随访时间6~53个月,平均16.7个月。末次随访时根据Matta评分标准,获优39例,良13例,可3例,优良率94.55%。结论基于骨盆三轴立体坐标轴的骨盆骨折三轴移位方式分类,能简便、精确表示患者骨折的移位方式,并可为患者术中复位进行精确指导。
[Abstract]:Objective to establish the three dimensional coordinate system of pelvis based on CT reconstruction of pelvis and analyze the three axis displacement mode of pelvic fracture and establish the principle of reduction. Methods from June 2015 to May 2016, 21 cases of CT data of normal pelvis were included, and the mean pelvic three-dimensional model was established, and the three-dimensional coordinate axis of the pelvis was established with the midpoint of anterior and inferior iliac spine as the origin. Based on the coordinate system, a three-axis displacement classification of pelvic fractures was established. From January 2012 to May 2016, 55 patients (29 males and 26 females) with pelvic fractures were treated. According to the above three axis shift classification method, according to the principle of reverse reduction, closed or open reduction was performed, and hollow screw, plate or external fixator was used to fix the treatment. To evaluate the clinical guiding value of three-axis displacement classification of pelvic fractures. Results according to the principle of three axes, pelvic fracture displacement was divided into x axis positive displacement / negative displacement, rotation positive / negative shift, y axis positive / negative shift, positive / negative rotation / negative displacement, z axis positive / negative displacement, and positive / negative rotation / negative displacement. The average reduction time of surgical incision was 7. 1 cm; and the average time of radiation exposure was 52. 3 s in patients with pelvic fracture. The mean time of screw implantation was 27. 2 min, after pelvic X-ray or 3 D CT showed that all pelvic fractures were well reduced and the screw plate implantation was correct, the average blood loss during operation was 96. 5 mL; and the average operative time was 2. 1 h. The average hospitalization time was 18.7 days. All patients were followed up for 6 ~ 53 months (mean 16.7 months). According to Matta score, 39 cases were excellent, 13 cases were good, 3 cases were fair. The excellent and good rate was 94.55%. Conclusion the classification of three axis displacement patterns of pelvic fractures based on three axis coordinate axes of pelvis is simple and accurate, and can be used as a guide for the patients with intraoperative reduction.
【作者单位】：四川大学华西医院骨科;四川大学华西临床医学院;
【基金】：国家自然科学基金资助项目(31370984、81501879) 四川省科技厅国际合作项目(2015HH0049) AO Asia Pacific研究基金会资助项目(AOTAP16-07)~~
【分类号】：R687.3

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