髂腰固定术治疗骨盆C型骨折和复杂骶骨骨折的临床疗效与经验

发布时间：2019-04-20 15:35

【摘要】：目的:通过随访,评价髂腰固定术治疗骨盆C型骨折和复杂骶骨骨折的临床疗效,总结治疗经验。方法:回顾性分析我院2014年3月至2016年12月之间,采用椎弓根螺钉系统经后路行髂腰固定术治疗的骨盆C型骨折和复杂的骶骨骨折患者19例,年龄:12~61岁,平均年龄34.1岁:。骨盆骨折根据tile分型:C1型3例,C2型5例,C3型11例;骶骨骨折根据denis分型,I型5例,II型7例,III型7例,合并有神经损伤的患者有2例。本组病例中骨盆后环损伤均采用经后路髂腰固定术治疗,前环损伤采用钢板螺钉系统固定;术前若通过影像学检查、体格检查高度怀疑有神经卡压的患者行后路直接减压或者通过对骨折块的复位进行间接减压。通过Matta评分系统来评价骨盆复位的质量,Majeed评分系统来评价临床疗效。结果:19例患者全部获得随访,平均随访时间12.5月。本组患者骨折愈合时间15周~32周,平均19周;术前移位最大为21.80mm,平均8.76mm,术后垂直移位最大为12.57mm,平均4.20mm,骨盆垂直移位复位平均达4.57mm,根据Matta评分,优17例,良1例,可1例,差0例,优良率94.7%。末次随访Majeed评分60~98分,优6例,良11例,可2例,差0例,优良率89.4%。术后出现骶尾部深部感染患者2例,通过反复清创和敏感抗生素的使用,感染得到控制,骨折愈合后才取出内固定系统。在取出内固定系统中,19例患者中影像学检查或术中发现螺钉松动的有5例,1例患者连接棒断裂;4例患者因螺钉从髂后上棘突出而感觉骶尾部异物感或不适。术前术后影像学Matta评分结果采用SPSS 19.0统计软件包进行分析。结论:采用髂腰固定术治疗骨盆C型骨折和复杂的骶骨骨折疗效明显,可恢复骨盆垂直方向的稳定性,利于患者的早期活动及负重。术后有螺钉松动、连接棒断裂和螺钉突出等并发症,骨折愈合后常规需取出内固定系统。
[Abstract]:Objective: to evaluate the clinical efficacy of iliolumbar fixation in the treatment of pelvic C-type fracture and complex sacral fracture. Methods: from March 2014 to December 2016, 19 patients with pelvic C fracture and complex sacral fracture treated by pedicle screw fixation were retrospectively analyzed. The average age is 34.1 years:. According to tile classification of pelvic fractures, there were 3 cases of C1 type, 5 cases of C2 type, 11 cases of C3 type, and 5 cases of sacral fracture according to denis classification, 5 cases of type I, 7 cases of type II, 7 cases of type III, and 2 cases of patients with nerve injury. The pelvic posterior ring injury was treated by posterior iliolumbar fixation, and the anterior ring injury was fixed by plate and screw system. If the imaging examination was passed before the operation, the patients who were highly suspected of nerve compression were treated with posterior direct decompression or indirect decompression through the reduction of the fracture mass. The quality of pelvic reduction was evaluated by Matta scoring system, and the clinical efficacy was evaluated by Majeed scoring system. Results: all 19 patients were followed up with an average follow-up time of 12.5 months. The fracture healing time ranged from 15 weeks to 32 weeks (mean 19 weeks). The maximum displacement was 21.80 mm (mean 8.76 mm) before operation, 12.57 mm (average 4.20 mm) and 4.57 mm (mean vertical displacement) after operation. According to Matta score, 17 cases were excellent, 1 case was good, 1 case was fair, and 0 cases were bad. The excellent and good rate is 94.7%. In the last follow-up, the Majeed score was 60-98, excellent in 6 cases, good in 11 cases, fair in 2 cases and poor in 0 cases. The excellent and good rate was 89.4%. There were 2 cases of deep sacrococcygeal infection after operation. The infection was controlled by repeated debridement and the use of sensitive antibiotics. The internal fixation system was removed only after fracture healing. Of the 19 patients, 5 had loosened screws, 1 had broken connecting rods, and 4 felt foreign sacrococcygeal sensation or discomfort due to the protrusion of the screws from the posterior superior iliac spine. Preoperative and postoperative imaging Matta scores were analyzed by SPSS 19.0 statistical software package. Conclusion: iliolumbar fixation is effective in the treatment of C-type fracture of pelvis and complicated sacral fracture, which can restore the vertical stability of pelvis and facilitate the early movement and weight-bearing of the patient. There were some complications such as screw loosening, fracture of connecting rod and screw protrusion after operation, and internal fixation system should be removed after fracture healing.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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