新型骨盆髂嵴外固定结合骶髂螺钉内固定治疗OTA-61C1.3型骨盆骨折
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摘要
[目的]评价新型骨盆髂嵴外固定结合骶髂螺钉内固定治疗OTA-61C1.3型骨盆骨折的临床效果。[方法]回顾分析2015年1月～2016年12月期间收治的35例OTA-61C1.3型骨盆骨折患者。男23例,女12例;年龄21～59岁,平均(38.23±12.28)岁。复位满意后经皮置入骶髂螺钉固定骨盆后环,应用新型骨盆髂嵴外固定稳定骨盆前环。术后影像资料评估外固定Schanz钉置入情况,应用Matta标准评价骨折复位情况,应用Majeed评分评价功能恢复情况。[结果]所有患者均顺利手术,无医源性神经血管损伤,影像检查显示骶髂螺钉及外固定Schanz钉置入精准,后者位于骨内深度在70～135 mm,平均(92.14±18.16) mm。Matta评价标准显示骨盆复位优27例,良6例,可2例,优良率94.29%。35例术后获得12～24个月随访,平均(15.26±4.45)个月。术后6周复查时去除外固定物。所有病例均无钉道感染、螺钉松动、固定失效。术后12个月随访时Majeed评分显示骨盆功能优31例,良3例,可1例,优良率97.14%。[结论]新型骨盆髂嵴外固定技术置钉精准深入,稳定可靠,结合后环经皮骶髂螺钉内固定治疗垂直不稳定型骨折创伤小且疗效确切。
[Objective] To evaluate the clinical results of a novel pelvic iliac crest external fixator combined with iliosacral screw for Orthopaedic Trauma Association type 61 C 1.3(OTA-61 C1.3) pelvic fractures. [Methods] A retrospective study was conducted on 35 patients who underwent surgical treatment for OTA-61 C1.3 pelvic fractures from January, 2015 to December,2016. The patients, including 23 males and 12 females with an average age of(38.23±12.28) years ranged from 21 to 59 years,had fracture fastened with a novel iliac crest pelvic external fixator for the anterior ring, combined with percutaneous iliosacral screw for the posterior ring of the pelvis after satisfactory closed reduction. After operation, the pelvic reduction was evaluated using the Matta criteria, intraosseous depth of the external fixation Schanz pins was measured on the iliac oblique radiographs,and functional recovery was evaluated by the Majeed score. [Results] All the patients had operation performed smoothly without iatrogenic neurovascular injuries. The radiographs revealed all the iliosacral screws and Schanz pins were inserted properly, the latter were 70 to 135 mm deep intraosseously with a mean of(92.14±18.16) mm. The quality of fracture reduction was graded as excellence in 27, good in 6 and fair in 2 patients with excellent and good rate of 94.29% based on Matta criteria. The 35 patients were followed up from 12 to 24 months with an average of(15.26±4.45) months. The external fixators were removed at 6 weeks postoperatively. No pin track infection, screw loosening and implant failure were noticed in anyone of them. At 12 months postoperatively, the clinical consequences were marked as excellent in 31, good in 3 and fair in 1 patient associated with excellent and good rate of 97.14% according to Majeed scores. [Conclusion] This novel external fixator with advantages of accurate pin insertion deep properly and stable fixation, combined with percutaneous iliosacral screw is proved sound clinical outcomes for the vertical instable pelvic fracture.
[Objective] To evaluate the clinical results of a novel pelvic iliac crest external fixator combined with iliosacral screw for Orthopaedic Trauma Association type 61 C 1.3(OTA-61 C1.3) pelvic fractures. [Methods] A retrospective study was conducted on 35 patients who underwent surgical treatment for OTA-61 C1.3 pelvic fractures from January, 2015 to December,2016. The patients, including 23 males and 12 females with an average age of(38.23±12.28) years ranged from 21 to 59 years,had fracture fastened with a novel iliac crest pelvic external fixator for the anterior ring, combined with percutaneous iliosacral screw for the posterior ring of the pelvis after satisfactory closed reduction. After operation, the pelvic reduction was evaluated using the Matta criteria, intraosseous depth of the external fixation Schanz pins was measured on the iliac oblique radiographs,and functional recovery was evaluated by the Majeed score. [Results] All the patients had operation performed smoothly without iatrogenic neurovascular injuries. The radiographs revealed all the iliosacral screws and Schanz pins were inserted properly, the latter were 70 to 135 mm deep intraosseously with a mean of(92.14±18.16) mm. The quality of fracture reduction was graded as excellence in 27, good in 6 and fair in 2 patients with excellent and good rate of 94.29% based on Matta criteria. The 35 patients were followed up from 12 to 24 months with an average of(15.26±4.45) months. The external fixators were removed at 6 weeks postoperatively. No pin track infection, screw loosening and implant failure were noticed in anyone of them. At 12 months postoperatively, the clinical consequences were marked as excellent in 31, good in 3 and fair in 1 patient associated with excellent and good rate of 97.14% according to Majeed scores. [Conclusion] This novel external fixator with advantages of accurate pin insertion deep properly and stable fixation, combined with percutaneous iliosacral screw is proved sound clinical outcomes for the vertical instable pelvic fracture.
引文
[1] Routt ML Jr, Meier MC, Kregor PJ, et al. Percutaneous iliosacral screws with the patient supine technique[J]. Oper Tech Orthop,1993, 3(1):35-45.
[2] Routt ML Jr, Simonian PT. Closed reduction and percutaneous skeletal fixation of saral fractures[J]. Clin Orthop, 1996, 329(329):121-128.
[3] Tucher MC, Nork SE, Simonian PT, et al. Simple anterior pelvic external fixation[J]. J Trauma, 2000, 49:989-994.
[4] Calafi LA, Routt ML. Anterior pelvic external fixation:is there an optimal placement for the supra-acetabular pin[J]. Am J Orthop,2013, 42(1):E125-127.
[5]蔡鸿敏,刘又文,李红军,等.骨盆髂嵴外固定架Schanz钉置钉区域的影像学研究[J].中国骨伤, 2015, 28(7):617-621.
[6] Cai HM, Li HJ, Liu YW, et al. A palpation-based and fluoroscopyindependent percutaneous insertion technique for medullary iliac crest external fixation Schanz pins[J]. Tech Orthop, 2016, 31(1):65-68.
[7] Routt ML Jr, Simonian PT, Grujic L. The retrograde medullary superior pubic ramus screw for the treatment of anterior pelvic ring disruptions:a new technique[J]. J Orthop Trauma, 1995, 9(1):35-44.
[8]石成弟,郭晓山,胡炜,等.经皮空心钉固定治疗创伤性耻骨联合分离[J].中华骨科杂志, 2011, 3l(11):1218-1222.
[9] Cole PA, Gauger EM, Anavian J, et al. Anterior pelvic external fixator versus subcutaneous internal fixatior in the treatment of anterior ring pelvic fractures[J]. J Orthop Trauma, 2012, 26(5):269-277.
[10]祖罡,毕大卫,曹奇勇,等.髂前下棘椎弓根钉棒内固定技术在骨盆骨折中的应用[J].中国骨伤, 2016, 29(4):369-372.
[11]蔡鸿敏,成传德,张俊,等.骨盆轴向CT扫描在平向骶髂螺钉内固定术中的应用[J].中医正骨, 2013, 25(6):34-37.
[12]蔡鸿敏,高书图,成传德,等.基于连续骨盆轴向CT扫描的上骶段分型[J].中国骨伤, 2014, 27(10):866-869.
[13] Hou Z, Zhang Q, Chen W, et al. The application of the axial view projection of the S1 pedicel for iliosacral screw[J]. J Trauma,2010, 69(1):122-127.
[14] Mendel T, Wohlrab D, Radetzki F, et al. The smart screw:a fancy skill for iliosacral screw insertion[J]. J Trauma, 2011, 72:1089-1092.
[15]蔡鸿敏,刘又文,李红军,等. S2骶髂螺钉的置入技术[J].中国骨伤, 2015, 28(10):910-914.
[16] Majeed SA. Grading he outcome of pelvis fractures[J]. J Bone Joint Surg Br, 1989, 71(2):304-306.
[17] Matta JM, Saucedo T. Internal fixation of pelvic ring fractures[J].Clin Orthop, 1989, 242(242):83-97.
[18]胡昊,蔡林,金伟,等.外固定架联合髂腰固定术治疗垂直不稳定型骨盆骨折[J].中华骨科杂志, 2011, 31(1):61-65.
[19]辛景义,马宝通,曹红彬,等.有限切开内固定结合外固定器治疗Tile C型骨盆骨折[J].中华骨科杂志, 2008, 28(7):563-566.
[2] Routt ML Jr, Simonian PT. Closed reduction and percutaneous skeletal fixation of saral fractures[J]. Clin Orthop, 1996, 329(329):121-128.
[3] Tucher MC, Nork SE, Simonian PT, et al. Simple anterior pelvic external fixation[J]. J Trauma, 2000, 49:989-994.
[4] Calafi LA, Routt ML. Anterior pelvic external fixation:is there an optimal placement for the supra-acetabular pin[J]. Am J Orthop,2013, 42(1):E125-127.
[5]蔡鸿敏,刘又文,李红军,等.骨盆髂嵴外固定架Schanz钉置钉区域的影像学研究[J].中国骨伤, 2015, 28(7):617-621.
[6] Cai HM, Li HJ, Liu YW, et al. A palpation-based and fluoroscopyindependent percutaneous insertion technique for medullary iliac crest external fixation Schanz pins[J]. Tech Orthop, 2016, 31(1):65-68.
[7] Routt ML Jr, Simonian PT, Grujic L. The retrograde medullary superior pubic ramus screw for the treatment of anterior pelvic ring disruptions:a new technique[J]. J Orthop Trauma, 1995, 9(1):35-44.
[8]石成弟,郭晓山,胡炜,等.经皮空心钉固定治疗创伤性耻骨联合分离[J].中华骨科杂志, 2011, 3l(11):1218-1222.
[9] Cole PA, Gauger EM, Anavian J, et al. Anterior pelvic external fixator versus subcutaneous internal fixatior in the treatment of anterior ring pelvic fractures[J]. J Orthop Trauma, 2012, 26(5):269-277.
[10]祖罡,毕大卫,曹奇勇,等.髂前下棘椎弓根钉棒内固定技术在骨盆骨折中的应用[J].中国骨伤, 2016, 29(4):369-372.
[11]蔡鸿敏,成传德,张俊,等.骨盆轴向CT扫描在平向骶髂螺钉内固定术中的应用[J].中医正骨, 2013, 25(6):34-37.
[12]蔡鸿敏,高书图,成传德,等.基于连续骨盆轴向CT扫描的上骶段分型[J].中国骨伤, 2014, 27(10):866-869.
[13] Hou Z, Zhang Q, Chen W, et al. The application of the axial view projection of the S1 pedicel for iliosacral screw[J]. J Trauma,2010, 69(1):122-127.
[14] Mendel T, Wohlrab D, Radetzki F, et al. The smart screw:a fancy skill for iliosacral screw insertion[J]. J Trauma, 2011, 72:1089-1092.
[15]蔡鸿敏,刘又文,李红军,等. S2骶髂螺钉的置入技术[J].中国骨伤, 2015, 28(10):910-914.
[16] Majeed SA. Grading he outcome of pelvis fractures[J]. J Bone Joint Surg Br, 1989, 71(2):304-306.
[17] Matta JM, Saucedo T. Internal fixation of pelvic ring fractures[J].Clin Orthop, 1989, 242(242):83-97.
[18]胡昊,蔡林,金伟,等.外固定架联合髂腰固定术治疗垂直不稳定型骨盆骨折[J].中华骨科杂志, 2011, 31(1):61-65.
[19]辛景义,马宝通,曹红彬,等.有限切开内固定结合外固定器治疗Tile C型骨盆骨折[J].中华骨科杂志, 2008, 28(7):563-566.