三种钢板固定在不稳定型骨盆骨折中的临床疗效
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摘要
目的比较骶髂关节前方钢板固定(SAPF)、经皮骶髂螺钉内固定(PSCIF)和骶髂前路蝶形钢板固定(SAPP)三种手术方式在不稳定型骨盆骨折患者中的临床疗效。方法回顾性分析神木市医院2012年1月—2015年12月接受SAPF、PSCIF和SAPP手术的不稳定型骨盆骨折患者各26例,比较各组患者围手术期临床资料,包括手术时间、术中失血量、切口长度、下床活动时间、骨折愈合时间、切口感染率、术中和术后并发症率等,并通过Matta评分比较各组患者术后骨盆损伤复位情况,通过Majeed评分比较各组患者术后骨盆功能恢复情况。结果 PSCIF组患者的平均手术时间(88.8±14.0)min显著少于SAPF组(118.5±20.5)min和SAPP组(106.5±14.2)min,且PSCIF组患者的平均失血量(22.2±6.9)mL显著少于SAPF组(684.9±144.5)mL和SAPP组(570.8±127.5)mL,差异有统计学意义(P<0.05)。三组手术方式的Tile B型患者的手术时间和失血量均显著低于Tile C型患者,差异有统计学意义(P<0.05)。PSCIF组患者的平均手术切口长度(19.4±3.7)cm显著短于SAPP组(139.2±10.9)cm和SAPF组(124.6±8.3)cm(P<0.05);PSCIF组患者的平均住院天数(9.3±2.0)d也显著少于SAPF组(16.7±3.9)d和SAPP组(15.4±1.8)d(P<0.05);术后3dPSCIF组和SAPP组患者Matta评分优良率(96.1%、88.5%)分别高于SAPF组(65.4%)(P<0.05);PSCIF组患者的术后Majeed评分优良率(92.3%)显著高于SAPF组(65.4%)(P<0.05),但SAPF组与SAPP组的Majeed评分优良率差异无统计学意义。三组患者术中和术后并发症发生情况差异无统计学意义。结论与SAPP和SAPF术式相比,PSCIF更适合于不稳定型骨盆骨折患者。此外,SAPP对不稳定型骨盆骨折的手术疗效和术后恢复情况优于SAPF术式。
Objective To compare the clinical effects of sacroiliac anterior plate fixation(SAPF),percutaneous sacroiliac screw internal fixation(PSCIF) and sacroiliac anterior papilionaceous plate(SAPP) in patients with unstable pelvic fractures. Methods Patients with unstable pelvic fractures who underwent SAPF,PSCIF or SAPP surgery from Jan. 2012 to Dec. 2015 in Shenmu Hospital were retrospectively enrolled,with 26 cases for each group. The perioperative clinical data of each group were compared,including operation time,intraoperative blood loss,the incision length,the time of getting out of bed,the time of fracture healing,the incision infection rate,the intraoperative and postoperative complications. Reduction condition of pelvic injury in each group was compared by Matta score,and the postoperative pelvic function recovery were compared by Majeed score. Results The mean operative time in PSCIF group([88.8±14.0]min) was significantly less than in SAPF group([118.5±20.5]min) and SAPP group([106.5±14.2] min),and the mean blood loss in the PSCIF group([22.2±6.9]mL)was significantly lower than in SAPF group([684.9±144.5 ]mL) and SAPP group([570.8±127.5]mL),all with significant differences(P<0.05). The operation time and blood loss of patients with Tile B in the three groups were significantly lower than those of Tile C,with significant differences(P<0.05). The mean surgical incision length in PSCIF group([19.4 ± 3.7]cm) was significantly less than in SAPP group([139.2 ± 10.9 ]cm) and SAPF group([124.6 ± 8.3 ]cm)(P<0.05); the average length of hospital stay in the PSCIF group [(9.3 ±2.0) d] was also significantly shorter than in SAPF group([16.7±3.9 ]d) and SAPP group([15.4±1.8) d],P<0.05; the excellent and good rate of Matta score 3 days after operation in PSCIF group(96.1%) and SAPP group(88.5%) was higher than SAPF group(65.4%)(P<0.05). The excellent and good rate of postoperative Majeed score in PSCIF group(92.3%) was significantly higher than in SAPF group(65.4%)(P<0.05),but there was no significant difference between SAPF group and SAPP group. There were no significant differences in intraoperative and postoperative complications among the three groups. Conclusion Compared with the SAPP and SAPF procedures,PSCIF is more suitable for patients with unstable pelvic fractures. In addition,the surgical outcome and postoperative recovery of the unstable pelvic fractures of the SAPP procedure is superior to the SAPF procedure.
Objective To compare the clinical effects of sacroiliac anterior plate fixation(SAPF),percutaneous sacroiliac screw internal fixation(PSCIF) and sacroiliac anterior papilionaceous plate(SAPP) in patients with unstable pelvic fractures. Methods Patients with unstable pelvic fractures who underwent SAPF,PSCIF or SAPP surgery from Jan. 2012 to Dec. 2015 in Shenmu Hospital were retrospectively enrolled,with 26 cases for each group. The perioperative clinical data of each group were compared,including operation time,intraoperative blood loss,the incision length,the time of getting out of bed,the time of fracture healing,the incision infection rate,the intraoperative and postoperative complications. Reduction condition of pelvic injury in each group was compared by Matta score,and the postoperative pelvic function recovery were compared by Majeed score. Results The mean operative time in PSCIF group([88.8±14.0]min) was significantly less than in SAPF group([118.5±20.5]min) and SAPP group([106.5±14.2] min),and the mean blood loss in the PSCIF group([22.2±6.9]mL)was significantly lower than in SAPF group([684.9±144.5 ]mL) and SAPP group([570.8±127.5]mL),all with significant differences(P<0.05). The operation time and blood loss of patients with Tile B in the three groups were significantly lower than those of Tile C,with significant differences(P<0.05). The mean surgical incision length in PSCIF group([19.4 ± 3.7]cm) was significantly less than in SAPP group([139.2 ± 10.9 ]cm) and SAPF group([124.6 ± 8.3 ]cm)(P<0.05); the average length of hospital stay in the PSCIF group [(9.3 ±2.0) d] was also significantly shorter than in SAPF group([16.7±3.9 ]d) and SAPP group([15.4±1.8) d],P<0.05; the excellent and good rate of Matta score 3 days after operation in PSCIF group(96.1%) and SAPP group(88.5%) was higher than SAPF group(65.4%)(P<0.05). The excellent and good rate of postoperative Majeed score in PSCIF group(92.3%) was significantly higher than in SAPF group(65.4%)(P<0.05),but there was no significant difference between SAPF group and SAPP group. There were no significant differences in intraoperative and postoperative complications among the three groups. Conclusion Compared with the SAPP and SAPF procedures,PSCIF is more suitable for patients with unstable pelvic fractures. In addition,the surgical outcome and postoperative recovery of the unstable pelvic fractures of the SAPP procedure is superior to the SAPF procedure.
引文
[1] Scheyerer MJ,Zimmermann SM,Osterhoff G,et al.Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures[J].BMC Res Notes,2014,7(1):1-10.
[2] Kanezaki S,Miyazaki M,Notani N,et al.Clinical presentation of geriatric polytrauma patients with severe pelvic fractures:comparison with younger adult patients[J].Eur J Orthop Surg Traumatol,2016,26(8):885-890.
[3] 杨庆,蒋凯,陶星光,等.骨盆骨折合并损伤临床特点的分析[J].中国临床医生杂志,2017,45(1):66-68.
[4] Zhao JX,Zhao Z,Zhang LC,et al.A computer aided measurement method for unstable pelvic fractures based on standardized radiographs[J].BMC Med Imaging,2015,15(1):41.
[5] 张淼,肖玉周,陈笑天.骶髂关节损伤的治疗进展[J].安徽医药,2018,22(1):24-28.
[6] 蔺广生.经皮骶髂螺钉和骶髂关节前路钢板内固定治疗不稳定骨盆骨折的临床疗效比较[J].创伤外科杂志,2016,18(9):526-529.
[7] 李朋,杜传林.骶髂关节损伤治疗中骶髂前路蝶形钢板和传统重建钢板应用比较研究[J].临床医药文献电子杂志,2016,3(28):5627.
[8] Tile M.Acute pelvic fractures:I.causation and classification[J].J Am Acad Orthop Surg,1996,4(3):143-151.
[9] Matta JM,Rd TP.Internal fixation of unstable pelvic ring injuries[J].Clin Orthop Relat Res,1996,329(329):129-140.
[10] Majeed SA.Grading the outcome of pelvic fractures[J].J Bone Joint Surg Br,1989,71(2):304-306.
[11] 张伟,宋世锋,刘立柱,等.髂嵴-耻骨联合置钉外固定支架治疗不稳定型骨盆骨折[J].中华创伤骨科杂志,2016,18(2):163-165.
[12] 朱宏斌,高宗保,雷志刚,等.内外联合固定治疗不稳定性骨盆骨折[J].创伤外科杂志,2016,18(12):732-734.
[13] Heydemann J,Hartline B,Gibson ME,et al.Do transsacral-transiliac screws across uninjured sacroiliac joints affect pain and functional outcomes in trauma patients[J].Clin Orthop Relat Res,2016,474(6):1417-1421.
[14] Choy WS,Kim KJ,Sang KL,et al.Anterior pelvic plating and sacroiliac joint fixation in unstable pelvic ring injuries[J].Yonsei Med J,2012,53(2):422-426.
[15] Li CL.Clinical comparative analysis on unstable pelvic fractures in the treatment with percutaneous sacroiliac screws and sacroiliac joint anterior plate fixation[J].Eur Rev Med Pharmacol Sci,2014,18(18):2704-2708.
[16] Zhou KH,Luo CF,Chen N,et al.Minimally invasive surgery under fluoro-navigation for anterior pelvic ring fractures[J].Indian J Orthop,2016,50(3):250-255.
[17] 高益斌,童松林,刘观燚.微创重建锁定钢板内固定在骨盆后环损伤中的应用[J].中国骨与关节损伤杂志,2016,31(2):176-177.
[18] Miller AN,Routt ML Jr.Variations in sacral morphology and implications for iliosacral screw fixation[J].J Am Acad Orthop Surg,2012,20(1):8-16.
[19] 王国栋,周东生,谭国庆,等.骶髂前路蝶形钢板与传统重建钢板治疗骶髂关节损伤的比较研究[J].中华骨科杂志,2013,33(5):541-548.
[20] Morris SA,Loveridge J,Smart DK,et al.Is fixation failure after plate fixation of the symphysis pubis clinically important?[J].Clin Orthop Related Res,2012,470(8):2154-2160.
[21] Osterhoff G,Ossendorf C,Wanner GA,et al.Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries:technique and perioperative complications[J].Arch Orthop Trauma Surg,2011,131(6):809-813.
[22] Riehl J,Widmaier J.A simulator model for sacroiliac screw placement[J].J Surg Educ,2012,69(3):282-285.
[2] Kanezaki S,Miyazaki M,Notani N,et al.Clinical presentation of geriatric polytrauma patients with severe pelvic fractures:comparison with younger adult patients[J].Eur J Orthop Surg Traumatol,2016,26(8):885-890.
[3] 杨庆,蒋凯,陶星光,等.骨盆骨折合并损伤临床特点的分析[J].中国临床医生杂志,2017,45(1):66-68.
[4] Zhao JX,Zhao Z,Zhang LC,et al.A computer aided measurement method for unstable pelvic fractures based on standardized radiographs[J].BMC Med Imaging,2015,15(1):41.
[5] 张淼,肖玉周,陈笑天.骶髂关节损伤的治疗进展[J].安徽医药,2018,22(1):24-28.
[6] 蔺广生.经皮骶髂螺钉和骶髂关节前路钢板内固定治疗不稳定骨盆骨折的临床疗效比较[J].创伤外科杂志,2016,18(9):526-529.
[7] 李朋,杜传林.骶髂关节损伤治疗中骶髂前路蝶形钢板和传统重建钢板应用比较研究[J].临床医药文献电子杂志,2016,3(28):5627.
[8] Tile M.Acute pelvic fractures:I.causation and classification[J].J Am Acad Orthop Surg,1996,4(3):143-151.
[9] Matta JM,Rd TP.Internal fixation of unstable pelvic ring injuries[J].Clin Orthop Relat Res,1996,329(329):129-140.
[10] Majeed SA.Grading the outcome of pelvic fractures[J].J Bone Joint Surg Br,1989,71(2):304-306.
[11] 张伟,宋世锋,刘立柱,等.髂嵴-耻骨联合置钉外固定支架治疗不稳定型骨盆骨折[J].中华创伤骨科杂志,2016,18(2):163-165.
[12] 朱宏斌,高宗保,雷志刚,等.内外联合固定治疗不稳定性骨盆骨折[J].创伤外科杂志,2016,18(12):732-734.
[13] Heydemann J,Hartline B,Gibson ME,et al.Do transsacral-transiliac screws across uninjured sacroiliac joints affect pain and functional outcomes in trauma patients[J].Clin Orthop Relat Res,2016,474(6):1417-1421.
[14] Choy WS,Kim KJ,Sang KL,et al.Anterior pelvic plating and sacroiliac joint fixation in unstable pelvic ring injuries[J].Yonsei Med J,2012,53(2):422-426.
[15] Li CL.Clinical comparative analysis on unstable pelvic fractures in the treatment with percutaneous sacroiliac screws and sacroiliac joint anterior plate fixation[J].Eur Rev Med Pharmacol Sci,2014,18(18):2704-2708.
[16] Zhou KH,Luo CF,Chen N,et al.Minimally invasive surgery under fluoro-navigation for anterior pelvic ring fractures[J].Indian J Orthop,2016,50(3):250-255.
[17] 高益斌,童松林,刘观燚.微创重建锁定钢板内固定在骨盆后环损伤中的应用[J].中国骨与关节损伤杂志,2016,31(2):176-177.
[18] Miller AN,Routt ML Jr.Variations in sacral morphology and implications for iliosacral screw fixation[J].J Am Acad Orthop Surg,2012,20(1):8-16.
[19] 王国栋,周东生,谭国庆,等.骶髂前路蝶形钢板与传统重建钢板治疗骶髂关节损伤的比较研究[J].中华骨科杂志,2013,33(5):541-548.
[20] Morris SA,Loveridge J,Smart DK,et al.Is fixation failure after plate fixation of the symphysis pubis clinically important?[J].Clin Orthop Related Res,2012,470(8):2154-2160.
[21] Osterhoff G,Ossendorf C,Wanner GA,et al.Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries:technique and perioperative complications[J].Arch Orthop Trauma Surg,2011,131(6):809-813.
[22] Riehl J,Widmaier J.A simulator model for sacroiliac screw placement[J].J Surg Educ,2012,69(3):282-285.