两种钉棒系统固定方式治疗骨盆前环损伤的疗效比较
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摘要
目的比较钉棒系统改良3钉和常规2钉固定治疗骨盆前环损伤的临床疗效。方法复旦大学附属中山医院青浦分院骨科2016年3月—2017年12月收治骨盆前环损伤患者48例,均为Tile B型骨盆骨折,按不同固定方式分为两组,分别行改良3钉(24例)和常规2钉固定(24例)。比较两组手术时间、术中出血量、住院时间、术后并发症,术后2、3个月和末次随访的Majeed功能评分情况。结果患者获得6～13个月随访,平均9.2个月。改良3钉组手术时间为(53.9±10.3)min,术中出血量为(33.6±8.5)mL,均多于常规2钉组(P<0.01),但两组住院时间和术后并发症比较差异无统计学意义(P>0.05)。改良3钉组术后2个月的Majeed评分为(75.3±9.3)分,术后3个月的Majeed评分为(80.5±10.4)分,均优于常规2钉组(P<0.05)。改良3钉组末次随访Majeed评分为(82.8±8.6)分,与常规2钉组比较差异无统计学意义(P>0.05)。结论改良3钉和常规2钉固定均是治疗Tile B型骨盆骨折的有效方法。改良3钉固定稳定性更好,可以更早期促进骨盆功能康复。
Objective To compare the clinical outcomes of modified three-screw-placement and two-screw-placement for Tile type B anterior pelvic ring injuries. Methods Forty-eight patients with Tile type B pelvic fractures,who were treated in Department of Orthopaedics,Qingpu Branch of Zhongshan Hospital,Fudan University from Mar.2016 to Dec.2017,were divided into modified three-screw-placement(24 cases) group and two-screw-placement group(24 cases) according to the fixation method. The operation time,intraoperative blood loss,hospital stays,postoperative complications,and Majeed scores at postoperative 2 months,3 months and the last follow-up were compared. Results All cases were followed up for 6 to 13(9.2 on average) months. The operation time and intraoperative blood loss of the modified three-screw-placement group were(53.9±10.3) min and(33.6±8.5) mL,respectively,which were more than those of the two-screw-placement group(P<0.01). There was no significant difference in hospital stays and postoperative complications(P>0.05). Majeed scores at postoperative 2 months and 3 months of the modified three-screw-placement group were(75.3±9.3) points and(80.5±10.4) points,which were higher than those of the two-screw-placement group(P<0.05). While there was no significant difference in Majeed scores at the last follow up(82.8±8.6 vs. 81.7±9.3,P>0.05). Conclusion Modified three-screw-placement and two-screw-placement are both effective treatments for Tile type B pelvic fractures. Modified three-screw-placement has better stability,and can promote pelvic functional rehabilitation earlier.
Objective To compare the clinical outcomes of modified three-screw-placement and two-screw-placement for Tile type B anterior pelvic ring injuries. Methods Forty-eight patients with Tile type B pelvic fractures,who were treated in Department of Orthopaedics,Qingpu Branch of Zhongshan Hospital,Fudan University from Mar.2016 to Dec.2017,were divided into modified three-screw-placement(24 cases) group and two-screw-placement group(24 cases) according to the fixation method. The operation time,intraoperative blood loss,hospital stays,postoperative complications,and Majeed scores at postoperative 2 months,3 months and the last follow-up were compared. Results All cases were followed up for 6 to 13(9.2 on average) months. The operation time and intraoperative blood loss of the modified three-screw-placement group were(53.9±10.3) min and(33.6±8.5) mL,respectively,which were more than those of the two-screw-placement group(P<0.01). There was no significant difference in hospital stays and postoperative complications(P>0.05). Majeed scores at postoperative 2 months and 3 months of the modified three-screw-placement group were(75.3±9.3) points and(80.5±10.4) points,which were higher than those of the two-screw-placement group(P<0.05). While there was no significant difference in Majeed scores at the last follow up(82.8±8.6 vs. 81.7±9.3,P>0.05). Conclusion Modified three-screw-placement and two-screw-placement are both effective treatments for Tile type B pelvic fractures. Modified three-screw-placement has better stability,and can promote pelvic functional rehabilitation earlier.
引文
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[7] Vaidya R,Oliphant B,Jain R,et al.The bikini area and bikini line as a location for anterior subcutaneous pelvic fixation: an anatomic and clinical investigation[J].Clin Anat,2013,26(3):392-399.
[8] Fang C,Alabdulrahman H,Pape H.Complications after percutaneous internal fixator for anterior pelvic ring injuries[J].Int Orthop,2017,41(9):1785-1790.
[9] Osterhoff G,Aichner EV,Scherer J,et al.Anterior subcutaneous internal fixation of the pelvis-what rod-to-bone distance is anatomically optimal[J].Injury,2017,48(10):2162-2168.
[10] Bi C,Wang Q,Wu J,et al.Modified pedicle screw-rod fixation versus anterior pelvic external fixation for the management of anterior pelvic ring fractures: a comparative study[J].J Orthop Surg Res,2017,12(1):185.
[11] Cole PA,Gauger EM,Anavian J,et al.Anterior pelvic external fixator versus subcutaneous internal fixator in the treatment of anterior ring pelvic fractures[J].J Orthop Trauma,2012,26(5):269-277.
[12] Wu X,Liu Z,Fu W,et al.Modified pedicle screw-rod fixation as a minimally invasive treatment for anterior pelvic ring injuries: an initial case series[J].J Orthop Surg Res,2017,12(1):84.
[13] Wang Q,Wang Q,Wang J.Treatment of type B pelvic fracture using anterior subcutaneous internal fixator with triple pedicle screws: a new surgical technique[J].Arch Orthop Trauma Surg,2017,137(7):887-893.
[14] 李斯铭,王冬梅,曲爱丽,等.钉棒内固定Tile B2型骨盆骨折的生物力学效果[J].医用生物力学,2016,31(3):240-246.
[15] Reichel LM,MacCormick LM,Dugarte AJ,et al.Minimally invasive anterior pelvic internal fixation: an anatomic study comparing Pelvic Bridge to INFIX[J].Injury,2018,49(2):309-314.
[16] Vaidya R,Martin AJ,Roth M,et al.Midterm radiographic and functional outcomes of the anterior subcutaneous internal pelvic fixator (INFIX) for pelvic ring injuries[J].J Orthop Trauma,2017,31(5):252-259.
[2] Tile M.Pelvic ring fractures: should they be fixed[J].J Bone Joint Surg(Br),1988,70(1):1-12.
[3] Majeed SA.Grading the outcome of pelvic fractures[J].J Bone Joint Surg(Br),1989,71(2):304-306.
[4] Bi C,Wang Q,Nagelli C,et al.Treatment of unstable posterior pelvic ring fracture with pedicle screw-rod fixator versus locking compression plate: a comparative study[J].Med Sci Monit,2016,22:3764-3770.
[5] Kuttner M,Klaiber A,Lorenz T,et al.The pelvic subcutaneous cross-over internal fixator[J].Unfallchirurg,2009,112(7):661-669.
[6] Merriman DJ,Ricci WM,McAndrew CM,et al.Is application of an internal anterior pelvic fixator anatomically feasible[J].Clin Orthop Relat Res,2012,470(8):2111-2115.
[7] Vaidya R,Oliphant B,Jain R,et al.The bikini area and bikini line as a location for anterior subcutaneous pelvic fixation: an anatomic and clinical investigation[J].Clin Anat,2013,26(3):392-399.
[8] Fang C,Alabdulrahman H,Pape H.Complications after percutaneous internal fixator for anterior pelvic ring injuries[J].Int Orthop,2017,41(9):1785-1790.
[9] Osterhoff G,Aichner EV,Scherer J,et al.Anterior subcutaneous internal fixation of the pelvis-what rod-to-bone distance is anatomically optimal[J].Injury,2017,48(10):2162-2168.
[10] Bi C,Wang Q,Wu J,et al.Modified pedicle screw-rod fixation versus anterior pelvic external fixation for the management of anterior pelvic ring fractures: a comparative study[J].J Orthop Surg Res,2017,12(1):185.
[11] Cole PA,Gauger EM,Anavian J,et al.Anterior pelvic external fixator versus subcutaneous internal fixator in the treatment of anterior ring pelvic fractures[J].J Orthop Trauma,2012,26(5):269-277.
[12] Wu X,Liu Z,Fu W,et al.Modified pedicle screw-rod fixation as a minimally invasive treatment for anterior pelvic ring injuries: an initial case series[J].J Orthop Surg Res,2017,12(1):84.
[13] Wang Q,Wang Q,Wang J.Treatment of type B pelvic fracture using anterior subcutaneous internal fixator with triple pedicle screws: a new surgical technique[J].Arch Orthop Trauma Surg,2017,137(7):887-893.
[14] 李斯铭,王冬梅,曲爱丽,等.钉棒内固定Tile B2型骨盆骨折的生物力学效果[J].医用生物力学,2016,31(3):240-246.
[15] Reichel LM,MacCormick LM,Dugarte AJ,et al.Minimally invasive anterior pelvic internal fixation: an anatomic study comparing Pelvic Bridge to INFIX[J].Injury,2018,49(2):309-314.
[16] Vaidya R,Martin AJ,Roth M,et al.Midterm radiographic and functional outcomes of the anterior subcutaneous internal pelvic fixator (INFIX) for pelvic ring injuries[J].J Orthop Trauma,2017,31(5):252-259.