微创技术在骨盆脆性骨折中的初步研究
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摘要
目的评估微创技术治疗骨盆脆性骨折(fragile fracture of pelvis,FFP)的临床疗效,评价FFP分型系统在FFP治疗中的指导意义。方法 2015年1月至2018年1月我院采用微创技术治疗FFP 26例,按照FFP分型系统分为FFP II型20例,FFP III型6例。统计术前有无神经损伤、术前疼痛视觉模拟评分(visualanalogue scale,VAS)、术中出血量、手术时间、手术方法。根据Matta放射评定标准评估骨折复位情况。统计术后并发症发生率、骨折愈合时间,末次随访时采用Majeed评分标准进行功能评定。结果 26例获平均10(6～12)个月随访,术前VAS评分为7分,其中骨盆后环采用经皮骶髂螺钉固定23例,背侧内支架系统固定3例,前环采用经皮耻骨上支螺钉固定18例,腹侧内支架(INFIX系统)固定8例。术中出血量平均为66(40～150) ml,平均手术时间为75 (50～105) min。根据Matta放射评定标准骨折复位优良率为85%,26例骨折均顺利愈合,骨折愈合时间为14 (12～18)周。末次随访时采用Majeed骨盆骨折评分标准进行功能评定优良率为80%,共6例术后出现并发症,并发症发生率为23.1%,其中2例股外侧皮神经损伤,1例支架螺钉退钉,2例压疮,1例泌尿系统感染,无重要血管损伤,无深部感染。结论 FFP分型系统对指导FFP的治疗有重要的临床意义,采用微创技术治疗FFP创伤小,术后恢复快,值得临床推广。
Objective To explore the clinical efficacy of minimally invasive technique in the treatment of pelvic fragile fracture, and to evaluate the guiding significance of FFP classification system in the treatment of pelvic fragile fracture. Methods From January 2015 to January 2018, 26 cases of pelvic fragile fracture were treated with minimally invasive technique. FFP classification system was used in 20 cases of type II and 6 cases of type III.Preoperative VAS score, intraoperative blood loss, operation time, operation method and reduction of fracture were recorded. Fracture reduction, complications and fractures were evaluated according to Matta radiological evaluation criteria. The healing time was assessed by Majeed score at the last follow-up. Results All 26 patients were followed up for an average of 10 months( range: 6-12 months). The preoperative VAS score was 7. Among them, 23 cases were fixed with percutaneous sacroiliac screw, 3 cases were fixed with dorsal internal stent system, 18 cases were fixed with percutaneous suprapubic branch screw and 8 cases were fixed with ventral internal stent( INFIX system). The average amount of bleeding during operation was 66 ml( range: 40-150 ml), and the average operation time was 75 minutes( range: 50-105 minutes). The excellent and good rate of reduction was 85% according to Matta radiometric criteria.All 26 cases of fracture healed smoothly. The excellent and good rate of fracture healing was 80% according to Majeed score at the last follow-up of 14 weeks( range: 12-18 weeks). There were 2 cases of lateral femoral cutaneous nerve injury, 1 case of stent screw retraction, 2 cases of pressure ulcer, 1 case of urinary tract infection, the incidence of complications was 23.1%. There were no major vascular injury or deep infection. Conclusions FFP classification system has important clinical significance in guiding the treatment of pelvic fragile fracture with small trauma and quick recovery. It is worthy of clinical promotion.
Objective To explore the clinical efficacy of minimally invasive technique in the treatment of pelvic fragile fracture, and to evaluate the guiding significance of FFP classification system in the treatment of pelvic fragile fracture. Methods From January 2015 to January 2018, 26 cases of pelvic fragile fracture were treated with minimally invasive technique. FFP classification system was used in 20 cases of type II and 6 cases of type III.Preoperative VAS score, intraoperative blood loss, operation time, operation method and reduction of fracture were recorded. Fracture reduction, complications and fractures were evaluated according to Matta radiological evaluation criteria. The healing time was assessed by Majeed score at the last follow-up. Results All 26 patients were followed up for an average of 10 months( range: 6-12 months). The preoperative VAS score was 7. Among them, 23 cases were fixed with percutaneous sacroiliac screw, 3 cases were fixed with dorsal internal stent system, 18 cases were fixed with percutaneous suprapubic branch screw and 8 cases were fixed with ventral internal stent( INFIX system). The average amount of bleeding during operation was 66 ml( range: 40-150 ml), and the average operation time was 75 minutes( range: 50-105 minutes). The excellent and good rate of reduction was 85% according to Matta radiometric criteria.All 26 cases of fracture healed smoothly. The excellent and good rate of fracture healing was 80% according to Majeed score at the last follow-up of 14 weeks( range: 12-18 weeks). There were 2 cases of lateral femoral cutaneous nerve injury, 1 case of stent screw retraction, 2 cases of pressure ulcer, 1 case of urinary tract infection, the incidence of complications was 23.1%. There were no major vascular injury or deep infection. Conclusions FFP classification system has important clinical significance in guiding the treatment of pelvic fragile fracture with small trauma and quick recovery. It is worthy of clinical promotion.
引文
[1]王颢,吴新宝.老年骨质疏松性骨盆骨折(一)--流行病学、病因学、诊断与临床分型[J].中华创伤骨科杂志,2017,(11):1007-1012.
[2]Rommens PM,Hofmann A.Comprehensive classification of fragility fractures of the pelvic ring:Recommendations for surgical treatment[J].Injury,2013,44(12):1733-1744.
[3]Wagner D,Hofmann A,Kamer L,et al.Fragility fractures of the sacrum occur in elderly patients with severe loss of sacral bone mass[J].Arch Orthop Trauma Surg,2018,138(7):971-977.
[4]Rollmann MF,Herath SC,Kirchhoff F,et al.Pelvic ring fractures in the elderly now and then-a pelvic registry study[J].Arch Gerontol Geriatr,2017,71:83-88.
[5]Tamaki Y,Nagamachi A,Inoue K,et al.Incidence and clinical features of sacral insufficiency fracture in the emergency department[J].Am J Emerg Med,2017,35(9):1314-1316.
[6]Lau TW,Leung F.Occult posterior pelvic ring fractures in elderly patients with osteoporotic pubic rami fractures[J].J Orthop Surg(Hong Kong),2010,18(2):153-157.
[7]Finiels H,Finiels PJ,Jacquot JM,et al.Fractures of the sacrum caused by bone insufficiency.Meta-analysis of 508 cases[J].Presse Med,1997,26(33):1568-1573.
[8]Soubrier M,Dubost JJ,Boisgard S,et al.Insufficiency fracture.A survey of 60 cases and review of the literature[J].Joint Bone Spine,2003,70(3):209-218.
[9]Arduini M,Saturnino L,Piperno A,et al.Fragility fractures of the pelvis:treatment and preliminary results[J].Aging Clin Exp Res,2015,27(Suppl 1):S61-67.
[10]Rommens PM,Ossendorf C,Pairon P,et al.Clinical pathways for fragility fractures of the pelvic ring:personal experience and review of the literature[J].J Orthop Sci,2015,20(1):1-11.
[11]Rommens PM,Wagner D,Hofmann A.Fragility fractures of the pelvis[J].JBJS Rev,2017,5(3):1.
[12]Dechert TA,Duane TM,Frykberg BP,et al.Elderly patients with pelvic fracture:interventions and outcomes[J].Am Surg,2009,75(4):291-295.
[13]Whitlow CT,Yazdani SK,Reedy ML,et al.Investigating sacroplasty:technical considerations and finite element analysis of polymethylmethacrylate infusion into cadaveric sacrum[J].AJNR Am J Neuroradiol,2007,28(6):1036-1041.
[14]Collinge CA,Crist BD.Combined percutaneous iliosacral screw fixation with sacroplasty using resorbable calcium phosphate cement for osteoporotic pelvic fractures requiring surgery[J].J Orthop Trauma,2016,30(6):e217-222.
[15]O’Connor TJ,Cole PA.Pelvic insufficiency fractures[J].Geriatr Orthop Surg Rehabil,2014,5(4):178-190.
[2]Rommens PM,Hofmann A.Comprehensive classification of fragility fractures of the pelvic ring:Recommendations for surgical treatment[J].Injury,2013,44(12):1733-1744.
[3]Wagner D,Hofmann A,Kamer L,et al.Fragility fractures of the sacrum occur in elderly patients with severe loss of sacral bone mass[J].Arch Orthop Trauma Surg,2018,138(7):971-977.
[4]Rollmann MF,Herath SC,Kirchhoff F,et al.Pelvic ring fractures in the elderly now and then-a pelvic registry study[J].Arch Gerontol Geriatr,2017,71:83-88.
[5]Tamaki Y,Nagamachi A,Inoue K,et al.Incidence and clinical features of sacral insufficiency fracture in the emergency department[J].Am J Emerg Med,2017,35(9):1314-1316.
[6]Lau TW,Leung F.Occult posterior pelvic ring fractures in elderly patients with osteoporotic pubic rami fractures[J].J Orthop Surg(Hong Kong),2010,18(2):153-157.
[7]Finiels H,Finiels PJ,Jacquot JM,et al.Fractures of the sacrum caused by bone insufficiency.Meta-analysis of 508 cases[J].Presse Med,1997,26(33):1568-1573.
[8]Soubrier M,Dubost JJ,Boisgard S,et al.Insufficiency fracture.A survey of 60 cases and review of the literature[J].Joint Bone Spine,2003,70(3):209-218.
[9]Arduini M,Saturnino L,Piperno A,et al.Fragility fractures of the pelvis:treatment and preliminary results[J].Aging Clin Exp Res,2015,27(Suppl 1):S61-67.
[10]Rommens PM,Ossendorf C,Pairon P,et al.Clinical pathways for fragility fractures of the pelvic ring:personal experience and review of the literature[J].J Orthop Sci,2015,20(1):1-11.
[11]Rommens PM,Wagner D,Hofmann A.Fragility fractures of the pelvis[J].JBJS Rev,2017,5(3):1.
[12]Dechert TA,Duane TM,Frykberg BP,et al.Elderly patients with pelvic fracture:interventions and outcomes[J].Am Surg,2009,75(4):291-295.
[13]Whitlow CT,Yazdani SK,Reedy ML,et al.Investigating sacroplasty:technical considerations and finite element analysis of polymethylmethacrylate infusion into cadaveric sacrum[J].AJNR Am J Neuroradiol,2007,28(6):1036-1041.
[14]Collinge CA,Crist BD.Combined percutaneous iliosacral screw fixation with sacroplasty using resorbable calcium phosphate cement for osteoporotic pelvic fractures requiring surgery[J].J Orthop Trauma,2016,30(6):e217-222.
[15]O’Connor TJ,Cole PA.Pelvic insufficiency fractures[J].Geriatr Orthop Surg Rehabil,2014,5(4):178-190.