INFIX置钉入路的改良研究及其在骨盆骨折治疗中的应用
|
摘要
目的探讨将INFIX置钉入路内移至缝匠肌与髂腰肌间隙的可行性,并评估其临床疗效和并发症。方法在大体标本上测量缝匠肌内、外缘至股外侧皮神经和股神经的距离,用t检验比较各组间的差异性。收集南方医科大学珠江医院从2016年8月～2018年12月应用INFIX技术治疗的骨盆骨折14例,从骨盆畸形指数、耻骨联合宽度、术后负重时间、内固定取出时间及Majeed评分等方面评估临床疗效,分析有无股外侧皮神经损伤、股神经损伤等并发症。结果缝匠肌内缘比外缘至股外侧皮神经的距离增加了7.71mm(P<0.01),而至股神经的距离仍有22.36 mm。INFIX术后骨盆畸形指数减少了1.82%(P<0.01),耻骨联合宽度缩小了6.98 mm(P<0.05),平均12.70周负重,29.50周取出内固定,Majeed评分90.80分。术后无股外侧皮神经和股神经损伤,2例出现切口感染,1例有主观不适感。结论 INFIX置钉入路内移至缝匠肌与髂腰肌间隙可减少股外侧皮神经的损伤风险,且不干扰股神经,对于骨盆前环骨折具有微创、疗效好、并发症少等优势。
Objective To explore the feasibility of INFIX nailing into the space between sartorius and iliopsoas muscle, and to evaluate its clinical efficacy and complications. Methods The distance from the medial and lateral margins of sartorius to the lateral femoral cutaneous nerve and femoral nerve were measured on gross specimens, and the differences among groups were compared with t-test. Then, the clinical data of 14 pelvic fracture patients treated with INFIX were collected from Zhujiang Hospital of Southern Medical University from August 2016 to December 2018. Evaluation of clinical efficacy depended on the pelvic deformity index(PDI) and the width of pubic symphysis, as well as the weighting time, the time to remove internal fixation and the Majeed score after INFIX. Complications included the injury to lateral femoral cutaneous nerve(LFCN), the injury to femoral nerve, and so on. Results Compared to the lateral margin of sartorius, the distance from medial margin to LFCN increased 7.71 mm(P<0.01), and to the femoral nerve still remained 22.36 mm. After INFIX, the PDI decreased 1.82%(P<0.01), the width of pubic symphysis decreased 6.98 mm(P<0.05), the average weighting time was 12.70 week, the time to remove internal fixation was 29.50 week, and the Majeed score was 90.80. There was no injury of LFCN and the femoral nerve, 2patients had incisional infection, and 1 patient had subjective discomfort. Conclusion The INFIX nailing into the space between sartorius and iliopsoas muscle can reduce the risk of injury to LFCN, and does not interfere with the femoral nerve. It has several advantages for anterior pelvic ring fracture including minimal invasion, good curative effect, and few complications.
Objective To explore the feasibility of INFIX nailing into the space between sartorius and iliopsoas muscle, and to evaluate its clinical efficacy and complications. Methods The distance from the medial and lateral margins of sartorius to the lateral femoral cutaneous nerve and femoral nerve were measured on gross specimens, and the differences among groups were compared with t-test. Then, the clinical data of 14 pelvic fracture patients treated with INFIX were collected from Zhujiang Hospital of Southern Medical University from August 2016 to December 2018. Evaluation of clinical efficacy depended on the pelvic deformity index(PDI) and the width of pubic symphysis, as well as the weighting time, the time to remove internal fixation and the Majeed score after INFIX. Complications included the injury to lateral femoral cutaneous nerve(LFCN), the injury to femoral nerve, and so on. Results Compared to the lateral margin of sartorius, the distance from medial margin to LFCN increased 7.71 mm(P<0.01), and to the femoral nerve still remained 22.36 mm. After INFIX, the PDI decreased 1.82%(P<0.01), the width of pubic symphysis decreased 6.98 mm(P<0.05), the average weighting time was 12.70 week, the time to remove internal fixation was 29.50 week, and the Majeed score was 90.80. There was no injury of LFCN and the femoral nerve, 2patients had incisional infection, and 1 patient had subjective discomfort. Conclusion The INFIX nailing into the space between sartorius and iliopsoas muscle can reduce the risk of injury to LFCN, and does not interfere with the femoral nerve. It has several advantages for anterior pelvic ring fracture including minimal invasion, good curative effect, and few complications.
引文
[1]Mason W T M,Khan S N,James C L,et al.Complications of temporary and definitive external fixation of pelvic ring injuries[J].Injury,2005,36(5):599-604.
[2]Vaidya R,Martin A J,Roth M,et al.INFIX versus plating for pelvic fractures with disruption of the symphysis pubis[J].Int Orthop,2017,41(8):1671-1678.
[3]Kuttner M,Klaiber A,Lorenz T,et al.The pelvic subcutaneous crossover internal fixator[J].Unfallchirurg,2009,112(7):661-669.
[4]Vaidya R,Colen R,Vigdorchik J,et al.Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation:initial clinical series[J].J Orthop Trauma,2012,26(1):1-8.
[5]Fang C,Alabdulrahman H,Pape H C.Complications after percutaneous internal fixator for anterior pelvic ring injuries[J].Int Orthop,2017,41(9):1785-1790.
[6]Dahill M,Mcarthur J,Roberts G L,et al.The use of an anterior pelvic internal fixator to treat disruptions of the anterior pelvic ring:a repor of technique,indications and complications[J].Bone Joint J,2017,99-B(9):1232-1236.
[7]Young J W,Burgess A R,Brumback R J,et al.Pelvic fractures:value of plain radiography in early assessment and management[J].Radiology1986,160(2):445-451.
[8]Majeed S A.Grading the outcome of pelvic fractures[J].J Bone Join Surg Br,1989,71(2):304-306.
[9]Berry J L,Stahurski T,Asher MA.Morphometry of the supra sciatic notch intrailiac implant anchor passage[J].Spine,2001,26(7):143-148.
[10]盛伟超,高延征,钟世镇.髂骨螺钉骨性通道毗连血管及神经的解剖学研究[J].中国临床解剖学杂志,2018,36(3):248-251.
[11]Haidukewych G J,Kumar S,Prpa B.Placement of half-pins for supraacetabular external fixation:an anatomic study[J].Clin Orthop Rela Res,2003,(411):269-273.
[12]Gardner M J,Nork S E.Stabilization of unstable pelvic fractures with supraacetabular compression external fixation[J].J Orthop Trauma2007,21(4):269-273.
[13]谭山,高仕长,张安维,等.髋臼上区域置钉安全范围的影像学研究[J].中国临床解剖学杂志,2018,36(3):259-263.
[14]Poelstra K A,Kahler D M.Supra-acetabular placement of externa fixator pins:a safe and expedient method of providing the injured pelvis with stability[J].Am J Orthop,2005,34(3):148-151.
[15]Kim W Y,Hearn T C,Seleem O,et al.Effect of pin location on stability of pelvic external fixation[J].Clin Orthop Relat Res,1999,(361):237-244.
[16]Vaidya R,Martin A J,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.
[17]Reichel L M,Maccormick L M,Dugarte A J,et al.Minimally invasive anterior pelvic internal fixation:An anatomic study comparing Pelvic Bridge to INFIX[J].Injury,2018,49(2):309-314.
[18]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.
[19]Vigdorchik J M,Esquivel A O,Jin X,et al.Biomechanical stability of a supra-acetabular pedicle screw internal fixation device(INFIX)vs external fixation and plates for vertically unstable pelvic fractures[J].JOrthop Surg Res,2012,7:31-35.
[20]李尚政,苏伟,赵劲民,等.钉-棒系统与外固定支架固定骨盆不稳定损伤模型的生物力学比较[J].中华创伤骨科杂志,2013,15(6):517-520.
[21]李尚政,苏伟,庄小强,等.钢板与钉棒系统固定骨盆Tile B1型损伤模型的生物力学比较[J].中华创伤骨科杂志,2014,16(2):161-164.
[22]Eagan M,Kim H,Manson T T,et al.Internal anterior fixators for pelvic ring injuries:Do monaxial pedicle screws provide more stiffness than polyaxial pedicle screws[J]?Injury,2015,46(6):996-1000.
[2]Vaidya R,Martin A J,Roth M,et al.INFIX versus plating for pelvic fractures with disruption of the symphysis pubis[J].Int Orthop,2017,41(8):1671-1678.
[3]Kuttner M,Klaiber A,Lorenz T,et al.The pelvic subcutaneous crossover internal fixator[J].Unfallchirurg,2009,112(7):661-669.
[4]Vaidya R,Colen R,Vigdorchik J,et al.Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation:initial clinical series[J].J Orthop Trauma,2012,26(1):1-8.
[5]Fang C,Alabdulrahman H,Pape H C.Complications after percutaneous internal fixator for anterior pelvic ring injuries[J].Int Orthop,2017,41(9):1785-1790.
[6]Dahill M,Mcarthur J,Roberts G L,et al.The use of an anterior pelvic internal fixator to treat disruptions of the anterior pelvic ring:a repor of technique,indications and complications[J].Bone Joint J,2017,99-B(9):1232-1236.
[7]Young J W,Burgess A R,Brumback R J,et al.Pelvic fractures:value of plain radiography in early assessment and management[J].Radiology1986,160(2):445-451.
[8]Majeed S A.Grading the outcome of pelvic fractures[J].J Bone Join Surg Br,1989,71(2):304-306.
[9]Berry J L,Stahurski T,Asher MA.Morphometry of the supra sciatic notch intrailiac implant anchor passage[J].Spine,2001,26(7):143-148.
[10]盛伟超,高延征,钟世镇.髂骨螺钉骨性通道毗连血管及神经的解剖学研究[J].中国临床解剖学杂志,2018,36(3):248-251.
[11]Haidukewych G J,Kumar S,Prpa B.Placement of half-pins for supraacetabular external fixation:an anatomic study[J].Clin Orthop Rela Res,2003,(411):269-273.
[12]Gardner M J,Nork S E.Stabilization of unstable pelvic fractures with supraacetabular compression external fixation[J].J Orthop Trauma2007,21(4):269-273.
[13]谭山,高仕长,张安维,等.髋臼上区域置钉安全范围的影像学研究[J].中国临床解剖学杂志,2018,36(3):259-263.
[14]Poelstra K A,Kahler D M.Supra-acetabular placement of externa fixator pins:a safe and expedient method of providing the injured pelvis with stability[J].Am J Orthop,2005,34(3):148-151.
[15]Kim W Y,Hearn T C,Seleem O,et al.Effect of pin location on stability of pelvic external fixation[J].Clin Orthop Relat Res,1999,(361):237-244.
[16]Vaidya R,Martin A J,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.
[17]Reichel L M,Maccormick L M,Dugarte A J,et al.Minimally invasive anterior pelvic internal fixation:An anatomic study comparing Pelvic Bridge to INFIX[J].Injury,2018,49(2):309-314.
[18]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.
[19]Vigdorchik J M,Esquivel A O,Jin X,et al.Biomechanical stability of a supra-acetabular pedicle screw internal fixation device(INFIX)vs external fixation and plates for vertically unstable pelvic fractures[J].JOrthop Surg Res,2012,7:31-35.
[20]李尚政,苏伟,赵劲民,等.钉-棒系统与外固定支架固定骨盆不稳定损伤模型的生物力学比较[J].中华创伤骨科杂志,2013,15(6):517-520.
[21]李尚政,苏伟,庄小强,等.钢板与钉棒系统固定骨盆Tile B1型损伤模型的生物力学比较[J].中华创伤骨科杂志,2014,16(2):161-164.
[22]Eagan M,Kim H,Manson T T,et al.Internal anterior fixators for pelvic ring injuries:Do monaxial pedicle screws provide more stiffness than polyaxial pedicle screws[J]?Injury,2015,46(6):996-1000.