Starr架辅助复位INFIX与前柱螺钉内固定治疗不稳定骨盆骨折临床比较分析
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摘要
目的应用Starr复位架经皮复位、骨盆前环皮下钉棒系统(INFIX)与前柱拉力螺钉固定治疗Tile B/C型骨盆骨折,比较疗效并探讨操作技巧。方法回顾性分析比较2016年4月—2017年6月广西医科大学附属第四医院收治的35例Tile B/C型骨盆骨折患者,其中B1型4例,B2型10例,B3型5例,C1型10例,C2型6例;男性16例,女性19例;年龄22～66岁,平均42岁。前环损伤采用INFIX内固定系统固定19例(INFIX组),采用前柱螺钉固定16例(前柱螺钉组)。骨盆后环损伤均采用骶髂关节螺钉固定。记录各组Starr架复位时间、前环内固定置入时间、透视次数等,按Matta标准评定骨盆骨折复位质量,功能评分采用Majeed功能评分量表。结果两组患者Starr架复位时间分别为(30. 3±11. 2) min、(34. 4±5. 9) min;INFIX组内固定置入时间(25. 4±2. 1) min,前柱螺钉组(38. 0±4. 2) min,差异无统计学意义。两组透视次数分别为(30. 2±3. 5)次、(26. 1±9. 2)次,差异有统计学意义。Matta标准评定骨折复位结果显示INFIX组优10例,良8例,差1例;前柱螺钉组优9例,良6例,差1例。Majeed功能评分显示INFIX组优8例,良11例;前柱螺钉组优10例,良6例。两组骨折复位及功能评分结果比较,差异无统计学意义。结论 Starr复位架辅助复位灵活可靠,INFIX或前柱螺钉固定治疗Tile B/C型骨盆骨折操作简便、疗效确切;经皮复位微创螺钉置入技术具有明显临床优势及广阔应用前景。
Objective To apply Starr frame for reduction,INFIX subcutaneous pedicle screw-rod systemor anterior column screw to treat Tile B/C pelvic fracture and compare their efficacy. Methods Totally 35 cases ofTile B/C fractures in our hospital from Apr. 2016 to Jun. 2017 on whom Starr frame assisted reduction was appliedwere retrospectively reviewed. There were 16 males and 19 females aged from 22-66 (average,42) years. Of them4 cases were Type B1,10 cases were B2,5 cases were B3,10 cases were C1 and 6 cases were C2. Of them 19 cases (INFIX group) had the anterior pelvic ring fracture fixed with INFIX internal fixation,and 16 cases (sacroiliacscrew group) were fixed with the sacroiliac screw. The reduction time,anterior ring internal fixation placement time,and fluoroscopy times were recorded. The reduction quality of pelvic fracture was assessed according Matta criteria,and the functional score was based on the Majeed scale. Results The reduction duration of Starr frame in the twogroups was (30. 3 ± 11. 2) min,(34. 4 ± 5. 9) min,respectively. The duration of anterior ring internal fixation place-ment time in the INFIX group was (25. 4 ± 2. 1) min,and (38. 0 ± 4. 2) min in the anterior column screw group. Thetimes of fluoroscopy were 30. 2 ± 3. 5,26. 1 ± 9. 2,respectively. The results of Matta criteria displayed 10 cases of ex-cellent,8 cases of good and 1 case of fair in the INFIX group,while 9 case of excellent,6 case of good and 1 case offair in the anterior column screw group. Majeed scales showed that 8 cases were excellent and 11 cases were good inthe INFIX group,while 10 cases were excellent and 6 cases were good in the anterior column screw group. No signifi-cant difference was found between the two groups. Conclusion It is simple and flexible to treat Tile B/C pelvic frac-tures with the help of Starr frame for reduction,and the application of INFIX or screw was easy and effective. Thetechnique of percutaneous reduction and minimally invasive screw placement has obvious clinical advantages and wideapplication prospect.
Objective To apply Starr frame for reduction,INFIX subcutaneous pedicle screw-rod systemor anterior column screw to treat Tile B/C pelvic fracture and compare their efficacy. Methods Totally 35 cases ofTile B/C fractures in our hospital from Apr. 2016 to Jun. 2017 on whom Starr frame assisted reduction was appliedwere retrospectively reviewed. There were 16 males and 19 females aged from 22-66 (average,42) years. Of them4 cases were Type B1,10 cases were B2,5 cases were B3,10 cases were C1 and 6 cases were C2. Of them 19 cases (INFIX group) had the anterior pelvic ring fracture fixed with INFIX internal fixation,and 16 cases (sacroiliacscrew group) were fixed with the sacroiliac screw. The reduction time,anterior ring internal fixation placement time,and fluoroscopy times were recorded. The reduction quality of pelvic fracture was assessed according Matta criteria,and the functional score was based on the Majeed scale. Results The reduction duration of Starr frame in the twogroups was (30. 3 ± 11. 2) min,(34. 4 ± 5. 9) min,respectively. The duration of anterior ring internal fixation place-ment time in the INFIX group was (25. 4 ± 2. 1) min,and (38. 0 ± 4. 2) min in the anterior column screw group. Thetimes of fluoroscopy were 30. 2 ± 3. 5,26. 1 ± 9. 2,respectively. The results of Matta criteria displayed 10 cases of ex-cellent,8 cases of good and 1 case of fair in the INFIX group,while 9 case of excellent,6 case of good and 1 case offair in the anterior column screw group. Majeed scales showed that 8 cases were excellent and 11 cases were good inthe INFIX group,while 10 cases were excellent and 6 cases were good in the anterior column screw group. No signifi-cant difference was found between the two groups. Conclusion It is simple and flexible to treat Tile B/C pelvic frac-tures with the help of Starr frame for reduction,and the application of INFIX or screw was easy and effective. Thetechnique of percutaneous reduction and minimally invasive screw placement has obvious clinical advantages and wideapplication prospect.
引文
[1]聂玉琪,汪国栋,刘曦明.髋臼前柱螺钉微创内固定技术的研究进展[J].创伤外科杂志,2017,19(4):310-314.
[2]Stevenson AJ,Swartman B,Bucknill AT.Percutaneous internal fixation of pelvic fractures[J].Der Unfallchirurg,2017,120(S1):10-18.
[3]Lefaivre KA,Starr AJ,Reinert CM.Reduction of displaced pelvic ring disruptions using a pelvic reduction frame[J].JOrthop Trauma,2009,23(4):299-308.
[4]Vaidya R,Martin AJ,Roth M,et al.INFIX versus plating for pelvic fractures with disruption of the symphysis pubis[J].Inter Orthop,2017,41(8):1671-1678.
[5]Ochs BG,Stuby FM,Ateschrang A,et al.Retrograde lag screw placement in anterior acetabular column with regard to the anterior pelvic plane and midsagittal plane-virtual mapping of 260 three-dimensional hemipelvises for quantitative anatomic analysis[J].Injury,2014,45(10):1590-1598.
[6]Lefaivre KA,Slobogean G,Starr AJ,et al.Methodology and interpretation of radiographic outcomes in surgically treated pelvic fractures:a systematic review[J].J Orthop Trauma,2012,26(8):474-481.
[7]Vigdorchik JM,Esquivel AO,Jin XY,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].J Orthop Surg Res,2012,7(3):1-3.
[8]Hammad AS,El-Khadrawe TA,Waly AH,et al.The efficacy of posterior plating and anterior column screw fixation in the management of T-shaped acetabular fractures-CARTanalysis of prospective cohort study[J].Injury,2017,48(3):680-686.
[9]Lefaivre KA,Starr AJ,Barker BP,et al.Early experience with reduction of displaced disruption of the pelvic ring using a pelvic reduction frame[J].J Bone Joint Surg(Br),2009,91(9):1201-1207.
[10]Kerschbaum M,Hausmann N,Worlicek M,et al.Patientrelated outcome of unstable pelvic ring fractures stabilized with a minimal invasive screw-rod system[J].Health Qual Life Out,2017,15(1):248.
[11]Cole PA,Dyskin EA,Gilbertson JA.Minimally-invasive fixation for anterior pelvic ring disruptions[J].Injury,2015,46(S3):S27-34.
[12]Hesse D,Kandmir U,Solberg B,et al.Femoral nerve palsy after pelvic fracture treated with INFIX:a case series[J].J Orthop Trauma,2015,29(3):138-143.
[13]Smith A,Malek IA,Lewis J,et al.Vascular occlusion following application of subcutaneous anterior pelvic fixation (INFIX) technique[J].J Orthop Surg (HK),2017,25(1):230-234.
[14]Vaidya R,Tonnos F,Nasr K,et al.The anterior subcutaneous pelvic fixator (INFIX) in an anterior posterior compression type 3 pelvic fracture[J].J Orthop Trauma,2016,30(S2):S21-22.
[15]聂玉琪,汪国栋,孟乘飞,等.三维数字规划结合导航与单纯导航下经皮髋臼前柱螺钉内固定术的对比研究[J].中华创伤杂志,2017,33(1):51-56.
[16]Chen H,Tang P,Yao Y,et al.Anatomical study of anterior column screw tunnels through virtual three-dimensional models of the pelvis[J].Eur J Orthop Surg Traumatol,2015,25(1):105-110.
[17]Peng Y,Zhang L,Min W,et al.Comparison of anterograde versus retrograde percutaneous screw fixation of anterior column acetabular fractures[J].Int J Comput Ass Rad,2016,11(4):635-639.
[2]Stevenson AJ,Swartman B,Bucknill AT.Percutaneous internal fixation of pelvic fractures[J].Der Unfallchirurg,2017,120(S1):10-18.
[3]Lefaivre KA,Starr AJ,Reinert CM.Reduction of displaced pelvic ring disruptions using a pelvic reduction frame[J].JOrthop Trauma,2009,23(4):299-308.
[4]Vaidya R,Martin AJ,Roth M,et al.INFIX versus plating for pelvic fractures with disruption of the symphysis pubis[J].Inter Orthop,2017,41(8):1671-1678.
[5]Ochs BG,Stuby FM,Ateschrang A,et al.Retrograde lag screw placement in anterior acetabular column with regard to the anterior pelvic plane and midsagittal plane-virtual mapping of 260 three-dimensional hemipelvises for quantitative anatomic analysis[J].Injury,2014,45(10):1590-1598.
[6]Lefaivre KA,Slobogean G,Starr AJ,et al.Methodology and interpretation of radiographic outcomes in surgically treated pelvic fractures:a systematic review[J].J Orthop Trauma,2012,26(8):474-481.
[7]Vigdorchik JM,Esquivel AO,Jin XY,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].J Orthop Surg Res,2012,7(3):1-3.
[8]Hammad AS,El-Khadrawe TA,Waly AH,et al.The efficacy of posterior plating and anterior column screw fixation in the management of T-shaped acetabular fractures-CARTanalysis of prospective cohort study[J].Injury,2017,48(3):680-686.
[9]Lefaivre KA,Starr AJ,Barker BP,et al.Early experience with reduction of displaced disruption of the pelvic ring using a pelvic reduction frame[J].J Bone Joint Surg(Br),2009,91(9):1201-1207.
[10]Kerschbaum M,Hausmann N,Worlicek M,et al.Patientrelated outcome of unstable pelvic ring fractures stabilized with a minimal invasive screw-rod system[J].Health Qual Life Out,2017,15(1):248.
[11]Cole PA,Dyskin EA,Gilbertson JA.Minimally-invasive fixation for anterior pelvic ring disruptions[J].Injury,2015,46(S3):S27-34.
[12]Hesse D,Kandmir U,Solberg B,et al.Femoral nerve palsy after pelvic fracture treated with INFIX:a case series[J].J Orthop Trauma,2015,29(3):138-143.
[13]Smith A,Malek IA,Lewis J,et al.Vascular occlusion following application of subcutaneous anterior pelvic fixation (INFIX) technique[J].J Orthop Surg (HK),2017,25(1):230-234.
[14]Vaidya R,Tonnos F,Nasr K,et al.The anterior subcutaneous pelvic fixator (INFIX) in an anterior posterior compression type 3 pelvic fracture[J].J Orthop Trauma,2016,30(S2):S21-22.
[15]聂玉琪,汪国栋,孟乘飞,等.三维数字规划结合导航与单纯导航下经皮髋臼前柱螺钉内固定术的对比研究[J].中华创伤杂志,2017,33(1):51-56.
[16]Chen H,Tang P,Yao Y,et al.Anatomical study of anterior column screw tunnels through virtual three-dimensional models of the pelvis[J].Eur J Orthop Surg Traumatol,2015,25(1):105-110.
[17]Peng Y,Zhang L,Min W,et al.Comparison of anterograde versus retrograde percutaneous screw fixation of anterior column acetabular fractures[J].Int J Comput Ass Rad,2016,11(4):635-639.