骨盆环微创内固定治疗骨盆C型骨折

目的 :探讨骨盆前、后环微创内固定在骨盆C型骨折治疗中的可行性、技术要点以及临床效果。方法:自2010年12月至2015年12月,选择经髂腹股沟微创小切口重建接骨板内固定治疗骨盆前环损伤;经皮骶髂关节螺钉内固定治疗骨盆后环损伤患者18例,男11例,女7例;年龄29~68岁,平均43.6岁。骨折按Tile分型:C1型14例,C2型3例,C3型1例。耻骨骨折合并同侧骶骨骨折12例,耻骨骨折合并同侧骶髂关节脱位2例,双侧耻骨骨折合并单侧骶骨骨折伴耻骨联合分离3例,双侧耻骨骨折合并双侧骶髂关节骨折脱位1例。观察结果包括手术时间、手术出血量、腰骶神经及髂血管损伤情况、骨折复位情况等。结果:所有患者伤口Ⅰ期愈合,无感染、深静脉血栓、腰骶神经及髂血管损伤、异位骨化等并发症发生。根据Matta复位标准,优14例,良3例,可1例。16例患者获得随访,时间6~33个月,平均16.7个月。根据Majeed疗效评价标准,优15例,良1例,Majeed评分92.13±5.44。结论:骨盆前环损伤选择经髂腹股沟微创小切口重建接骨板内固定,骨盆后环损伤选择经皮骶髂关节螺钉内固定治疗骨盆C型骨折具有手术时间短、创伤小、出血少等优点,临床操作安全可行,疗效满意。     

经皮空心螺钉内固定术治疗DayⅡ型骨盆新月型骨折北大核心CSCD

目的探讨经皮空心螺钉内固定术治疗DayⅡ型骨盆新月型骨折的可行性及疗效。方法回顾分析2009年1月—2016年7月采用经皮空心螺钉内固定术治疗的14例DayⅡ型骨盆新月型骨折患者临床资料。其中男9例,女5例;年龄17~65岁,平均38岁。致伤原因:交通事故伤8例,高处坠落伤3例,重物砸伤3例;均为闭合性骨折。骨盆骨折Tile分型:B型8例,C型6例。13例伴骨盆前环骨折,其中耻骨上下支均骨折8例,耻骨上支骨折伴耻骨联合分离1例,耻骨联合分离4例。受伤至入院时间1~72 h,平均16 h;伤后至手术时间3~8 d,平均5 d。术后根据Matta评价标准评价骨折复位情况,采用Majeed功能评分进行临床功能评价。结果总手术时间35~95 min,平均55 min;术中累计C臂X线机透视时间3~8 min,平均5 min;术中均无神经损伤及盆腔脏器损伤等发生。术后2 d行X线片检查显示各有2例垂直移位及轻度旋转移位未完全纠正。术后3 d行CT检查,发现2枚耻骨联合螺钉突破闭孔骨皮质;所有耻骨支螺钉均未进入髋臼,1枚耻骨上支螺钉突破耻骨上支后侧骨皮质;1枚髂骨后柱螺钉突破髂骨内侧骨皮质;但均未引起临床症状。1例出现耻骨联合处伤口感染,经更换敷料2周后伤口愈合;其余伤口均Ⅰ期愈合。骨折复位按Matta评价标准评价,获优9例,良4例,可1例,优良率92.9%。术后14例均获随访,随访时间8~24个月,平均14个月。骨折均在术后4个月内愈合,术后6个月患者均恢复正常行走功能。3例患者劳累或行走时骶髂部轻微疼痛,轻度跛行;1例平卧时有髂后部疼痛不适感。随访期间无螺钉松动、断裂等内固定失效发生。末次随访时按Majeed功能评分评价临床功能,获优7例,良5例,可2例,优良率85.7%。结论经皮空心螺钉内固定术治疗DayⅡ型骨盆新月型骨折,复位满意,固定可靠,疗效较好。     

经皮空心螺钉内固定术治疗DayⅡ型骨盆新月型骨折

目的探讨经皮空心螺钉内固定术治疗DayⅡ型骨盆新月型骨折的可行性及疗效。方法回顾分析2009年1月—2016年7月采用经皮空心螺钉内固定术治疗的14例DayⅡ型骨盆新月型骨折患者临床资料。其中男9例,女5例;年龄17~65岁,平均38岁。致伤原因:交通事故伤8例,高处坠落伤3例,重物砸伤3例;均为闭合性骨折。骨盆骨折Tile分型:B型8例,C型6例。13例伴骨盆前环骨折,其中耻骨上下支均骨折8例,耻骨上支骨折伴耻骨联合分离1例,耻骨联合分离4例。受伤至入院时间1~72 h,平均16 h;伤后至手术时间3~8 d,平均5 d。术后根据Matta评价标准评价骨折复位情况,采用Majeed功能评分进行临床功能评价。结果总手术时间35~95 min,平均55 min;术中累计C臂X线机透视时间3~8 min,平均5 min;术中均无神经损伤及盆腔脏器损伤等发生。术后2 d行X线片检查显示各有2例垂直移位及轻度旋转移位未完全纠正。术后3 d行CT检查,发现2枚耻骨联合螺钉突破闭孔骨皮质;所有耻骨支螺钉均未进入髋臼,1枚耻骨上支螺钉突破耻骨上支后侧骨皮质;1枚髂骨后柱螺钉突破髂骨内侧骨皮质;但均未引起临床症状。1例出现耻骨联合处伤口感染,经更换敷料2周后伤口愈合;其余伤口均Ⅰ期愈合。骨折复位按Matta评价标准评价,获优9例,良4例,可1例,优良率92.9%。术后14例均获随访,随访时间8~24个月,平均14个月。骨折均在术后4个月内愈合,术后6个月患者均恢复正常行走功能。3例患者劳累或行走时骶髂部轻微疼痛,轻度跛行;1例平卧时有髂后部疼痛不适感。随访期间无螺钉松动、断裂等内固定失效发生。末次随访时按Majeed功能评分评价临床功能,获优7例,良5例,可2例,优良率85.7%。结论经皮空心螺钉内固定术治疗DayⅡ型骨盆新月型骨折,复位满意,固定可靠,疗效较好。     

经皮空心螺钉内固定治疗耻骨支骨折

目的探讨经皮空心螺钉内固定治疗耻骨支骨折的临床疗效。方法对19例耻骨支骨折（均为不稳定性骨盆前环骨折）患者行闭合复位经皮空心螺钉内固定治疗。结果患者均获随访,时间5-24个月。骨折均获骨性愈合,愈合时间3-5.5（3.9±0.6）个月。无切口感染、无内固定松动、无神经血管损伤、无尿路损伤。2例出现再移位,经卧床、延迟下地时间后达骨折愈合。结论经皮空心螺钉内固定治疗耻骨支骨折是一种安全、有效的治疗方法。满意的复位、准确的进针点和角度对手术疗效具有重要意义。     

经皮加压螺钉固定治疗耻骨联合漂浮损伤

目的 探讨经皮加压螺钉固定治疗耻骨联合漂浮损伤的疗效. 方法 2003年3月至2007年3月,采用经皮加压螺钉固定治疗48例耻骨联合漂浮损伤患者,男27例,女21例;平均年龄29.4岁.39例患者伴有不同程度的骨盆后环损伤,其中28例行后环经皮内固定术,11例患者后环稳定不需行内固定.对于耻骨联合漂浮损伤,固定前应用C型臂透视机结合导针或者预固定螺钉进行撬拨复位,术中应用不同角度的透视引导,使用直径6.5～7.3 mm空心加压螺钉固定治疗耻骨联合漂浮损伤.急诊手术13例,3～7 d内手术27例,7～14 d内手术8例.结果 48例患者平均手术时间55min(31～100 min),手术出血量为20～30 mL.41例患者获得良好复位和固定,7例复位欠佳.术后3～6个月骨折全部愈合,未见感染、骨不连、血管神经及脏器损伤.仅1例术后3 d出现螺钉退出,予以重新置钉后结果 良好.根据Orlando骨盆骨折评分标准评定疗效:优37例,良7例,可3例,差1例,优良率为91.7%. 结论 经皮加压螺钉治疗耻骨联合漂浮损伤手术创伤较小、手术时间短、并发症少,对伴有腹腔、盆腔脏器损伤的患者尤为有利.     

Colorado 2TM脊柱内固定系统及髂骨螺钉联合应用治疗骨盆后环损伤

目的:探讨Colorado 2TM脊柱内固定系统与髂骨螺钉联合应用治疗骨盆后环骨折脱位的疗效.方法:2006年1月至2007年12月共收治骨盆后环骨折脱位患者8例,男5例,女3例;年龄26～52岁,平均37.6岁.按照AO分型,B2型1例,C1型2例,C2型2例,C3型3例.其中合并单侧骶骨骨折伴脱位5例;均合并骨盆前环骨折,包括耻骨联合分离2例,耻骨上下支骨折5例,耻骨上下支骨折合并髋臼骨折1例.合并骶丛神经损伤2例,膀胱破裂1例.均行Colorado 2TM脊柱内固定系统与髂骨螺钉联合内固定术,应用Majeed标准(优,≥85分;良,70～84分;一般,55～69分;差,<55分)评价患者功能恢复情况,随访观察治疗效果.结果:术后X线片示8例患者垂直和旋转移位均获满意复位.随访6～24个月,平均10个月.合并神经损伤者,1例随访10个月遗留会阴区麻木,另1例术后6个月复查功能恢复良好.膀胱破裂患者经手术修补随访8个月功能恢复满意.末次随访时患者双下肢运动、感觉功能恢复满意,经Majeed功能评定,优6例,良1例,一般1例.X线片及CT扫描未发现内固定松动、断裂,骶髂关节无再脱位,骨折部位已呈骨性融合.结论:Colorado 2TM脊柱内固定系统与髂骨螺钉联合应用治疗骨盆后环骨折脱位可获得即刻稳定并能够维持良好复位效果,为骨盆后环骨折脱位的治疗提供了一种新的方法.     

经皮空心钉固定治疗创伤性耻骨联合分离

 目的 探讨经皮空心钉固定治疗创伤性耻骨联合分离的手术方法及临床疗效。方法 2003年 2月至 2010年 12月, 治疗 46例伴耻骨联合分离的不稳定骨盆骨折, 男 27例, 女 19例;年龄 18~61岁, 平均 34.6岁。按 Tile分型: B1.1型 4例, B1.2型 7例, B2型 2例, B3型 2例, C1.1型 7例, C1.2型 7例, C1.3型 10例, C2型 5例, C3型 2例。行闭合复位经皮耻骨联合螺钉内固定后, 再行后环 固定, 包括经皮骶髂螺钉、经皮髂骨后部螺钉固定。除 4例 B1.1型骨折仅固定耻骨联合外, 余均同时行 后环固定。结果 手术时间 15~65 min, 平均 45 min;出血量 10~50 ml, 平均 25 ml。 46例患者均置入 1 枚耻骨联合螺钉, 35例术后行骨盆 CT检查, 其中 3例发现螺钉侵入盆腔, 但未引起任何临床症状。术后 无一例发生切口及钉道感染。 46例患者均获得随访, 随访时间 5~48个月, 平均 23.5个月;随访期间未 发现明显的复位丢失。根据 Matta和 Tornetta标准, 末次随访时优 43例, 良 3例。 31例(67.39%)患者恢 复原工作, 6例因合并损伤而改变原工作, 9例尚处于恢复期。 28例患者无骶髂关节疼痛;13例仅在用 力时有耻骨联合部或耻骨微痛, 但不影响日常生活;5例有不同程度的骶髂关节疼痛。结论 闭合复位经皮空心钉固定治疗创伤性耻骨联合分离安全可行, 操作简便, 损伤小, 疗效满意。     

C形臂X线透视下经皮空心螺钉微创内固定治疗骨盆前后环骨折

目的：探讨在C形臂X线透视下经皮空心螺钉微创固定治疗骨盆前后环骨折的效果及相关注意事项.方法：2010年6月至2012年6月,采用C形臂X线透视下经皮微创空心螺钉内固定方法治疗骨盆前后环不稳定骨折19例,男13例,女6例;年龄22～58岁,平均41岁;车祸伤11例,高处坠落伤8例.单纯前环骨折3例,前后环均骨折16例,其中骶髂关节脱位9例,骶骨骨折7例,髂骨骨折2（1例累及骶管）.根据Tile分型：C型15例,B型4例.观察内容包括术中失血量、手术时间、术后骨折复位情况、并发症、功能恢复情况等,固定方法包括骶髂螺钉固定、耻骨支空心钉固定、耻骨联合分离空心钉固定.结果：解剖复位10例,满意复位8例,不满意复位1例.骨折愈合时间8～12周,平均10周,无伤口感染、骨折不愈合发生.根据Majeed功能评价：优12例,良6例,可1例.结论：C形臂X线透视下经皮空心螺钉微创内固定治疗骨盆骨折具有创伤小、术中失血少、手术并发症发生率低、固定可靠、无须输血、可以早期功能活动等优点,能很好地重建骨盆环的稳定性,但是对术者的技术要求较高,应有充分的术前准备.     

陈旧性骨盆桶柄样Tilt骨折的手术治疗

目的探讨陈旧性骨盆桶柄样Tilt骨折的临床特征和治疗方法。方法自1998年10月～2002年10月,共收治6例由侧方挤压暴力所致的陈旧性TileB2型骨盆桶柄样Tilt骨折,伤后至手术时间为2～15个月,平均6.5个月。术前损伤骨盆的桶柄侧内旋畸形均大于30°,下肢短缩2～3.5cm,平均2.5cm;骨盆前环Tilt畸形的骨折近端均向后下方旋转移位,耻骨联合陷入会阴。所有患者均采用髂腹股沟入路行手术治疗,耻骨上支畸形均沿骨折处原位截骨;骨盆后环畸形经髂骨截骨3例,骶骨外缘截骨1例,骶髂关节切开翻转并植骨融合2例。术中使用重建钢板固定3例,重建钢板联合拉力螺钉固定1例,重建钢板辅以支架固定2例。结果术后随访3～45个月,平均15.6个月。骨折愈合,肢体短缩纠正满意。根据Mears的影像评价标准,本组骨盆解剖复位5例,复位满意1例。根据Majeed的疗效评定标准,优5例,良1例。术后出现迟发性坐骨神经损伤1例,未行特殊处理,6周后症状自行缓解。结论骨盆前后环的联合截骨矫形及手术重建,是提高复位质量、纠正桶柄侧下肢短缩及防治远期并发症的有效方法。     

S1椎弓根螺钉结合髂骨板间螺钉治疗骶髂关节骨折脱位

目的 探索S1椎弓根螺钉结合髂骨板问螺钉治疗骶髂关节骨折脱位的临床疗效，评价两者结合对骶髂关节骨折脱位的治疗价值。方法 对11例骶髂关节骨折脱位患者用脊柱内固定系统(TSRH)之S1椎弓根螺钉结合髂骨板间螺钉进行固定，该组患者涉及骶髂关节的垂直移位及旋转的骨盆环变形，归于Tile分型的B类或C类骨盆损伤。11例患者均伴有前环损伤，其中9例予以加压钢板(smith nephew)内固定，余2例患者单纯采用后路手术内固定。结果 7例患者垂直移位完全复位，9例旋转畸形纠正，未发现感染及神经损伤等并发症。结论 S1椎弓根螺钉结合髂骨板问螺钉固定技术治疗骶髂关节骨折脱位，可获得即刻稳定性并良好地维持了复位的效果．这一混合技术对于涉及垂直及旋转损伤的骨盆环损伤有稳定的作用。     

Minimally invasive fluoro-navigation screw fixation for the treatment of pelvic ring injuries

Intensive use of intraoperative fluoroscopy is mandatory to achieve good accuracy and avoid neural or vascular injury and may prolong surgical time and increase exposure-related hazards. New methods of percutaneous treatment in conjunction with innovative fluoroscopy-based computerized navigation have evolved in an attempt to overcome the existing difficulties. This report described our experience in applying fluoroscopic surgical navigation technique and evaluated its clinical application to pelvic ring injuries, including its feasibility, merits and limitations. Twenty-two patients with pelvic ring injuries were treated with percutaneous pubic ramus screw and sacroiliac screw techniques under the guidance of a fluoroscopy-based navigation system. A total of forty-four screws were inserted, including twenty-seven pubic ramus screws and seventeen sacroiliac screws. The average operation time and the average fluoroscopy time per screw were 23.6 minutes and 22.2 seconds respectively. Compared to the final position of the screw, the average deviated distance of wire tip was 2.8 mm and the average trajectory difference was 2.6°. A ventral cortex perforation of the sacrum was found in one sacroiliac screw without any clinical symptoms. No superficial or deep infection occurred. No patient sustained recognized neurologic, vascular, or urologic injury as a result of percutaneous screw fixation of pubic ramus fractures, sacroiliac disruptions, or sacral fractures. Our results showed that fluoroscopy-based navigation technique for the pelvic ring injuries could become a safe and effective alterative method for the treatment of pelvic ring injuries in some selected patients.     

经皮微创内固定治疗不稳定骨盆骨折

目的:探讨经皮微创内固定技术治疗不稳定骨盆骨折的临床疗效.方法:2005年1月至2009年1月,行经皮微创内固定治疗不稳定骨盆骨折48例,男31例,女17例;年龄12～66岁,平均37.8岁.致伤原因:车祸伤29例,高处坠落伤14例,挤压伤5例.骨折类型按Tile分型:B1型4例,B2型3例,C1型25例,C2型14例,C3型2例.48例患者分别采用经皮骶髂螺钉(其中耻骨支螺钉固定16例、耻骨联合螺钉固定4例),重建钢板(其中耻骨支螺钉固定20例、耻骨联合螺钉固定8例)微创内固定治疗.术后通过X线观察患者复位情况并根据Majeed功能评分标准对疗效进行评定.结果:48例患者均获得随访,时间12～39个月,平均17个月.未发生切口感染、血管神经损伤、内固定松动及断裂、骨不愈合等并发症.解剖复位29例,满意复位18例,复位不满意1例.根据Majeed功能评价:优29例,良15例,可4例,优良率为91.7%.结论:经皮微创内固定治疗不稳定骨盆骨折手术创伤小,出血少,术后并发症少,骨折愈合率高,固定可靠,患者功能恢复满意,是治疗骨盆骨折的有效手段,但对操作者要求高.     

Percutaneous fixation of pelvic ring disruptions

Percutaneous pelvic fixation is possible because intraoperative fluoroscopic imaging and other technologies have been refined. Anterior and posterior unstable pelvic ring disruptions are amenable to percutaneous fixation after closed manipulation or open reduction. Stable and safe fixation is achieved only after an accurate reduction. Anterior pelvic external fixation remains the most common form of percutaneous pelvic fixation; however, percutaneously inserted medullary pubic ramus, transiliac, and iliosacral screws stabilize pelvic disruptions directly while diminishing operative blood loss and operative time. These percutaneous techniques do not decompress the pelvic hematoma allowing early definitive fixation without the risk of additional hemorrhage. Complications associated with open posterior pelvic surgical procedures are similarly avoided by using percutaneous techniques. A thorough knowledge of pelvic osseous anatomy, injury patterns, deformities, and their fluoroscopic correlations are mandatory for percutaneous pelvic fixation to be effective.     

Biomechanical study of 4-hole pubic symphyseal plating: locked versus unlocked constructs

To the authors' knowledge, no published studies have examined the use of locking plates on injuries of the anterior pelvic ring. The purpose of this study was to determine whether locked plates provide enhanced stability in the treatment of pubic symphyseal disruptions. Completely unstable pelvic injuries were simulated in pelvic Sawbones (model 1301; Pacific Research Laboratories, Vashon, Washington) and 2 different fixation constructs used for anterior fixation (4-hole, 3.5-mm pubic symphysis plate with all locked or all unlocked screws). Adjunctive sacroiliac screw fixation with a single 7.3-mm screw placed into S1 was used in all specimens. Specimens were analyzed for motion at the pubic symphysis and sacroiliac joints using a Material Testing System (MTS Systems Corporation, Eden Prairie, Minnesota). Each specimen was subjected to compressive loading in a single-limb stance. Side loading was also examined. The main outcome measurement was motion at the pubic symphysis and sacroiliac joints and overall construct stiffness. No significant difference existed in overall construct stiffness between the 2 methods of pubic symphysis fixation. The motions at the pubic symphysis or injured sacroiliac joints were not significantly different. In addition, motion at the pubic symphysis joint with lateral load was not improved with a locking construct.No significant difference existed between 4-hole locked or unlocked constructs used for fixation of the pubic symphysis. No apparent advantage of locking screws exists for disruptions of the pubic symphysis, and recent reports have questioned the possibility of catastrophic failure.     

旋转和垂直不稳定型骨盆骨折患者的诊断和治疗

目的探讨旋转和垂直不稳定型骨盆骨折的临床特点及其急诊处理、诊断和治疗方法选择。方法回顾性分析18例存在旋转和垂直不稳定的骨盆骨折患者，10例保守治疗，8例手术治疗。8例手术患者骨盆前环骨折均行切开复位内固定，2例耻骨上支骨折采用重建钢板固定，2例采用拉力螺钉固定，4例耻骨联合分离患者均采用双钢板固定；6例骨盆后环骨折患者采用切开复位双钢板固定，2例在CT引导下经皮置入骶髂关节松质骨拉力螺钉固定。结果18例患者全部恢复行走功能，所有保守治疗患者骨盆骨折均畸形愈合，遗留骶髂关节部位酸痛6例，遗留双小腿、双足麻木3例，行走跛行2例。8例手术治疗患者骨盆外形均恢复好，仅1例患者诉沿髂嵴切口有不适，2例CT引导下经皮置入骶髂关节螺钉患者骨盆外形接近完全恢复，功能恢复快而满意。结论旋转和垂直不稳定型骨盆骨折患者保守治疗效果差，宜首选内固定手术治疗，宜同时固定骨盆前、后环或先行前环切开复位内固定，2～3d后再次在CT引导下经皮置入骶髂关节螺钉内固定。CT引导下经皮置入骶髂关节螺钉手术操作简单、时间短、出血少、固定牢靠，是固定骶髂关节骨折脱位的首选方法。     

Die perkutane transiliosakrale Zugschraubenosteosynthese des hinteren Beckenrings

BACKGROUND: In recent years, the closed reduction and percutaneous fixation of posterior pelvic ring fractures by sacroiliac screws has become a well established treatment option for stabilization of posterior pelvic ring disruptions. Stable percutaneous pelvic ring fixation also implies a very low complication rate, e.g., in operative blood loss, wound healing, and operative time. To avoid malpositioning of the screws, sufficient reduction and radiologic visualization are essential. The surgical technique has been described in several studies; however, great importance is attached to the personal experience of the surgeon. Therefore, this study was conducted to establish a standard procedure that allows different surgeons a safe positioning of sacroiliac screws. RESULTS: A total of 41 injuries of the posterior pelvic ring were stabilized with 73 sacroiliac lag screws inserted by 7 different surgeons using a standardized technique. In all cases adequate reduction of the fracture and radiologic visualization were achieved. No wound infections, no relevant bleedings, and no spiral fractures of screws were observed. In two cases malpositioning led to revision of the screws. Of interest, one case of S1 paresthesia resulting from a malpositioned screw could be revised. In contrast, two cases of screw loosening and one case of screw bending did not require further intervention. CONCLUSION: We conclude that safe positioning of the sacroiliac screws was accomplished by all surgeons given a standardized technique. For safe insertion preparation of the patients, accurate visualization of the fracture zone, and potential closed reduction is always required.     

Percutaneous screw fixation of pubic symphysis disruption: A preliminary report

BackgroundPercutaneous techniques are commonly used to treat pelvic ring disruptions but are not mainstream for fixation of pubic symphysis disruption worldwide. Potential advantages include less blood loss and lower risk of surgical site infection, especially in the morbidly obese or multiply injured patient. This study was performed to describe the clinical and radiographic outcomes of patients after percutaneous reduction and screw fixation of pubic symphysis disruption and to evaluate the preliminary safety and efficacy of this technique and its appropriateness for further study as an alternative method of fixation.MethodsA retrospective review was performed to identify all patients who underwent percutaneous fixation of pubic symphysis disruption by two surgeons at an academic Level I trauma center over a 3-year period. Patients underwent percutaneous reduction and fixation of the pubic symphysis using 1 or 2 fully or partially threaded 5.5, 6.5, or 7.3 mm cannulated screws in a transverse or oblique configuration. Associated posterior ring injuries were fixed with trans-sacral and/or iliosacral screws. The primary outcome of interest was loss of reduction, defined as symphysis distance greater than 15 mm measured on final AP pelvis radiograph. Secondary outcomes collected by chart review were operative time, blood loss, vascular or urologic injury, sexual dysfunction, infection, implant loosening or breakage, and revision surgery.ResultsTwelve patients met criteria and primary and secondary outcomes were collected. Mean clinical and radiographic follow-up were 15 months each. One patient lost reduction. Mean operative time and blood loss were 124 min and 29 cc, respectively. No vascular or urologic injuries occurred. Two patients reported sexual dysfunction. No patients became infected or required revision surgery. Four patients underwent implant removal. Seventeen additional patients were excluded due to short follow-up and limited outcomes were collected. Two of these patients lost reduction. Three underwent implant removal.ConclusionThese data support percutaneous reduction and screw fixation of pubic symphysis disruption as a potentially safe and effective method of treatment that warrants further investigation.     

仰卧位经皮骶髂置钉固定术治疗骨盆后环损伤

目的 探讨仰卧位经皮骶髂置钉固定术治疗骨盆后环损伤的可行性、手术方法及疗效.方法 在10具尸体操作的基础上,2004年10月至2007年10月对14例骨盆后环损伤行仰卧位经皮骶髂置钉固定术.男7例,女7例;年龄28～75岁,平均41.6岁.Tile B型损伤4例,C型损伤10例.患者仰卧位,于"C"型臂X线机透视下以髂前上棘上2 cm与腋后线交点及髂前上棘与髂后上棘连线中、后1/3交点为进钉点,若两点距离较大,则在透视下确定最佳进钉点.进钉角度为向前20°～30°角,向尾端倾斜5°～15°.经皮骶髂置入一枚直径7.2 mm空心钛螺钉固定.术后摄骨盆正位、骶骨侧位X线片,并行骶髂关节CT扫描,观察螺钉在S1椎体的位置.结果 14例均获随访,平均随访16个月.术后3个月骨盆骨折均临床愈合.14例共置入15枚空心钛螺钉,未发生与置钉有关的并发症.随访期间无神经损伤、螺钉松动及断裂现象,无骨盆畸形及骶髂部疼痛.Majeed疗效评定标准优良率为92.9%.结论 采用体表双定位法,可提高仰卧位骶髂置钉固定术的安全性;仰卧位经皮骶髂置钉固定术治疗骨盆后环损伤方便、可行.