骶髂关节螺钉联合前环耻骨支螺钉在Tile B型骨盆骨折中的应用

目的 :探讨微创经皮骨盆前环耻骨支螺钉固定在Tile B型骨折中的应用及疗效。方法 :回顾性分析自2010年5月至2015年8月收治的骨盆后环损伤伴前环耻骨支、坐骨支骨折患者56例,其中男31例,女25例;年龄35~65岁,平均36.8岁。按Tile分型:B1型13例,B2型28例,B3型15例。26例采用骶髂螺钉联合外固定架治疗(外固定架组),30例采用骶髂螺钉联合前柱螺钉治疗(耻骨支螺钉组),从术中出血量、术后并发症、术后下地时间、骨折愈合情况、Majeed骨盆功能评分和视觉模拟评分(visual aualogue scale,VAS)等方面进行对比分析。结果:54例获得随访,时间3~24个月,平均12个月,两组术中出血量比较差异无统计学意义(P0.05),耻骨支螺钉组术后下床时间、骨折愈合时间明显短于外固定架组,差异有统计学意义(P0.05)。耻骨支螺钉组术后平均Majeed及VAS评分明显高于外固定架组,差异有统计学意义(P0.05)。耻骨支螺钉组并发症发生率明显低于外固定架组,差异有统计学意义(P0.05)。结论 :骶髂螺钉联合经皮耻骨支螺钉在治疗骨盆后环损伤伴前环耻骨支、坐骨支骨折的Tile B型骨盆骨折中具有术后下地时间早、疼痛减轻、并发症少等优点,是一种有效安全的治疗方法,能提高术后肢体功能,且有效减少术后并发症的发生。

Clinical application of percutaneous iliosacral screws combined with pubic ramus screws in Tile B pelvic fracture

Objective: To investigate the application and effect of minimally invasive percutaneous anterior pelvic pubic ramus screw fixation in Tile B fractures.Methods: A retrospective review was conducted on 56 patients with posterior pelvic ring injury combined with fractures of anterior pubic and ischiadic ramus treated between May 2010 and August 2015,including 31 males and 25 females with an average age of 36.8 years old ranging from 35 to 65 years old. Based on the Tile classification,there were 13 cases of Tile B1 type,28 cases of Tile B2 type and 15 cases of Tile B3 type. Among them,26 patients were treated with sacroiliac screws combined with external fixation(external fixator group)and the other 30 patients underwent sacroiliac screw fixation combined with anterior screw fixation(pubic ramus screw group). Postoperative complications,postoperative ambulation time,fracture healing,blood loss,Majeed pelvic function score and visual analogue scale(VAS)were compared between two groups.Results: Fifty-four patients were followed up from 3 to 24 months with a mean of 12 months. There were no significant difference in the peri-operative bleeding and operation time between two groups(P>0.05). The postoperative activity time and fracture healing time of pubic ramus screw group were shorter than those of the external fixator group,the differences were statistically significant(P<0.05). The Majeed score,VAS score of pubic ramus screw group were higher than those of the external fixator group,the differences were statistically significant(P<0.05). The incidence of postoperative complications of pubic ramus screw was lower than that of the external fixator group,the difference was statistically significant(P<0.05).Conclusion: Percutaneous iliosacral screws fixation combined with the pubic ramus screw is an effective and safty treatment method to the Tile B pelvic fracture. It has advantages of early ambulation,relief of the pain and few complications.