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。

Diagnosis and Treatment of Rotately and Vertically Unstable Pelvic Fracture

Objective To discuss the diagnosis and treatment of rotately and vertically unstable pelvic fracture. Methods 18 cases with rotately and vertically unstable pelvic fracture were retrospectively reviewed. 10 cases were treated conservatively. 8 cases were treated with operation, Anterior ring of pelvis were treated with ORIF. 4 cases who had pubic bone fractures were treated with double plate fixation. Of posterior ring of pelvis fractures, 6 cases were treated with open reduction and double plate fixation, 2 cases were treated with close reduction and CT-assisted lag screws fixation. Results 18 patients were followed up from 6 months to 3 years. Among 10 patients who were treated conservatively, all patients had deformity of pelvis, 6 cases left behind the pain of sacroiliac joint, 3 cases felt anaesthesia on lower limbs, 2 cases had a claudication. While 8 patients who were treated with ORIF and CT assisted reduction and lag screws fixation were completely recovered. The appearance of pelvis and function of lower limbs were satisfying. Conclusion The patients with rotately and vertically unstable pelvic fracture should be treated with operation. Because of the operation is simple, minimal invasive and effective, CT assisted reduction and percutaneous cannulated lag screws fixation has a good prospect on the treatment of posterior ring injury of pelvic.