创伤性耻骨联合分离合并骶髂复合体损伤的手术治疗

目的:探讨创伤性耻骨联合分离合并骶髂复合体损伤适应证、手术方法及疗效。方法:2002年3月-2004年6月,对20例创伤性耻骨联合分离合并骶髂复合体损伤患者,采用前路切开复位重建钢板内固定治疗耻骨联合分离和后路在CT引导下经皮空心拉力螺钉固定治疗骶髂复合体损伤。男12例,女8例;年龄18～65岁,平均42.6岁。通过影像学检查明确20例患者有34侧骨盆骶髂复合体损伤。按照AO骨盆环损伤方法分型:B型8例,其中B2型5例,B3型3例;C型12例,其中C1型4例,C2型5例,C3型3例。结果:20例均获随访,随访时间4～21个月,平均14.2个月。平均入院后第8天手术。前路手术时间平均150min,后路手术时间平均60min。前路术中平均失血200ml,后路术中平均失血30ml。20例共置入骶髂螺钉34枚。术后3周患者可扶双拐下地行走,3～4个月可完全负重行走,并逐渐恢复体力劳动。未发生神经损伤及螺钉断裂现象。耻骨联合分离患者术后影像学显示解剖学形态完全恢复,耻骨联合间隙<2cm。结论:前环耻骨联合分离时要考虑可能有后环骶髂复合体损伤存在。耻骨联合分离与骶髂关节损伤应分别根据具体情况采用相应的固定术式。

Operative treatment of traumatic diastasis of pubic symphysis combined with sacroiliac joint injury

Objective:To explore the indication,operative procedure and the result of treatment for traumatic diastasis of pubic symphysis combined with sacroiliac joint injury.Methods:From March 2002 to June 2004,20 patients with traumatic diastasis of pubic symphysis combined with sacroiliac joint injury were treated with reconstruction plate fixation through anterior approach and sacroiliac screws fixation through posterior approach under CT-guidance.Among them,12 patients were male and 8 patients were female,the age ranging from 18 to 65 years with the mean of 42.6 years.All the 20 patients had 34 sides of unilateral or bilateral injuries of the sacroiliac complex by radiology.According to the classification of AO system,there were 5 cases of B2,3 of B3,4 of C1,5 of C2 and 3 of C3.Results:All the patients were followed up from 4 to 21 months with the mean of 14.2 months.Operation was executed at the average of 8th day after admission.The average of anterior operation time was 150 minutes and the posterior was 60 minutes.The average bleeding of anterior and posterior operation were 200 ml and 30 ml respectively.A total of 34 screws were fixed in 20 cases.The patients could ambulate with amb-crutch at 3 weeks after operation and walk with full weight loading at 3-4 months after operation.There were no nerve injuries and breakage of the screws in the study.The function of the sacroiliac joint and lower extremities recovered nearly.The anatomic configuration of diastasis of the symphysis pubis recovered completely.The articulation space of pubis was minor(below 2 cm).Conclusion:The diastasis of pubic symphysis and sacroiliac joint injury may occur simultaneously,for these injuries,we ought to adopt suitable fixation according to specific circumstance.