不稳定性骨盆环骨折的手术治疗

目的 探讨开放复位内固定治疗不稳定性骨盆环骨折的方法和效果.方法 2001年10月至2006年10月,对78例不稳定骨盆环骨折患者采用切开复位重建钢板内固定和"C"型臂X线机或CT引导下经皮空心螺钉内固定及TSRH系统固定.按照AO分型:B2型3例,B3型4例,C1型12例,C2型34例,C3型25例.患者入院后均在抗休克、输血等治疗的同时急诊用骨盆外固定架暂时固定复位,以稳定病情、减少出血.伤后7～10 d手术,20例前路手术后1周行后路手术,58例为一期前后路同时手术内固定.后路经皮"C"型臂X线机引导下骶髂复合体空心螺钉固定10例,CT引导下经皮空心螺钉固定20例,切开复位TSRH系统固定48例.手术时间2～5 h,平均3 h.结果 术后浅表感染5例,经换药愈合;深部感染2例,经清创引流愈合.3例术中损伤膀胱行及时修补,2例术后发现膀胱损伤行膀胱造瘘后愈合.发生下肢深静脉血栓6例,经溶栓等保守治疗治愈.术前合并骶丛损伤的患者术后3～6个月功能大部分恢复.术后随访6～60个月,平均30个月,无骨折不愈合.下肢长度差异在10 mm内72例,10～20 mm 6例.复位根据Tornetta和Matta评定标准,优58例,良16例,可4例,优良率94.9%.术后功能按照Majeed评分系统,优45例,良20例,可13例,优良率83.3%.结论 对不稳定性骨盆环骨折患者采用前后环切开复位内固定,稳定性好、并发症少,可使患者早期康复.

Surgical treatment of unstable pelvic ring fractures

Objective To study the clinical outcome of open reduction and internal fixation to unstable pelvic ring fractures.Methods Seventy-eight patients with unstable pelvic ring fractures had been treated by open reduction and internal fixation using reconstruction plates and combined with C-arm or CT guided percutaneous screw fixation or TSRH system fixation.There were 3 cases in type B2,4 cases in type B3,12 cases in type C1,34 cases in type C2,25 cases in type C3.Initial stabilization and treatment protocols were performed.Patients with hemodynamic instability were administered blond and fluid transfusion and an external fixator was applied to control of the osseous instability.Subsequently ORIF was performed when the patient was hemodynamically stable after 7-10 days.58 patients were treated with a one-stage combination of anterior and posterior approach.20 patients underwent internal fixation of both anterior and posterior arch in two stages.Tornetta and Matta criteria and Majeed criteria were used to evaluate the outcomes of reductions and clinical function respectively.Results Complications included of superficial infection in 5 cases and deep infection in 2 cases which were treated successfully with debridement,Iatrogenic bladder rupture in 5 patients, deep vein thrombosis(DVT)in 6 patients.All complications were resolved with appropriate treatments.All patients were followed-up for an average of 30 months(range,6-60 months).There was no cases of nonunion of either the anterior or posterior fracture.Seven patients with neurologic deficiency recovered partially.Leg-length difference was less than 10 mm in 72 cases and 10-20 mm in 6 cases.The outcomes of reductions were evaluated by Tornetta and Matta criteri, .overall there were 58 in excellent, 16 in good,4 in fair reduction, 94.9% of all reductions were excellent or good.The functional outcomes were determined the Majeed score.There were excellent in 45 cases, good in 20, and fair in 13.Excellent or good rat was 83.3%.Conclusion The results are satisfied if unstable pelvic ring fractures are treated by open reduction and internal fixation using reconstruction plates and C-arm or CT guided percutaneous screw fixation or TSRH system.C-arm or CT guided fixation or TSRH technique minimizes blood loss and allows early mobilization.