微创接骨板内固定治疗不稳定型骨盆骨折的临床疗效观察

目的 探讨微创接骨板内固定（MIPO）治疗不稳定型骨盆骨折的临床疗效。方法 回顾性分析2014年3月至2016年12月河南省南阳市中心医院骨科收治的27例不稳定型骨盆骨折患者资料，所有患者骨盆前环、后环骨折均采用MIPO内固定技术，统计手术时间、术中出血量、透视时间，术后复位质量、术后5～12个月随访骨折愈合及功能恢复情况。结果 27例骨盆骨折患者平均手术时间及术中平均出血量前环分别为：（55.65±10.50）min、（110.50±50.41）mL，后环分别为：（45.83±6.62）min、（135.50±45.10）mL，术中透视时间平均为（1.25±0.81）min，术后第3天复查骨盆X线片及CT三维重建，优良率为88.94%；术后有1例患者手术切口出现感染，经过2次清洗、负压封闭引流（VSD）覆盖，1个月后痊愈；其余患者手术切口均I期愈合，且无内固定松动、断裂，神经损伤等并发症；术后经5～12个月随访，27例患者骨折均获得骨性愈合，双下肢及骨盆功能恢复良好，末次随访时采用Majeed评分标准评定骨盆功能，优良率为100.00%。结论 MIPO内固定技术治疗不稳定型骨盆骨折，具有创伤小、并发症少及固定牢靠等优势，临床可推广使用。

Clinical efficacy observation of minimally invasive plate osteosynthesis in treatment of unstable pelvic fractures

Objective To explore the feasibility and clinical effect of minimally invasive plate osteosynthesis in treatment of unstable pelvic fractures.Methods From March 2014 to Dec 2016, 27 patients with unstable pelvic fracture were treated with minimally invasive plate osteosynthesis. MIPO internal fixation was used in all patients with fracture of the anterior pelvic and posterior rings, at the same time, the operation time, the amount of bleeding, the time of perspective, the quality of postoperative reduction, the healing of fracture and the recovery of function were recorded. Results The average operation time and the mean bleeding volume of 27 cases of pelvic fracture were 55.65±10.50 min and 110.50±50.41 mL in anterior pelvic ring, and the posterior ring was 45.83±6.62 min and 135.50±45.10 mL respectively, and the mean time of intraoperative fluoroscopy was 1.25±0.81 min. The pelvis X-ray and CT 3D reconstruction were reviewed on 3^rd day after operation. The quality of reduction was evaluated according to the Matta radiology evaluation standard, with a good rate of 88.94%. Postoperative incision infection occurred in one patient, whose wound healed after one month after twice cleaning and vacuum sealing drainage coverage, then recovered after one month. All the other patients healed at I stage without complications such as loosening of internal fixation, fracture and nerve injury. All 27 patients were followed up for 5~12months after operation for an average of 7.35±2.40 months. All fractures achieved bony healing. The function of both lower extremities and pelvis recovered well. The pelvic function was evaluated by Majeed score at the last follow-up, and the excellent and good rate achiieved 100.00%.Conclusion The treatment of unstable pelvic fractures with MIPO internal fixation has advantages such as smaller trauma, fewer complications and more reliable fixation. It is a good surgical method worth popularizing in clinical application.