不稳定骨盆骨折的手术治疗

目的 总结不稳定骨盆骨折手术治疗的临床效果.方法 回顾性研究2002年1月至2008年1月手术治疗、病历资料完整、受伤至手术时间在60 d以内,并获得随访的83例不稳定骨盆骨折患者资料.按照Tile骨盆骨折分型:B型35例,其中B1型17例,B2型11例,B3型7例;C型48例,其中C1型34例,C2型9例,C3型5例.66例患者伴有合并伤.25例伴有骶骨骨折:1区5例,2区16例,3区4例.合并髋臼骨折23例.12例患者因血流动力学不稳定而行急诊抢救.所有患者根据骨折类型及伤情分别采用单纯前环固定(17例)、单纯后环固定(29例)及前后环同时固定(37例)治疗.最终随访时采用Majeed评分和Harris评分评定疗效.本组患者受伤至手术时间平均12.0 d(0～51 d).结果 1例患者在住院期间死亡,其余82例患者术后获平均3.3年(1.0～7.1年)随访.术后82例患者Majeed评分平均87.5分(51～100分),其中优54例,良22例,可4例,差2例,优良率为92.7%;Harris评分平均91.1分(50～100分),其中优59例,良17例,可1例,差5例,优良率为92.7%.合并髋臼骨折行手术治疗的17例患者,14例效果优良.19例腰骶丛神经损伤患者,11例基本恢复,5例不完全恢复,3例无恢复.医源性神经损伤10例,9例完全恢复,1例不全恢复,仍残存足踝背伸力弱.3例发生内固定失效. 结论 手术治疗不稳定骨盆骨折可获得良好疗效,合并严重腰骶丛神经损伤、固定失效及合并髋臼骨折会影响最终疗效.

Operative treatment of unstable pelvic ring fractures

Objective To evaluate the operative treatment for patients with unstable pelvic ring fractures. Methods A retrospective study was done for the 83 patients with unstable pelvic ring fractures who had received operative treatment from January 2002 to January 2008 and complete follow-up. The duration from injury to operation averaged 12. 0 (0 to 51) days in this group. According to Tile classification, there were 35 cases of type B (B1: 17; B2: 11; B3: 7) and 48 type C (C1: 34; C2: 9; C3: 5). Sixty-six patients had associated injuries. Twenty-five cases were complicated with sacral fractures (Denis Ⅰ: 5; Denis Ⅱ: 16; Denis Ⅲ: 4), and 23 patients with acetabular fractures. Twelve hemodynamically unstable patients received resuscitation. Simple anterior ring fixation was applied in 17 patients, simple posterior ring fixation in 29 patients and combined anterior and posterior fixation in 37 patients. The functional outcome was evaluated using Majced and Harris scores. Results One patient died during the early postoperative period. The mean follow-up was 3.3 (1.0 to 7.1) years for the other 82 patients. At the time of final follow-up, the mean Majeed score was 87.5 (51 to 100). The clinical outcome was excellent in 55 patients, good in 22, fair in 4 and poor in 2. The overall good to excellent rate was 92. 7%. The mean Harris score was 91.1 (50 to 100) . The clinical outcome was excellent in 59 patients, good in 17, fair in 1 and poor in 5. The overall good to ex-cellent rate was 92.7%. Of the 17 cases with associated acetabular fractures that were operatively treated, 14 were graded as good and excellent. Of the 19 patients with associated lumbosacral plexus injury before oper-ation, 11 obtained full recovery, 5 partial recovery and 3 no recovery. Of the 10 cases with iatrogenic nerve injury, 9 obtained full recovery and 1 partial recovery with residual weakness of foot and ankle dorsiflexion.Implant failure occurred in 3 cases. Conclusions Good clinical results can be expected with operative treatment for unstable pelvic ring fractures. Severe lumbosacral plexus injury, implant failure and associated acetabular fracture are risk factors for an unsatisfactory clinical result.