经皮重建钢板内固定治疗不稳定骨盆后环骨折

目的:探讨应用经皮重建钢板内固定治疗不稳定骨盆后环骨折的方法和临床疗效。方法:2004年3月至2008年10月治疗不稳定骨盆后环骨折36例。男26例,女10例;年龄10～65岁,平均37.3岁。牵引复位后,于双侧髂后上棘外侧顺髂嵴做弧形切口,长3～5cm,在患侧将重建钢板通过皮下隧道到对侧,经皮重建钢板内固定治疗。结果:36例均获得随访,时间12～36个月,平均17.8个月。无切口感染,无术中血管神经损伤,无内固定松动及断裂,无骨不愈合,无明显双下肢不等长。平均切口长度、手术时间、术中出血量分别为(4.36±0.99)cm、(42.61±7.97)min、(168.61±40.44)ml。术后功能恢复根据Majeed评价,优12例,良18例,可6例。结论:经皮重建钢板内固定治疗不稳定骨盆后环骨折操作简单、安全、创伤小、恢复快、并发症少,是治疗不稳定骨盆后环骨折的一种比较理想的手术方法。     

不稳定性骨盆骨折的内固定治疗

目的:探讨不稳定性骨盆骨折手术治疗的临床疗效。方法:自2000年5月至2006年3月手术内固定治疗不稳定性骨盆骨折39例,男25例,女14例;年龄16～61岁,平均38.6岁。根据Tile分型,B1型8例,B2型16例,B3型5例,C1型7例,C2型3例。B型和部分C1型骨折,采用耻骨联合上方弧形切口或经髂腹股沟入路,应用钛合金重建钢板内固定。C1型骨折,主要采用闭合复位,经皮骶髂拉力螺钉内因定。C2型骨折,采用闭合复位,经皮骶髂拉力螺钉内固定,再前方入路内固定。结果:术后随访时间2～68个月,平均18.6个月,骨折愈合时间平均2.4个月。术后并发症:切口感染1例,创伤性湿肺1例,神经牵拉伤1例,均治愈,无死亡病例。按Mears术后影像评定标准:解剖复位31例,复位满意7例,复位不满意1例。按照Majeed的疗效评定标准:优32例,良7例。结论:不稳定性骨盆骨折采用手术内固定,可以有效恢复骨盆的稳定性,远期疗效好,极大地降低其致残率。     

不稳定性骨盆骨折的手术内固定治疗

目的探讨不稳定性骨盆骨折内固定手术治疗的临床疗效.方法41例不稳定性骨盆骨折采用开收复位加内固定手术治疗.前环骨折采用耻骨联合上方弧形切口或经腹股沟入路．应用钛合金重建钢板内固定;后环骨折分别采用骶骨棒、骶髂拉力螺钉固定.结果41例均获随访．时间3～36个月,骨折愈合时间为2．0～3．5（2．5±0．4）个月。疗效评估：优14例,良18例,中8例．差1例.结论不稳定性骨盆骨折采用手术内固定叮以重建有效骨盆稳定性,疗效满意。     

经皮微创内固定治疗不稳定骨盆骨折

目的:探讨经皮微创内固定技术治疗不稳定骨盆骨折的临床疗效.方法:2005年1月至2009年1月,行经皮微创内固定治疗不稳定骨盆骨折48例,男31例,女17例;年龄12～66岁,平均37.8岁.致伤原因:车祸伤29例,高处坠落伤14例,挤压伤5例.骨折类型按Tile分型:B1型4例,B2型3例,C1型25例,C2型14例,C3型2例.48例患者分别采用经皮骶髂螺钉(其中耻骨支螺钉固定16例、耻骨联合螺钉固定4例),重建钢板(其中耻骨支螺钉固定20例、耻骨联合螺钉固定8例)微创内固定治疗.术后通过X线观察患者复位情况并根据Majeed功能评分标准对疗效进行评定.结果:48例患者均获得随访,时间12～39个月,平均17个月.未发生切口感染、血管神经损伤、内固定松动及断裂、骨不愈合等并发症.解剖复位29例,满意复位18例,复位不满意1例.根据Majeed功能评价:优29例,良15例,可4例,优良率为91.7%.结论:经皮微创内固定治疗不稳定骨盆骨折手术创伤小,出血少,术后并发症少,骨折愈合率高,固定可靠,患者功能恢复满意,是治疗骨盆骨折的有效手段,但对操作者要求高.     

前环皮下内置外固定架联合后环骶髂螺钉治疗不稳定骨盆骨折

目的评估应用前环皮下内置外固定架(internal fixation,INFIX)联合后环骶髂螺钉治疗不稳定骨盆骨折的临床疗效。方法2016年8月-2017年9月,采用前环皮下INFIX联合后环骶髂螺钉治疗不稳定骨盆骨折19例。其中男14例,女5例;年龄17~69岁,平均40.6岁。致伤原因:交通事故伤11例,高处坠落伤5例,重物砸伤3例。骨折根据Tile分型,B1型2例,B2型6例,C型11例。前环损伤包括双侧耻骨坐骨支骨折12例,单侧耻骨坐骨支骨折5例,耻骨联合分离2例;后环损伤包括骶髂韧带损伤2例,单侧髂骨骨折3例,单侧骶骨骨折11例,单侧骶髂关节脱位2例,双侧骶骨骨折1例。受伤至手术时间2~11 d,平均6.1 d。记录术中出血量及手术时间,观察骨折愈合情况及术后并发症情况。采用Matta评分标准评价骨折复位情况,采用Majeed评分标准评估患者术后功能。结果患者手术时间为47~123 min,平均61.4 min;术中出血量为50~115 mL,平均61.1 mL。术后1例发生植钉处切口浅表感染,1例发生单侧股外侧皮神经激惹,经相应处理后治愈或症状消失。无泌尿系统、生殖系统及肠道等损伤。所有患者均获随访,随访时间12~25个月,平均18.1个月。术后骨折均愈合,愈合时间8~13周,平均9.5周;无骨折不愈合、延迟愈合,内固定物松动、断裂等情况发生。2例术前腰骶丛神经损伤患者中,1例功能完全恢复,1例残留轻度跛行症状。末次随访时采用Matta评分标准评价骨折复位情况,获优13例、良6例,优良率100%;采用Majeed评分标准评价功能,获优15例、良4例,优良率100%。结论应用前环皮下INFIX联合后环骶髂螺钉治疗不稳定骨盆骨折临床疗效满意,并发症较少,是一种微创治疗骨盆环损伤的有效方法。     

External fixation of unstable pelvic fractures

Summary The Hoffmann external fixator was used to stabilize unstable pelvic fractures in 56 patients with multiple injuries. It was applied under general anaesthesia and the dislocated pelvis reduced and secured with a single tie bar. In 16 cases residual dislocation of less than 1.5 cm was noted after the reduction and the reduced position was maintained in 48 out of 51 cases, a minor redislocation occurred in the remaining 3 patients. Few complications could be attributed to the method, infection was noted in one patient, the iliac crest was fractured in one case and an exostosis of the iliac crest occurred in one youth.Forty-three patients were symptom free with regard to the pelvis at the time of review whereas 5 patients had residual pain and 3 diffuse symptoms.The technique of application is simple but requires two surgeons at the time of reduction and fixation of the pelvis.

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Résumé Les auteurs ont utilisé le fixateur externe d'Hoffmann pour maintenir une fracture instable du bassin chez 56 blessés présentant des traumatismes multiples. Le fixateur a été mis en place sous anesthésie générale et le bassin fracturé réduit et maintenu par une barre simple. Dans 16 cas, il persistait après réduction une disjonction inférieure à 1,5 cm. La position de réduction s'est maintenue dans 48 des 51 cas, tandis qu'un redéplacement modéré s'est produit dans les 3 autres cas. Il n'y a eu qu'un petit nombre de complications dues à la méthode: une infection, une fracture de la crête iliaque et une exostose de la crête iliaque chez un sujet jeune.Quarante-trois blessés ne présentaient aucune séquelle en ce qui concerne le bassin lors de l'examen de contrôle, tandis que cinq signalaient des douleurs résiduelles et trois des troubles divers.Cette technique est de réalisation facile mais elle nécessite la présence de deux chirurgiens pour effectuer la réduction et la fixation du bassin.

     

经皮内固定结合外固定支架治疗垂直不稳定骨盆骨折

目的 探讨内固定结合外固定治疗垂直不稳定骨盆骨折的疗效.方法 采用经皮中空螺钉固定骶髂关节联合外固定支架固定治疗15例垂直不稳定骨盆骨折患者.结果 15例均获随访,时间3～ 32个月,骨折均愈合.Matta影像学评分:优10例,中5例.按照Majeed标准评定疗效:优9例,良5例,可1例.结论 经皮中空螺钉固定骶髂关节联合外固定支架固定治疗垂直不稳定骨盆骨折,创伤小,可以即刻有效恢复骨盆的稳定性.     

切开复位内固定治疗垂直不稳定骨盆骨折

目的探讨切开复位内固定治疗垂直不稳定骨盆骨折的临床疗效。方法28例垂直不稳定骨盆骨折患者在大重量牵引纠正垂直移位后,全部行切开复位内固定,骨盆前环骨折均用重建钢板内固定。结果随访12~48个月,平均23.2个月,均骨性愈合,无下肢不等长,骨盆畸形基本纠正,按刘利民等功能评定标准,优10例,良13例,可5例。结论切开复位内固定治疗垂直不稳定骨盆骨折可取得满意疗效,对前后环骨盆骨折尽可能手术固定。     

骨盆环不稳定性骨盆骨折的手术入路和内固定选择

目的 :探讨在骨盆环不稳定骨盆骨折中手术入路与内固定的选择。方法 :2010年5月至2015年5月,45例骨盆前后环不稳定患者分别采取不同的固定方法及手术入路治疗,男38例,女7例;年龄21~61岁,平均45岁;病程在2周内。按照Young-Burg分型,其中LC型23例,VS型6例,APC型16例。术前患者髋部疼痛,活动受限,摄片示骨盆环断裂骨折移位。结果:术后患者伤口愈合佳,无相关并发症。45例患者术后获得随访,时间9~21个月,平均13个月。术后患者髋部疼痛缓解,X线片示骨盆复位满意,骨盆环形态恢复良好。Majeed功能评分(93.5±11.6)分;结果优35例,良8例,可2例。结论:伴有骨盆环不稳定的骨盆髋臼骨折,往往并发复合伤,手术原则既要考虑减少手术创伤,又要顾及骨折复位,特别要考虑关节内骨折复位和骨盆环的稳定性,所以往往需要切开手术入路和微创手术相结合,才能达到满意的疗效。     

切开复位内固定治疗不稳定骨盆骨折

目的：总结不稳定骨盆骨折手术方法和疗效。方法：入路：前环采用横切口或髂腹股沟切门，后环用骶髂前入路或后入路。固定方法：对于髂骨骨折、耻骨联合分离或耻骨上支骨折，采用钢板固定于髂骨内板、耻骨联合上方或前方和耻骨支上方；对于髂骨后部骨折、骶髂关节分离或骶骨骨折采用前路钢板、后路骶骨棒和骶髂关节螺钉固定。结果：87例病人，随访3个月～5年，97％的病人满意。结论：切开复位内固定是不稳定骨盆骨折的可靠治疗方法，术前应特别重视纠正骨盆骨折内出血。     

Immediate external fixation of unstable pelvic fractures

Immediate external fixation has been proposed as a means of stabilizing severe pelvic fractures to reduce the chance of organ failure and death. Sixty-six patients were admitted from January 1980 through December 1983 with double fractures of the pelvic ring that involved the posterior elements. Twenty-six patients (39 percent) underwent immediate external fixation for instability, and 40 patients (61 percent) with stable fractures were treated with bed rest. The two groups were similar in age, injury severity score, and degree of shock. The mortality rate of the two groups was the same (12 percent), as was the incidence of organ failure. The mean transfusion requirement in the unstable group was greater, but not significantly. Our results were better than those reported in recent studies in which immediate rigid fixation was not used. We conclude that the patient with multiple trauma without unstable pelvic fracture should undergo immediate external fixation to decrease morbidity and mortality rates and limit soft tissue damage.     

不稳定型骨盆骨折的内固定治疗

目的探讨不稳定型骨盆骨折内固定治疗的疗效。方法对48例骨盆骨折患者采用钢板、螺钉等内固定材料进行骨折复位、固定,恢复骨盆前后环的稳定。结果 43例患者获得随访,时间8～24个月。患者均获得骨性愈合,未出现腰腿痛、肢体缩短和跛行等。根据Matta评分标准:优30例,良8例,可3例,差2例,优良率为88.4%。结论手术复位、内固定治疗不稳定型骨盆骨折可以恢复骨盆的正常结构,重建骨盆的稳定性,临床疗效满意。     

可调式骨盆外固定架治疗不稳定性骨盆骨折

2007年3月～2011年1月,我科应用可调式骨盆外固定架治疗不稳定性骨盆骨折48例,临床效果满意,报道如下。1材料与方法1.1器械开口器和钻孔器(见图1):开口器尖部呈三棱锥样,长约1 cm,较     

复合固定技术治疗不稳定性骨盆骨折

[目的] 探讨复合固定技术治疗不稳定性骨盆骨折的疗效.[方法] 2000年1月-2007年6月共收治28例不稳定性骨盆骨折患者.男18例,女10例,年龄22～68岁,平均38岁.按Tile分型:B2型9例,B3型8例,C1型6例,C2型2例,C3型3例.均有不同的合并损伤,28例患者采用复合固定技术进行了手术治疗.[结果] 根据影像学Matta法和功能恢复情况评价,优18例,良7例,可2例,差1例,优良率89%.[结论] 早期外固定为抢救赢取时间,病情平稳后根据情况选择内固定治疗,复合固定技术是治疗不稳定性骨盆骨折的良好方法.     

Triangular vertebropelvine stabilisation of unstable posterior pelvic ring fractures

It is the objective of this investigation to describe the early results (2 years outcome) after triangular vertebropelvine stabilisation (TVPS) of unstable fractures of the posterior pelvic ring. PATIENTS: Between 1.1.1997 and 31.12.2000 35 patients were treated. C1 fractures occurred 9 times (25.7 %), C2 injuries 16 times (45.7 %) and 10 patients suffered fom C3 fractures (28.6 %). The mean age of the injured was 36.6 years (15 to 77 years). 22 patients (62.8 %) were treated with the TVPS. Suffering from a monotrauma, mobilisation with full weight bearing of the injured pelvis was resumed immediately on the first postoperative day. In case of polytrauma mobilisation was continued when the additional injuries allowed so, after 8.8 days on average. RESULTS: After an average of 23.4 months 18 of 22 patients with TVPS were controlled. Radiological criteria as well as quality of life were ascertained. It could be proved, that TVPS offered good reduction and stable retention of the pelvic fractures. 16 patients (89.0 %) suffered from moderate or mild pain, 15 (83.3 %) had slight problems in walking. No restriction in the range of motion of the lumbal vertebral column could be observed. CONCLUSION: The following advantages of the TVPS could be demonstrated: anatomical reduction and stable retention of instable pelvic fractures, full weight bearing from the first day after surgery, and only slight restriction of the quality of life two years after operation     

Medium- and long-term results of open reduction and internal fixation for unstable pelvic ring fractures

Over a 10-year period, 74 patients with unstable pelvic injuries were treated with open reduction and internal fixation. Radiographic and clinical follow-up averaged 71 months (range: 38-141 months). Satisfactory (ie, good and very good) radiographic results were obtained in 90% of patients. Clinical results were superior in patients without associated injuries (P=.05-.001). Most of the complications in this series were due to associated injuries. Sepsis was mostly due to open pelvic injuries and malunion to either lack of patient cooperation or inadequate open reduction and internal fixation. Careful preoperative analysis of the nature of the pelvic injury and selection of the appropriate operative technique for open reduction and internal fixation result in a satisfactory outcome for the majority of operative patients.     

Anterior internal fixation to treat vertical unstable pelvic fracture

With the Chinese development of industry, agriculture and communication, various traffic and work related accidents are increasing, leading to an increase in pelvic fractures. Among the different kinds of fractures, pelvic fracture is the third largest cause of death.1 The treatment of pelvic fractures is a “hot spot” and a difficult point in orthopedic surgery. Since 1998 we have treated 20 patients with vertical unstable pelvic fracture using anterior internal fixation. Satisfactory results have been obtained.     

Computed tomography-guided fixation of unstable posterior pelvic ring disruptions.

Open reduction and internal fixation (ORIF), the current treatment of choice of posterior pelvic ring disruptions with instability, has significant disadvantages. These include relatively "blind" placement of the fixation screws, infection, exsanguinating hemorrhage, and high wound complication rates. We feel fluoroscopy does not offer significant clarity in defining the posterior structure. Advantages of computed tomography (CT)-guided sacral fixation are direct visualization of the course of the screws and absence of significant wound complications. This technique provides superior visualization of the nerve roots and sacral canal compared to fluoroscopic methods. Thirteen patients (10 unilateral and 3 bilateral) with unstable but reducible sacral fractures or sacroiliac joint (SIJ) disruptions underwent CT-guided posterior pelvic ring fixation using a cannulated screw system. Skeletal traction was required intraoperatively in one case by a traction-counteraction pulley system in the CT scanner. All other reductions were performed by preoperative skeletal traction or manually by the surgeons after anesthesia in the scanner or after push-pull films demonstrated instability. The guide pin, using depth and angulation measurements derived from the scout CT scans, was positioned across the fracture or SIJ. Following CT confirmation of the position of the pin, the screw tract was drilled and the cannulated screw was placed into position. Radiographic and clinical follow-up observation (7-24 months) showed healing with no significant complications in all 13 patients. Computed tomography-guided sacral fixation is a safe alternative to ORIF in selected patients with reducible unstable pelvic fractures.     

不稳定骨盆骨折内外固定的生物力学研究进展

骶髂关节的解剖生物力学机制以及邻近软组织的结构十分复杂，其复杂的运动包括同时在三维平面上的等于或小于3。的旋转和等于或小于2mm的移位，非直线性的运动轴线主要随着关节表面形态的变化而改变。骶髂关节的功能障碍和骨折移位的传统分型过于简单。骶髂关节有机系统的特殊功能是传递和分散机械力量，临床的治疗在于提高附近软组织的稳定性、减少因不良位置及在髂骨基底水平使用固定器械而带来的应力及应变。