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。     

骨盆骨折合并尿道损伤的处理

目的 探讨骨盆骨折合并后尿道损伤的治疗方法和疗效.方法 自2004年1月～2009年6月收治骨盆骨折合并后尿道损伤36例,尿道撕裂伤23例,断裂伤13例.骨盆骨折采用下肢牵引治疗9例,单纯骨盆前环外固定架固定13例,重建钢板内固定9例,骨盆前环内、外固定架+骨盆后环内固定5例.结果 36例均获得随访,随访时间10个月～4.5年.骨折愈合率为100%,继发骨盆畸形7例,25例拔除尿管后不能自行排尿,需行尿道扩张术.2例男性患者出现性功能不全,无一例发生尿失禁.结论 骨盆骨折合并后尿道损伤恢复并维持有效的血液动力学指标后,应尽早修复损伤尿道,能提高救治成功率;通过骨盆环复位固定,减小尿道吻合处及周围组织张力,提高尿道损伤修复术后通畅率.     

重建钢板内固定治疗Tile C型骨盆骨折

目的探讨前路或前后联合人路重建钢板内固定治疗Tile C型骨盆骨折的疗效。方法2006年6月至2009年6月,采用前路或前后联合入路重建钢板内固定治疗骨盆骨折24例,均为Tile C型,其中C1型8例,C2型2例,C3型14例。结果无围手术期死亡病例,24例切口均Ⅰ期愈合,无感染、血管神经损伤及内固定失败等并发症。全部病例随访10～46月,平均23．5月。所有患者术后8-12周可完全负重行走,骨折愈合时间为8-18周,平均14周。根据Majeed骨盆功能评分,本组优17例,良3例,可4例,优良率83．3％。结论前路或前后联合入路重建钢板内固定可较好的重建骨盆的稳定性,能获得良好的功能康复,是治疗TileC型骨盆骨折较理想的方法之一。     

重建钢板经髂后上棘骨内置入内固定治疗不稳定骨盆骨折

目的评价重建钢板经髂后上棘骨内置入内固定治疗不稳定骨盆骨折后环损伤的临床疗效。方法应用重建钢板经髂后上棘骨内置入内固定治疗不稳定骨盆骨折后环损伤28例,同期处理骨盆前环损伤。结果 24例获得随访12~42个月。按Tornetta等骨盆骨折复位标准,优良率83.3%;按Majeed疗效评价标准,优良率87.5%。结论经髂后上棘骨内置入重建钢板重建骨盆后环力学稳定性好、适应证广、操作简便、损伤小,可获得良好的临床疗效。     

切开复位内固定治疗桶柄样骨盆骨折

目的 探讨桶柄样骨盆骨折手术治疗方法,以提高桶柄样骨盆骨折的治愈率。方法切开复位内固定治疗56例桶柄样骨盆骨折。骨盆前环：经Pfannenstiel入路固定24例,其中9例予以1块骨盆重建钢板固定,骨盆重建钢板固定结合耻骨上支髓内螺钉固定9例,6例予以2块骨盆重建钢板固定;Pfannenstiel入路结合部分髂腹股沟入路予以1块骨盆重建钢板固定32例。骨盆后环：39例经患侧髂嵴入路以骨盆重建钢板固定,10例骶骨骨折经皮骶髂关节螺钉固定,7例未行后骨盆固定。结果56例均获随访,时间12—32（18±3．5）个月,骨性愈合时间5～9（6±1．2）个月,无下肢不等长,骨盆畸形基本纠正。按Majeed疗效评定标准：优38例,良14例,可1例,优良率为92．9％。结论前后联合人路,切开复位内固定治疗桶柄样骨盆骨折可以取得满意效果。     

重建钢板内固定治疗不稳定性骶骨骨折

目的 介绍重建钢板内固定治疗骶骨不稳定性骨折。方法 22例骶骨骨折在大重量骨牵引纠正骶骨垂直移位的情况下，采用2块重建钢板并排内固定治疗，对合并骨盆前环骨折同时前路内固定稳定骨盆，有骶神经损伤的病例进行神经探查减压。结果 随访12～36个月，骶骨骨折均骨性愈合，骨盆无明显畸形发生，双下肢等长。合并骶丛神经损伤的10例中，9例神经功能完全恢复，仅1例功能恢复欠满意。结论 应用重建钢板内固定治疗骶骨骨折是目前较为理想的一种方法。     

垂直不稳定型骨盆骨折的手术治疗(附84例报告)

目的　探讨垂直不稳定型骨盆骨折分型与切开复位内固定的关系 ,为临床内固定的选择提供依据 ,提高垂直不稳定型骨盆骨折的治愈率。方法　 8年来切开复位内固定治疗 84例垂直不稳定型骨盆骨折。其中 :Ⅰ型 13例、Ⅱ型 2 5例、Ⅲ型 5例、Ⅳ型 13例、Ⅴ型 2 0例、Ⅱ并Ⅳ型 8例。Ⅰ、Ⅱ、Ⅲ型前入路T形钢板或骨盆重建钢板固定 ,Ⅲ、Ⅳ、Ⅴ型和Ⅱ加Ⅳ型选择后入路π棒、骶骨棒或松质骨空心拉力螺丝钉固定。 18例前环骨折予耻骨上支髓内空心拉力螺丝钉或骨盆重建钢板固定。结果　平均随访 18个月。皆骨性愈合 ,无下肢不等长 ,骨盆畸形基本纠正。治愈率达 92 9%。结论　只有根据骨折分型和患者的具体情况 ,选择适当的手术入路和内固定器械 ,垂直不稳定型骨盆骨折的治疗方能取得满意效果。对前骨盆骨折尽可能手术固定。     

后环内固定加前环外固定治疗不稳定性骨盆骨折

目的探讨骨盆后环内固定术加前环外固定支架固定术治疗不稳定性骨盆骨折的疗效。方法 2005年1月至2008年7月共治疗不稳定性骨盆骨折17例,男14例,女3例,年龄16~57岁,平均34岁。腹股沟处骨折端外露1例,合并盆腔脏器损伤5例,股动脉损伤后血栓1例,腰骶神经损伤5例,下肢骨折4例,胸部外伤1例。均行快速复苏,12例同时行骨盆骨折外固定支架外固定术,复苏后行后环切开复位内固定术、继续前环外固定支架固定治疗;5例复苏后行后环切开复位内固定术、同时行前环外固定支架固定治疗。结果随访6~48个月,平均20.6个月,按照Co le等骨盆骨折效果评分表进行功能评价,17例中功能恢复优12例,良3例,可2例,差0例,优良率88.2%。无死亡病例,无切口感染,有2个钉道感染,无医源性损伤,腰骶神经损伤完全恢复3例,部分恢复2例。结论采取后环内固定术加前环外固定支架固定术治疗骨盆不稳定性骨折,可以获得稳定固定,疗效可靠,且手术操作简单、安全,创伤小、并发症少。     

前环固定结合后环TSRH固定治疗不稳定性骨盆骨折

目的总结骨盆骨折的治疗经验。方法回顾性总结了2001~2004年收治的资料完整的B型及C型骨盆骨折68例,治疗采用前环重建钢板、或耻骨空心螺钉固定,后环采用TSRH固定。结果68例获平均18个月随访,均骨性愈合,骨盆畸形均得以纠正,无下肢不等长,治愈率为94·5%。结论不稳定性骨盆骨折在固定前环的同时,还应进行后环的固定,TSRH在骨盆后环的固定中有较好的疗效,适用于B型骨盆骨折及C型、C型和C型骨盆骨折的内固定治疗。     

骨盆骨折合并会阴损伤的治疗

目的探讨骨盆骨折合并会阴损伤的治疗。方法13例会阴裂伤一期清创,骨盆环骨折内固定或外固定架临时固定、二期内固定。结果无一例死亡,会阴损伤愈合良好,无感染瘘道、大小便失禁、肛门和阴道狭窄等;骨盆骨折根据Majeed疗效评价标准:优10例,良3例。结论骨盆骨折合并会阴损伤,早期清创、止血、修复、固定骨盆能降低死亡率、减少并发症。     

Total pelvic clearance for advanced pelvic malignancy

Objective:  Advanced pelvic tumours require multidisciplinary care to improve outcome. This is an audit of one specialist unit's experience.
Method:  Consecutive patients referred from 2001 to 2005 for consideration of pelvic clearance were evaluated by retrospective review.
Results:  Of 100 patients assessed, 55 were considered unsuitable for surgery. Exclusions included unresectable pelvic side-wall disease (25), widespread disease (23) and severe co-morbidity (7). Forty-five patients were operated on; 22 had locally advanced disease, 14 had recurrence and nine had residual disease following previous surgery. The primary cancers were colorectal in 24, gynaecological in 10 and urogenital in 10; one patient had non-neoplastic disease. Preoperatively 39 (87%) had examination under anaesthetic (87%) and all had MR and CT imaging. Neoadjuvant radiotherapy and chemotherapy was given in 27 and 18 patients respectively. Following resection by a multi-speciality team, surgery was considered curative in 40 (90%) of cases as judged by a histologically negative margin. All patients received level 2 care postoperatively with only two requiring level 3 care. There was no 30-day mortality but there were 17 complications treated conservatively and five that required surgery.
Conclusion:  Advanced pelvic tumours require careful multidisciplinary assessment and treatment. This study shows that this can be performed safely with high levels of histological clearance of tumour.     

Relative pelvic version: an individualized pelvic incidence-based proportional parameter that quantifies pelvic version more precisely than pelvic tilt

Background Context

Pelvic tilt (PT) is used as an indicator of pelvic version with increased values indicating retroversion and disability. The concept of using PT solely as an absolute numerical value can be misleading, especially for the patients with pelvic incidence (PI) values near the upper and lower normal limits. Relative pelvic version (RPV) is a PI-based individualized measure of the pelvic version. Relative pelvic version indicates the individualized spatial orientation of the pelvis relative to the ideal sacral slope as defined by the magnitude of PI.

早期腹膜外骨盆填塞联合外固定支架治疗血流动力不稳定骨盆骨折

目的 探讨早期运用腹膜外骨盆填塞术联合骨盆外固定支架治疗血流动力不稳定骨盆骨折的临床疗效.方法 2004年12月至2009年12月,运用早期腹膜外骨盆填塞术联合骨盆外固定支架固定治疗15例血流动力不稳定骨盆骨折患者,男6例,女9例;年龄38～56岁,平均（44.0±1.2）岁.骨折根据Tile分型：B1型3例,B2-2型2例;C1-1型1例,C1-2型2例,C1-3型2例,C2型3例,C3型2例.15例患者均伴有低血容量性休克,且均采取急诊骨盆外固定支架固定与腹膜外骨盆填塞术.结果 15例患者术后的红细胞输注单位数与术前相比显著减少,血红蛋白、红细胞压积及收缩压与术前相比显著升高,差异均有统计学意义（P〈0.05）;脉率与术前相比差异无统计学意义（P〉0.05）.手术时间为30～40 min,平均（32.0±2.6）min.5例患者术后死亡,死亡时间为术后1～7 d,平均（72.0±4.2）h.在收缩压、脉率、血红蛋白、损伤严重程度评分、红细胞压积、红细胞输注单位数等方面,死亡患者与存活患者相比差异均无统计学意义（P〉0.05）.但在年龄和受伤至手术时间方面差异有统计学意义（P〈0.05）.结论 对于血流动力不稳定骨盆骨折患者,尤其是伴有低血容量性休克者,急诊行腹膜外骨盆填塞术联合骨盆外固定支架固定可以有效控制骨折端与骶前静脉丛的广泛渗血,明显改善患者的血流动力学参数,并可显著降低患者的死亡率.     

Emergent pelvic fixation in patients with exsanguinating pelvic fractures

BACKGROUND: An alternative to embolization or external pelvic fixation (EPF) in patients with multiple pelvic fractures and hemorrhage is a pelvic orthotic device (POD), which may easily be placed in the resuscitation area. Little published information is available about its effectiveness. This study evaluated the efficacy of the POD compared with EPF in patients with life-threatening pelvic fractures. STUDY DESIGN: We evaluated patients with blunt pelvic fractures over a 10-year period. Inclusion required multiple pelvic fractures with vascular disruption and severe retroperitoneal hematoma, open book fracture with symphysis diastasis, or sacroiliac disruption with vertical shear. Patients with EPF were compared with those in whom a POD was used. Outcomes included transfusions, hospital stay, and mortality. RESULTS: There were 3,359 patients with pelvic fractures who were admitted: 186 (6%) met entry criteria; 93 had EPF and 93 had POD. There were no differences in age or shock severity. Both 24-hour (4.9 versus 17.1 U, p < 0.0001) and 48-hour transfusions (6.0 versus 18.6 U, p < 0.0001) were reduced with POD. Twenty-three percent of each group underwent pelvic angiography, and 24-hour transfusion amounts for those patients were also reduced with POD (9.9 versus 21.5 U, p < 0.007). Hospital length of stay (16.5 versus 24.4 days, p < 0.03) was less with POD. Although there was decreased mortality with POD (26%) versus EPF (37%), it was not statistically significant (p=0.11). CONCLUSIONS: The therapeutic shift to POD has substantially reduced transfusion requirements and length of hospital stay, and has reduced mortality in patients with unstable pelvic fractures. POD has made a major contribution to the care of critically injured patients with the most severe pelvic fractures.