经皮螺钉固定与传统切开钢板固定治疗耻骨支骨折的比较

文题释义：经皮螺钉固定：是近年来一种新兴的微创技术，主要是在透视成像的辅助下闭合复位骨折端，并使用合适直径的螺钉将骨折端固定。相较于传统切开复位钢板固定，具有创伤小、术后恢复快等优点。 耻骨支骨折：是骨盆前环骨折的一种，随着生物力学的发展，人们逐渐认识到骨盆前环稳定的重要性。早期固定耻骨支骨折有利于骨盆环的稳定，同时减缓患者的疼痛，改善患者生活质量。 背景：耻骨支骨折是骨盆前环损伤的常见的损伤类型，固定耻骨支骨折能够降低骨盆后环固定系统的应力水平，减少耻骨联合的分离，有利于骨盆环的稳定。经皮螺钉固定与传统切开钢板固定均可用于固定耻骨支骨折，但目前文献中没有足够的证据表明哪种方法更具优势。 目的：比较经皮螺钉固定与传统的切开复位钢板固定治疗耻骨支骨折的疗效。 方法：将2014年1月至2018年12月安徽医科大学第二附属医院收治的65例符合标准的拟行手术固定的耻骨支骨折患者纳入研究，随机分为2组，经皮螺钉固定组33例，切开复位钢板固定组32例。所有患者对治疗方案均知情同意，且得到医院伦理委员会批准。2组患者例数、性别、年龄、骨折分型、美国麻醉医师协会分级等一般资料对比差异均无显著性意义。记录2组患者手术时间、总出血量、术后输血例数、切口长度、术后至出院时间及并发症发生情况；评估患者术后Matta复位评分、手术前后目测类比评分以及随访时Majeed评分。 结果与结论：①2组各有30例患者获得有效随访，经皮螺钉固定组随访8-59个月，切开复位钢板固定组随访8-57个月；②经皮螺钉固定组手术切口更小，切口感染率低，出血更少，术后住院时间更短(P < 0.05)；③2组术后的目测类比评分均较术前显著降低(P < 0.05)，其中术后3 d时经皮螺钉固定组的目测类比评分较切开复位钢板固定组更低(P < 0.05)，术后6个月时2组目测类比评分差异无显著性意义(P > 0.05)；④虽然经皮螺钉固定组Matta评分影像学复位的优良率低于切开复位钢板固定组，但2组间差异无显著性意义(P > 0.05)；⑤术后6个月时2组Majeed评分差异无显著性意义(P > 0.05)；⑥说明经皮螺钉固定能取得与传统钢板固定一样良好的疗效，且相对于传统钢板固定具有创伤小、术后恢复快等优点。 ORCID: 0000-0002-5888-3665(李家乐) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Percutaneous screw fixation versus traditional plate fixation for treating pubic branch fracture

BACKGROUND:Fracture of the pubic branch is a common type of anterior pelvic ring injury.Fixation of the pubic branch fracture can reduce the stress level of the posterior pelvic ring fixation system and reduce the separation of the pubic symphysis,which is beneficial to the stability of the pelvic ring.Both percutaneous screw fixation and traditional open reduction and internal fixation can be used to fix pubic branch fractures,but which method is better has not been confirmed.OBJECTIVE:To compare the efficacy of percutaneous screw fixation with conventional open reduction and plate fixation for pubic branch fracture.METHODS:Sixty-five patients of pubic branch fracture undergoing the surgical treatment at the Second Hospital of Anhui Medical University between January 2014 and December 2018 were included.The patients were randomly divided into percutaneous screw fixation group(n=33)and open reduction and plate fixation group(n=32).The patients signed the informed consents and the study was approved by the ethics committee of the hospital.The number of cases,sex,age,fracture classification,and American Society of Anesthesiologists score had no significant difference between two groups.The operation time,total blood loss,postoperative transfusion cases,incision length,postoperative discharge time and complications in both groups were recorded.Postoperative Matta score,Visual Analogue Scale score before and after surgery,and Majeed score during follow-up were recorded.RESULTS AND CONCLUSION:(1)Thirty patients in both groups were followed up,which was 8-59 months in the percutaneous screw fixation group,and 8-57 months in the open reduction and plate fixation group.(2)The percutaneous screw fixation group had smaller incision,lower incision infection rate,less bleeding,and shorter postoperative hospitalization time(P<0.05).(3)Postoperative Visual Analogue Scale scores in both groups were decreased compared with the baseline levels(P<0.05).The scores at postoperative 3 days in the percutaneous screw fixation group were significantly lower than those in the open reduction and plate fixation group(P<0.05).The scores at postoperative 6 months were insignificant difference between two groups(P>0.05).(4)The excellent and good rate of Matta score in the percutaneous screw fixation group was less than that in the open reduction and plate fixation group,and the difference was insignificant(P>0.05).(5)There was no significant difference in the Majeed score at postoperative 6 months between two groups(P>0.05).(6)Our results indicate that percutaneous screw fixation can achieve the same good effect as traditional plate fixation,and has the advantages of less trauma and faster postoperative recovery compared with traditional plate fixation.