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。

Choices of the internal fixation and approaches on unstable pelvic ring fractures

Objective: To discuss the suitable surgical approach and the internal fixation of unstable pelvic pelvic fractures.Methods: From May 2010 to May 2015,45 patients with unstable pelvic fractures were treated with different approaches and fixations,including 38 males and 7 females with an average age of 45 years ranging from 21 to 61 years. The course was within 2 weeks. According to Young-Burg classification,23 patients were lateral compression injuries,6 patients were vertical shearing injuries,16 patients were anterior-posterior compression injuries. All patients had hip pain and limitation of motion,the X-rays showed the pelvic ring fracture.Results: All wounds healed well without complications,45 cases were followed up for a mean period of 13 months(ranged 9 to 21 months). Patients with hip pain had a good postoperative pain relief. The post-operative X-rays showed the reduction was satisfied and the pelvic ring shaped well. According to Majeed standards,the final follow-up score was 93.5±11.6,35 cases got excellent results,8 were good,2 were fare.Conclusion: The unstable pelvic and acetabular fractures are always with compound injury. Beside the reduction,to decrease the second surgery trauma should take into consideration as well,the intra-articular reduction and the stability of the pelvic were especially valued,so combined the different approach with minimal invasive technique can get good clinical result.