椎弓根螺钉式置钉法在骨盆骨折中的应用

目的：比较椎弓根螺钉式置钉法与常规钻孔置钉法治疗骨盆骨折的效果。方法2005年2月～2013年1月，急诊行外固定架固定骨盆骨折合并休克28例，骨盆骨折AO/OTA分型：B1型1例，B2型6例，B3型8例，C1型8例，C2型4例，C3型1例。每侧髂骨置钉2枚，左侧用电钻钻孔法置钉（对照组），右侧用椎弓根螺钉式置钉法（观察组）。对比2组手术时间、钉道的准确性、术后螺钉松动、感染发生率。结果术后死亡2例，26例随访2个月～6年。与左侧对照组比较，右侧观察组手术时间短[（4．8±2．1） min vs．（11．2±2．8） min， t＝-8．834， P＝0．000]，孔深3 cm、5 cm时钉道穿透少[1．8％（1/56） vs．19．6％（11/56），χ2＝9．333， P＝0．002；10．7％（6/56） vs．33．9％（19/56），χ2＝8．703， P＝0．003]，术后钉周感染少[9．6％（5/52） vs．30．8％（16/52），χ2＝7．220， P＝0．007]，2组螺钉松动发生率差异无显著性（P＞0．05）。结论椎弓根螺钉式置钉法具有手术时间短、准确性高、术后并发症少的优点。

Application of Pedicle Screw Placement Method for Pelvic Fractures

Objective To compare the use of pedicle screws and conventional drilling screws in the treatment of pelvic fractures. Methods From February 2005 to January 2013, 28 cases of pelvic fractures complicated with shock were given emergency external fixation .The AO/OTA classification of pelvic fracture was：1 case of type B1, 6 cases of type B2, 8 cases of type B3, 8 cases of type C1, 4 cases of type C2, and 1 case of type C3.Two screws were placed in each iliac bone .The screws were inserted via a drilling hole in the left side （ control group ） , while by pedicle screwing in the right side （ observation group ） .The operation time , the accuracy of the screwing , screw loosening rate , and postoperative infection rate were compared between the two groups. Results After operation, 2 patients died.The remaining 26 patients were followed up for 2 months to 6 years.The operation time was significantly shorter in the observation group than in the control group [（4.8 ±2.1） min vs.（11.2 ±2.8） min, t=-8.834, P=0.000].The screw penetration at depth of 3 cm and 5 cm was significantly fewer in the observation group than in the control group [1.8%（1/56） vs.19.6% （11/56）, χ2 =9.333, P=0.002;10.7% （6/56） vs.33.9% （19/56）, χ2 =8.703, P=0.003].The local infection rate was significantly lower in the observation group than in the control group [9.6% （5/52） vs. 30.8% （16/52）,χ2 =7.220, P=0.007].Rate of screw loosening had no significant difference between the two groups （P〉0.05）. Conclusion Pedicle screw placement method has high accuracy , short operation time , and low postoperative complication rate .