经皮空心螺钉治疗累及骨盆环骨折21例临床分析

目的:评价C型臂引导下经皮空心螺钉治疗累及骨盆环骨折的临床安全性及疗效。方法:回顾分析应用经皮空心螺钉治疗骨盆环骨折21例,空心螺钉直径均为6.5 mm。单纯前环单侧骨折4例、双侧骨折5例;前后环均破坏中,一侧骶骨骨折脱位合并同侧或对侧耻骨上下支骨折7例,合并耻骨联合分离2例,合并双侧耻骨上下支骨折3例。骶骨骨折脱位除1例用2枚螺钉外,其余均用1枚螺钉固定,耻骨上支用1枚螺钉,耻骨联合分离用1枚螺钉。结果:手术时间20~50 min,平均30 min,术后21例均获得随访,时间1~14个月,平均10个月。所有患者均无医源性神经损伤,除1例骶髂关节骨折脱位合并耻骨联合分离螺钉欠佳外,其余螺钉位置良好,未见螺钉移位现象。该例患者出现生理负荷下骶髂部疼痛,行走有跛行。结论:C型臂X线机引导下经皮空心螺钉治疗累及骨盆环骨折,是一种安全、有效、微创的方法。

Clinical study of percutaneous cannulated screw fixation for pelvic ring fracture: an analysis of 21 cases

Objective:To evaluate the clinical safety and efficacy of percutaneous cannulated screw guided by C-arm X-ray machine in the management of pelvic ring fractures.Methods:21 cases suffered pelvic ring fracture were retrospectively analyzed,who accepted percutaneous cannulated screws fixation.The diameter of hollow screw was 6.5 mm.There were 4 cases suffered anterior ring fracture of unilateral,5 cases suffered bilateral fractures,7 cases suffered unilateral sacral fracture-dislocation combined with ipsilateral or contralateral superior and inferior pubic fracture,2 cases suffered symphysiolysis of symphysis pubis,3 cases suffered bilateral upper and lower pubic fracture.Apart from one case of sacral fracture-dislocation used two screws on the operation,the rest of cases were fixed with one screw,superior ramus of pubis used one screw,sacral fracture-dislocation used one screw.Results:The operating time was 20-50 minutes,averaging of 30 minutes.All of cases were followed up for 1-14 months,averaging of 10 months.There were no iatrogenic nerve injury happened in patients,however,one screw in the case of sacroiliac joint fracture-dislocation combined with diastasis of symphysis pubis displaced,other screws were fixed in good location.The patient would complain sacroiliac pain from physiological load with walking limp.Conclusion:The treatment of percutaneous cannulated screw guided by C-arm X-ray machine for pelvic ring fractures is a safe,effective and minimally invasive approach.