微创Legacy椎弓根螺钉系统治疗Tile C型骨盆骨折

目的 探讨应用微创Legacy椎弓根螺钉治疗Tile C型骨盆骨折的可行性并评价其疗效。 方法 自2008年1月至2010年3月选择性采用微创Legacy椎弓根螺钉治疗12例Tile C型骨盆骨折患者，其中男7例，女5例；年龄21 ～60岁，平均39.6岁。均为闭合性Tile C型骨折。骨盆后环损伤均为骶骨骨折；骨盆前环损伤类型为单侧耻骨坐骨支骨折4例，双侧耻骨坐骨支骨折8例。合并休克3例。前环采用微创技术重建带内固定术，后环采用微创Legacy椎弓根螺钉固定术。 结果 手术时间80 ～ 110 min,平均90 min；术中失血80 ～ 150 ml，平均105 ml。12例患者均获随访6 ～ 32个月，平均18个月。所有患者复位满意，骨折Ⅰ期愈合，愈合时间9～13周，平均11.5周。无伤口感染、内固定失败、神经损伤等并发症。参照Lindahl改良的骨盆损伤后功能评定标准：优10例，良2例，平均得分78.6分。 结论 在良好掌握手术适应证的前提下，利用微创技术Legacy椎弓根螺钉固定后环和重建带固定前环治疗Tile C型骨盆骨折具有创伤小、术中透视少、手术时间短、效果好、并发症少等优点。

Treatment of Tile type C pelvic fracture with legacy pedicle screw system plus minimally invasive technique

Objective To investigate the feasibility of Legacy pedicle screw system plus minimally invasive technique in treatment of Tile type C pelvic fracture and evaluate its therapeutic effects.Methods From January 2008 to March 2010, 12 patients with closed Tile type C pelvic fractures were treated with Legacy pedicle screw system plus minimally invasive technique.There were seven males and five females, at age range of 21-60 years (average 39.6 years).All patients had sacrum fractures of the posterior pelvic rings.The anterior pelvic ring fractures included unilateral ischiadic ramus fractures in four patients and bilateral ischiadic ramus fractures in eight.Three patients were combined with shock.The anterior pelvic rings were fixed with minimally invasive reconstruction plates and the posterior pelvic rings fixed with minimally invasive technique plus Legacy pedicle screw system. Results The operation lasted for average 90 minutes (range, 80-110 minutes) , with average intraoperative blood loss of 105 ml (range, 80-150 ml).All patients were followed up for average 18 months (range, 6-32 months), which showed that all patients got satisfactory reductions and that the fractures were healed at one stage, with average period of 11.5 weeks (range, 9-13 weeks).There occurred no infections, failures of internal fixations or nerve injuries.According to improved Lindahl standard of pelvic injury function assessment, the result was excellent in 10 patients and good in two, with average score of 78.6 points. Conclusions Under master of the surgical indications, Legacy pedicle screw system plus minimally invasive technique takes advantages of minor trauma, less intraoperative fluoroscopy, short operation time, good curative resuhs and few complications in treatment of Tile type C pelvic fractures by fixation of the posterior pelvic rings and reconstruction of the anterior pelvic rings.