骶髂拉力螺钉固定技术在骨盆后环损伤中的临床应用

目的 探讨应用骶髂拉力螺钉固定技术治疗骨盆后环损伤的适应证、手术方法及疗效。方法 1998年6月～2002年11月，对13例骨盆骶髂复合结构损伤患者采用后侧经骶髂关节的骶髂拉力螺钉固定方法治疗骨盆后环损伤，男10例，女3例；年龄21～49岁，平均37．5岁。通过影像学柱查明确13例患者有15侧骨盆骶髂复合结构损伤。按照AO骨盆环损伤方法分型：B型损伤6例．其中B2型4例，B3型2例；C型损伤7例．其中C1型2例，C2型3例，C3型2例。患者麻醉后俯卧位，行闭合或开放复位后用骶髂拉力螺钉固定。取髂骨翼后侧进钉点，根据S1椎体上缘和骶骨翼走行确定进钉方向。所有操作均在“C”型臂X线机透视下进行。结果 13例患者均获随访．随访时间6个月～4年6个月，平均19．7个月。手术平均时问为70min。13例共置入骶髂拉力螺钉21枚。患者在术后2-3周可持双拐下地行走，3～4个月双下肢可完全负重行走．并逐渐恢复体力劳动，未发生神经损伤及螺钉松动、断裂现象。腰骶及下肢活动接近正常。结论 骶髂拉力螺钉固定技术可使不稳定性骨盆后环损伤患者获得良好的即刻复位和固定，恢复骨盆的稳定性，适用于骶髂关节脱位及骶骨骨折的患者。

The clinical exploration of the sacroiliac lag screws fixation for the injuries in the posterior ring of pelvis

Objective To explore the indication, operative procedure and the result for the technique of sacroiliac lag screws fixation for the injuries in the posterior ring of pelvis. Methods From June 1998 to November 2002, 13 patients with the injuries in the posterior ring of pelvis were treated with sacroiliac lag screws fixation, which involved 10 males and 3 females, their average age was 37.5 years (range, 21-49 years). 13 patients were diagnosed as 15 unilateral or bilateral injuries of the sacroiliac complex by the radiography. According to the AO classification system: there were 4 of B2, 2 of B3, 2 of C1, 3 of C2 and 2 of C3. The patients were laid on prone position after anesthesia, and the injuries were fixed with lag screws after open or closed reduction, then entered through the posterior aspect of the ala of the ilium, and inserted the screw along the direction according to the superior edge of S1 and the shape of the ala of the ilium. The whole procedure was performed under monitoring of "C"-arm for safety and accuracy. Results All the patients were available at follow-up with a mean of 19.7 months (ranged from 6 months to 4 years and a half). The operations lasted 70 minutes averagely. A total of 21 screws were fixed in 13 patients. The patients could ambulate with the crutches 2-3 weeks postoperatively, and walked with full weight-bearing at the 3rd-4th month after operation. The function of the sacroiliac joint and low extremities recovered nearly to normal. There were no nerve injuries and breakage or loosening of the screws. Conclusion The technique of lag screw fixation is able to reduce and fix the unstable injuries in the posterior ring of pelvis perfectly and immediately after operation. It not only can rebuild the stability of pelvis, but also can be applied to the fractures of the sacrum and the fracture-dislocations of the sacroiliac joint.