前路钛板内固定治疗骶髂复合体损伤纵向残留移位与预后

目的探讨骶髂复合体损伤前路钛板内固定术后纵向残留移位程度与术后功能恢复相关性。方法随访我院2007年10月～2011年6月39例骶髂复合体损伤前路钛板内固定患者,根据术前、终末随访X线片或CT平扫、三维重建资料,参照Tornetta和Matta评价纵向残留移位程度,Majeed评价功能情况,统计学分析纵向残留移位与术后功能相关性。结果随访6个月～4年,平均16个月。术后2例出现切口不愈合,2例遗留L5神经根症状,末次随访骨折纵向残留移位〈4mm（优）11例、4～10mm（良）19例、10～20mm（中）8例、〉20mm（差）1例,优良率76.9%;功能恢复优18例、良10例、可9例、差2例,优良率71.8%;术后功能在纵向残留移位〈10mm与〉10mm者之间比较有统计学意义,在〈4mm与4～10mm者之间比较无统计学意义。结论前路钛板内固定能取得满意疗效,但其抗纵向应力较弱,骶髂复合体纵向残留移位〈10mm对术后功能恢复影响小。

Relationship between outcome and residual vertical displacement of sacroiliac complex injury treated with reconstruction plate via the anterior approach

Objective To explore the relationship between outcome and residual vertical displacement of sacroiliac complex injury(SCI) managed by reconstruction plate via the anterior approach.Methods A total of 39 patients with SCI were treated with reconstruction plate through the anterior approach form Oct.2007 to Jun.2011.Based on the X-ray radiography or three dimensional CT scan before and after operation,the postoperative residual vertical displacement was assessed using the Tornetta and Matta reduction evaluation,and was statistically analyzed between the extent of the displacement and postoperative outcome.The functional results were scored with the MaJeed functional recovery system.Results All patients were followed up for 6 to 48 months(mean 16 months).The incision was not healed in two cases and injury of the fifth lumbar nerve root was reserved in two.The excellent and good rate of the reduction quality was 76.9%.There was less than 4 mm(excellent) of the residual vertical displacement in 11 patients,4 to 10 mm(good) in 19,10 to 20 mm(fair) in 8 and more than 20 mm(poor) in 1.The excellent and good rate of the functional outcome was 71.8%.Excellent function happened in 18 patients,good in 10,fair in 9 and poor in 2.In the residual vertical displacement,there was statistical significance between less than 10mm and more than 10mm,but no difference between 0 to 4mm and 4 to 10mm.Conclusion The reconstruction plate via the anterior approach can achieve satisfactory effect even if it could not provide enough resistance to vertical shear of sacroiliac complex.There is no apparent interfere in the post-operative function if the residual vertical displacement is less than 10mm in sacroiliac complex.