旋转和垂直不稳定型骨盆骨折临床特点与治疗方法探讨

目的：探讨旋转和垂直不稳定型骨盆骨折的临床特点及其治疗方法选择。方法：30例旋转和垂直不稳定的骨盆骨折患者，16例保守治疗，14例手术治疗，骨盆前环均行切开复位内固定；5例骨盆后环行切开复位双钢板固定，9例在CT引导经皮置人松质骨螺钉固定骶髂关节。结果：30例随访2—3年，14例手术患者全部恢复行走功能：9例cT引导经皮骶髂关节螺钉内固定骨盆外形恢复好，功能恢复快，效果满意，5例行前路切开骶髂关节双钢板固定患者中骨盆外形恢复，3例沿髂嵴切口不适；16例保守治疗患者全部骨盆畸形愈合，10例遗留骶髂关节部位酸痛。结论：旋转和垂直不稳定型骨盆骨折保守治疗效果差，宜首选内固定治疗。CT引导下经皮骶髂关节螺钉内固定操作简单、费时短、出血少、损伤轻、牢靠，是骶髂关节骨折固定的好方法。

The treatment of rotational and vertical unstable pelvic fracture

Objective: To investigate the clinical character and treatment choice of rotational and vertical unstable pelvic fracture. Methods: 30 cases with rotational and vertical unstable pelvic fracture were retrospectively reviewed.16 cases were treated conservatively.14 cases operated. Anterior ring of pelvis were treated by ORIF(open reduction and internal fixation). For posterior ring fixation, 5 cases were treated by open reduction and double plate fixation. 9 cases were treated by close reduction and CT-assisted lag screw fixation. Results: 30 patients were followed up for 2 to 3 years, 14 cases treated by ORIF recovers the function of normal walk. 9 patients who were treated by CT-assisted reduction and lag screw fixation and 5 patients who were treated by open reduction and double plate fixation, the appearance of pelvis and function of lower limbs were completely recovered, among 3 cases felt discomfort in surgical position. 16 patients who were treated conservatively, all had deformity of pelvis, 10 patients felt pain of sacroiliac joint. Conclusions: The patients with rotational and vertical unstable pelvic fracture should be treated by operation. CT-assisted reduction and percutaneous cannulated lag screw fixation has a good prospect in the treatment of pelvic fracture, the operation is simple, minimal invasive and effective.