S1椎弓根螺钉结合髂骨板间螺钉治疗骶髂关节骨折脱位

目的 探索S1椎弓根螺钉结合髂骨板问螺钉治疗骶髂关节骨折脱位的临床疗效，评价两者结合对骶髂关节骨折脱位的治疗价值。方法 对11例骶髂关节骨折脱位患者用脊柱内固定系统(TSRH)之S1椎弓根螺钉结合髂骨板间螺钉进行固定，该组患者涉及骶髂关节的垂直移位及旋转的骨盆环变形，归于Tile分型的B类或C类骨盆损伤。11例患者均伴有前环损伤，其中9例予以加压钢板(smith nephew)内固定，余2例患者单纯采用后路手术内固定。结果 7例患者垂直移位完全复位，9例旋转畸形纠正，未发现感染及神经损伤等并发症。结论 S1椎弓根螺钉结合髂骨板问螺钉固定技术治疗骶髂关节骨折脱位，可获得即刻稳定性并良好地维持了复位的效果．这一混合技术对于涉及垂直及旋转损伤的骨盆环损伤有稳定的作用。

Fixation by S1 pedicle screws combined with iliac screws to treat sacroiliac joint dislocation and fracture

Objective To evaluate the clinical effectiveness of the combined use of S1 pedicle screws and the iliac screws in treatment of sacroiliac dislocation and fracture. Methods 11 patients with sacroiliac dislocation and fracture were treated with S1 pedicle screw and iliac screw fixation technique. In this group, the dislocation was associated with vertical displacement of the sacroiliac joint and rotational deformity of the pelvic ring. They were classified as type B or type C pelvic disruption according to the Tile's classification. 7 patients with disruption of the symphysis pubis or pubic branch fracture underwent additional fixation of the pelvic ring using a reconstruction plate. The remaining 4 patients were treated by the posterior procedure alone. Results The vertical displacement was completely reduced in 7 patients, and the rotational deformity completely corrected in 4 patients. The reduction was maintained at the time of final follow up evaluation. No perioperative complications were found. The combined use of S1 pedicle screws and the iliac screws provided immediate stability and sufficient reduction for sacroiliac dislocation in the 11 patients in this study. Conclusion This hybrid internal fixation procedure is useful for reduction and fixation of sacroiliac dislocation associated with the vertical and rotational instability of the pelvic ring.