Xiang Da-Ye, Chi Yong-Long, Zheng An-Xiang, He Shao-Bo, Lian Yong-Sheng
Department of Orthopedics, Second People's Hospital of Yueqing City, Yueqing 325608, China.
Zhonghua Yi Xue Za Zhi. 2007 Mar 6;87(9):585-9.
To evaluate the clinical feasibility and safety of percutaneous screw fixation in the management of vertically unstable pelvic fractures.
Forty S1 CT films of orthopedic patients aged 18 - 73, were analyzed so as to provide the best screw entrance point and angle for screw entrance. The data thus obtained were used on 14 patients with unequivocally vertical unstable pelvic fractures, 11 cases being of Tile C(1) type, 2 of C(2) type, and 1 of C type, 9 males and 5 females, aged 19 to 68. All the patients received heavy traction to reduce displacement before the surgery. Percutaneous pelvic screw fixation of the disrupted pelvic ring was performed when the patients were in the supine position, and then fixation of sacroiliac joint was performed when the patients were in the prone position.
S1 CT scanning showed an average distance from the standard screw entrance point to the backbone of 10.78 cm (9.80 - 12.00 cm), and a standard screw entrance angle of 61.24 degrees (52.18 - 68.20 degrees). Anatomic reduction was achieved in all 14 patients. One patient had neurological deficit due to the screw penetrating into 1/2 of the intervertebral foramen, but the side-effect was released when the screw was removed 21 days after operation. A 6-24 months postoperative follow-up revealed that all the patients had recovered from fracture and resumed their previous work.
With advantages including simple procedures, better bony stability, minimal invasion of compromised soft tissue and limited blood loss, percutaneous screw fixation is a practical technique which can be widely used to treat vertical unstable pelvic fracture.
评估经皮螺钉固定治疗垂直不稳定型骨盆骨折的临床可行性及安全性。
分析40例年龄在18 - 73岁的骨科患者的S1 CT影像，以确定最佳螺钉进针点及进针角度。将所得数据应用于14例明确为垂直不稳定型骨盆骨折的患者，其中Tile C(1)型11例，C(2)型2例，C型1例，男性9例，女性5例，年龄19至68岁。所有患者在手术前均接受大重量牵引以减少移位。患者仰卧位时进行经皮骨盆螺钉固定以修复骨盆环断裂，然后患者俯卧位时进行骶髂关节固定。
S1 CT扫描显示标准螺钉进针点至椎体的平均距离为10.78 cm（9.80 - 12.00 cm），标准螺钉进针角度为61.24°（52.18 - 68.20°）。14例患者均达到解剖复位。1例患者因螺钉穿入椎间孔1/2而出现神经功能缺损，但术后21天取出螺钉后副作用缓解。术后6至24个月随访显示，所有患者骨折均愈合并恢复原工作。
经皮螺钉固定具有操作简单、骨稳定性好、对受损软组织侵袭小、失血少等优点，是一种可广泛应用于治疗垂直不稳定型骨盆骨折的实用技术。
