耻骨分离症的治疗效果：我们 19 例患者的经验。
Management outcomes in pubic diastasis: our experience with 19 patients.
机构信息
Dept of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh-160 012, India.
出版信息
J Orthop Surg Res. 2011 May 17;6:21. doi: 10.1186/1749-799X-6-21.
BACKGROUND
Pubic diastasis, a result of high energy antero-posterior compression (APC) injury, has been managed based on the Young and Burguess classification system. The mode of fixation in APC II injury has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the posterior pelvic ring elements in these injuries.
METHODS
The study included a total of 19 patients with pubic diastasis managed by us from May 2006 to December 2007. There was a single patient with type I APC injury who treated conservatively. Type II APC injuries (13 patients) were treated surgically with symphyseal plating using single anterior/superior plates or double perpendicularly placed plates. Type III injuries (5 patients) in addition underwent posterior fixation using plates or percutaneous sacro-iliac screws. The outcome was assessed clinically (Majeed score) and radiologically.
RESULTS
The mean follow-up was for 2.9 years (6 months to 4.5 years). Among the 13 patients with APC II injuries, the clinical scores were excellent in one (7.6%), good in 6 (46.15%), fair in 4 (30.76%) and poor in 2 (15.38%). Radiological scores were excellent in 2 (15.38%), good in 8 (61.53%), fair in 2 (15.38%) and poor in one patient (7.6%). Among the 5 patients with APC III injuries, there were 2 patients each with good (50%) and fair (50%) clinical scores while one patient was lost on long term follow up. The radiological outcomes were also similar in these. Complications included implant failure in 3 patients, postoperative infection in 2 patients, deep venous thrombosis in one patient and bladder herniation in one of the patients with implant failure.
CONCLUSIONS
There is no observed dissimilarity in outcomes between isolated anterior and combined symphyseal (perpendicular) plating techniques in APC II injuries. Single anterior symphyseal plating along with posterior stabilisation provides a stable fixation in type III APC injuries. Limited dissection ensuring adequate intactness of rectus sheath is important to avoid long term post-operative complications.
背景
耻骨分离是一种由高能前后压缩（APC）损伤引起的结果，已经根据 Young 和 Burguess 分类系统进行了管理。然而，APC II 损伤的固定方式一直存在争议，一些作者提出需要解决这些损伤中部分后骨盆环元素破裂的问题。
方法
这项研究共包括 19 名我们在 2006 年 5 月至 2007 年 12 月期间治疗的耻骨分离患者。有一名患者为 I 型 APC 损伤，采用保守治疗。13 名 II 型 APC 损伤患者采用耻骨联合钢板固定术进行手术治疗，使用单前/上钢板或双垂直放置钢板。5 名 III 型损伤患者还采用后固定术，使用钢板或经皮骶髂螺钉。通过临床（Majeed 评分）和影像学评估结果。
结果
平均随访时间为 2.9 年（6 个月至 4.5 年）。在 13 名 II 型 APC 损伤患者中，临床评分优秀者 1 名（7.6%），良好者 6 名（46.15%），尚可者 4 名（30.76%），差者 2 名（15.38%）。影像学评分优秀者 2 名（15.38%），良好者 8 名（61.53%），尚可者 2 名（15.38%），差者 1 名（7.6%）。在 5 名 III 型 APC 损伤患者中，2 名患者的临床评分均为良好（50%）和尚可（50%），1 名患者在长期随访中丢失。这些患者的影像学结果也相似。并发症包括 3 名患者的植入物失败，2 名患者术后感染，1 名患者深静脉血栓形成，1 名患者植入物失败导致膀胱疝。
结论
在 APC II 损伤中，单独的前侧和联合耻骨（垂直）钢板固定技术的结果没有明显差异。单一的前侧耻骨钢板固定结合后侧稳定提供了 III 型 APC 损伤的稳定固定。确保腹直肌鞘完整的有限解剖对于避免长期术后并发症很重要。
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