Harris Methodist Fort Worth Hospital and John Peter Smith Orthopaedic Surgery Residency Program, Fort Worth, TX 76104, USA.
Clin Orthop Relat Res. 2012 Aug;470(8):2148-53. doi: 10.1007/s11999-012-2340-5.
Implant failure after symphyseal disruption and plating reportedly occurs in 0% to 21% of patients but the actual occurrence may be much more frequent and the characteristics of this failure have not been well described.
QUESTIONS/PURPOSES: We therefore determined the incidence and characterized radiographic implant failures in patients undergoing symphyseal plating after disruption of the pubic symphysis.
We retrospectively reviewed 165 adult patients with Orthopaedic Trauma Association (OTA) 61-B (Tile B) or OTA 61-C (Tile C) pelvic injuries treated with symphyseal plating at two regional Level I and one Level II trauma centers. Immediate postoperative and latest followup anteroposterior radiographs were reviewed for implant loosening or breakage and for recurrent diastasis of the pubic symphysis. The minimum followup was 6 months (average, 12.2 months; range, 6-65 months).
Failure of fixation, including screw loosening or breakage of the symphyseal fixation, occurred in 95 of the 127 patients (75%), which resulted in widening of the pubic symphyseal space in 84 of those cases (88%) when compared with the immediate postoperative radiograph. The mean width of the pubic space measured 4.9 mm (range, 2-10 mm) on immediate postoperative radiographs; however, on the last radiographs, the mean was 8.4 mm (range, 3-21 mm), representing a 71% increase. In seven patients (6%), the symphysis widened 10 mm or more; however, only one of these patients required revision surgery.
Failure of fixation with recurrent widening of the pubic space can be expected after plating of the pubic symphysis for traumatic diastasis. Although widening may represent a benign condition as motion is restored to the pubic symphysis, patients should be counseled regarding a high risk of radiographic failure but a small likelihood of revision surgery.
Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.
据报道，耻骨联合破坏后植入物失败的发生率为 0%至 21%，但实际发生率可能更高，且这种失败的特征尚未得到很好的描述。
问题/目的：因此，我们确定了耻骨联合切开复位内固定术后发生影像学植入物失败的发生率，并对其进行了特征描述。
我们回顾性分析了在两家区域性一级和一家二级创伤中心接受耻骨联合切开复位内固定术治疗的 165 例成人患者（OTA 61-B [Tile B] 或 OTA 61-C [Tile C] 骨盆损伤）。对即时术后和最新随访的前后位 X 线片进行评估，以观察植入物松动或断裂以及耻骨联合再分离的情况。最小随访时间为 6 个月（平均 12.2 个月；范围，6-65 个月）。
127 例患者中有 95 例（75%）固定失败，包括耻骨联合固定的螺钉松动或断裂，其中 84 例（88%）与即时术后 X 线片相比，耻骨联合间隙增宽。即时术后 X 线片上耻骨联合间隙的平均宽度为 4.9 毫米（范围，2-10 毫米）；然而，在最后一次 X 线片上，平均值为 8.4 毫米（范围，3-21 毫米），增加了 71%。7 例患者（6%）耻骨联合增宽 10 毫米或以上，但仅 1 例患者需要接受翻修手术。
耻骨联合切开复位内固定术后，可预期固定失败并伴有耻骨联合间隙的再增宽。尽管增宽可能代表耻骨联合运动恢复的良性状态，但应告知患者存在影像学失败的高风险，但翻修手术的可能性较小。
IV 级，病例系列。欲了解完整的证据水平描述，请参见作者指南。
