Salášek M, Pavelka T
Klinika ortopedie a traumatologie pohybového ústrojí LF UK a FN Plzeň.
Acta Chir Orthop Traumatol Cech. 2012;79(4):335-40.
To evaluate the results of stabilisation of the posterior pelvic segment with a transiliacal internal fixator (TIFI) in type C fractures of the pelvis.
Between 2008 and 2011, the TIFI method was used in 27 patients with unstable type C pelvic ring fractures (AO classification) at our department. The patient group included 15 men and 12 women with an average age of 35 years (range, 15 to 65 years). All patients suffered high-energy trauma in traffic accidents (59.3%), by falls from a height (33.3%) or due to other causes (7.4%). In 40.7% of the patients, pelvic injury was part of polytrauma. Fixation was carried out using two polyaxial screws and the rod of a spinal instrumentation Legacy® or Colorado®. The method was employed for unilateral SI joint dislocation in five cases, and for unilateral sacral fractures of Pohlemann type I in six cases, Pohlemann type II in 13 cases and Pohlemann type III in three cases. The patients were mobilised, with associated injuries taken into consideration, at 5 post-operative weeks on the average. They were followed up at 6-week intervals until healing of fracture, then at one year after surgery and every 12 months thereafter. RESULTS All 27 patients achieved bone union within 6 months. The average operative time was 29 min (21 to 45 min). The average hospital stay was 22 days (11 to 66 days). The average duration of bed rest was 36 days (14 to 71 days). Complications included bronchopneumonia in two patients, and a redislocation with displacement of the posterior segment up to 10 mm in one patient.
Transiliacal internal fixation is a minimally invasive method used to treat unstable pelvic ring fractures. Compared to other types of fixation, it carries a low risk of injury to nerve and vascular structures as well as a low risk of infectious complications, is associated with low blood loss and is easy to perform. The TIFI provides stability comparable with the use of two iliosacral screws, without the risk of excessive compression even in comminuted transforaminal fractures of the sacrum. However, the need to operate on patients lying in the prone position is a disadvantage because, in polytraumatised patients, it makes implantation at the acute phase impossible.
The TIFI technique is one of the options for fixation of posterior pelvic segment fractures. A short operative time and minimum complications are undeniable advantages. Indications should be carefully considered in each patient. TIFI is a minimally invasive method for anterior pelvic segment fixation that can also be used in the acute stage of injury.
评估使用经髂内固定器（TIFI）稳定骨盆后段在C型骨盆骨折中的治疗效果。
2008年至2011年期间，我科对27例不稳定C型骨盆环骨折（AO分类）患者采用了TIFI方法。患者组包括15名男性和12名女性，平均年龄35岁（范围15至65岁）。所有患者均因交通事故（59.3%）、高处坠落（33.3%）或其他原因（7.4%）遭受高能创伤。40.7%的患者骨盆损伤为多发伤的一部分。使用两枚多轴螺钉和脊柱内固定系统Legacy®或Colorado®的棒进行固定。该方法用于5例单侧骶髂关节脱位、6例Pohlemann I型单侧骶骨骨折、13例Pohlemann II型单侧骶骨骨折和3例Pohlemann III型单侧骶骨骨折。患者平均在术后5周开始活动，并考虑相关损伤情况。术后每6周进行随访直至骨折愈合，然后在术后1年及此后每年随访1次。结果27例患者均在6个月内实现骨愈合。平均手术时间为29分钟（21至45分钟）。平均住院时间为22天（11至66天）。平均卧床休息时间为36天（14至71天）。并发症包括2例支气管肺炎，1例患者后段再脱位且移位达10毫米。
经髂内固定是治疗不稳定骨盆环骨折的一种微创方法。与其他类型的固定相比，其对神经和血管结构的损伤风险低，感染并发症风险低，失血少且操作简便。TIFI提供的稳定性与使用两枚髂骶螺钉相当，即使在骶骨粉碎性经椎间孔骨折中也无过度压缩的风险。然而，需要对俯卧位患者进行手术是一个缺点，因为在多发伤患者中，急性期无法进行植入操作。
TIFI技术是骨盆后段骨折固定的选择之一。手术时间短和并发症少是不可否认的优点。应仔细考虑每位患者的适应证。TIFI是一种用于骨盆前段固定的微创方法，也可在损伤急性期使用。
