Elzohairy M M, Salama A M
Department of Orthopaedic Surgery, Faculty of medicine, Zagazig University Hospital, Zagazig, Egypt.
Orthop Traumatol Surg Res. 2017 Apr;103(2):223-227. doi: 10.1016/j.otsr.2016.12.002. Epub 2016 Dec 23.
Surgical stabilization of posterior pelvic ring fractures can be achieved by either open or closed methods. They all provide a comparable biomechanical stability. The aim of the present study is to compare the clinical results of both techniques for treating posterior pelvic ring injuries.
Seventy patients operated for unstable posterior pelvic ring disruptions were retrospectively reviewed. We compared 35 patients treated by open reduction internal fixation (ORIF group) versus 35 patients stabilized by using closed reduction and percutaneous iliosacral screw fixation (CRIF group) under fluoroscopic guidance.
According to pelvic outcome scoring system of Pohlemann et al., 28 patients out of the ORIF group obtained good or excellent results (20 excellent and 8 good), five fair and two poor. In the CRIF group, 30 patients obtained good or excellent results (25 excellent and 5 good), four fair and one poor (P=0.64). The average intraoperative blood loss in the ORIF group was 500cc with average blood transfusion of 2units (1000cc) compared to blood loss 150cc in the CRIF group, with average blood transfusion of 1unit (500cc) (P=0.002). No intraoperative complications were reported in the ORIF group while operative guide wires were broken in two cases in the CRIF group (P=0.16). There were no neurological complications observed in the ORIF group, but one radiculopathy (L5 root palsy) occurred in the CRIF group (P=0.317). In the ORIF group, three patients had superficial wound infection and one patient had deep infection while in the CRIF group, we noted only one case of deep infection (P=0.083).
No difference was noticed between ORIF and CRIF. The technical decision is variable according to time of surgery, fracture types, patient general condition, skin condition, presence of ipsilateral fractures of the acetabulum and feasibility of the closed reduction. More studies are needed to identify prognostic factors related to quality of the reduction. We need for creation of decisional algorithm for ORIF versus CRIF.
Level 4.
骨盆后环骨折的手术稳定可通过开放或闭合方法实现。它们都能提供相当的生物力学稳定性。本研究的目的是比较这两种治疗骨盆后环损伤技术的临床结果。
回顾性分析70例因不稳定骨盆后环损伤而接受手术的患者。我们比较了35例采用切开复位内固定治疗的患者（切开复位内固定组）与35例在透视引导下采用闭合复位经皮髂骶螺钉固定治疗的患者（闭合复位经皮髂骶螺钉固定组）。
根据Pohlemann等人的骨盆结果评分系统，切开复位内固定组中有28例患者获得了良好或优秀的结果（20例优秀，8例良好），5例一般，2例较差。在闭合复位经皮髂骶螺钉固定组中，30例患者获得了良好或优秀的结果（25例优秀，5例良好），4例一般，1例较差（P = 0.64）。切开复位内固定组术中平均失血量为500cc，平均输血2单位（1000cc），而闭合复位经皮髂骶螺钉固定组失血量为150cc，平均输血1单位（500cc）（P = 0.002）。切开复位内固定组未报告术中并发症，而闭合复位经皮髂骶螺钉固定组有2例手术导丝断裂（P = 0.16）。切开复位内固定组未观察到神经并发症，但闭合复位经皮髂骶螺钉固定组发生1例神经根病（L5神经根麻痹）（P = 0.317）。切开复位内固定组有3例患者发生浅表伤口感染，1例患者发生深部感染，而在闭合复位经皮髂骶螺钉固定组，仅记录到1例深部感染（P = 0.083）。
切开复位内固定与闭合复位经皮髂骶螺钉固定之间未发现差异。技术决策应根据手术时间、骨折类型、患者一般状况、皮肤状况、同侧髋臼骨折的存在以及闭合复位的可行性而有所不同。需要更多研究来确定与复位质量相关的预后因素。我们需要创建切开复位内固定与闭合复位经皮髂骶螺钉固定的决策算法。
4级。
