Guimarães João Antonio Matheus, Rocha Vinícius Magno da, Barcellos André Luiz Loyelo
Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil.
Rev Bras Ortop. 2017 Aug 24;52(Suppl 1):63-68. doi: 10.1016/j.rboe.2017.08.010. eCollection 2017.
Pelvic ring fractures occur in association with potentially fatal lesions, whose treatment is a priority in the polytrauma setting. As consequence, the definitive orthopedic approach may be postponed, leading patients to chronic and potentially disabling deformities. The treatment of these deformities is a challenge, requiring highly complex and staged surgical reconstructions. The ilioinguinal approach has been widely used in these surgeries, because it allows the release and mobilization of the hemipelvis and, in some cases, anterior fixation of the sacroiliac joint. However, in most cases, stable pelvic ring reconstruction requires this approach to be complemented by two other surgical approaches (posterior longitudinal and Pfannestiel). This requirement critically increases the surgical time and the risk of complications, such as neurovascular lesions and surgical wound infection. The current study presents a posterior osteotomy technique for posterior and anterior release of the sacroiliac joint, eliminating the need for ilioinguinal approach. The technique is performed by posterior longitudinal access; it allows adequate mobilization of the hemipelvis and reduction of vertical and rotational deformities, before the spinopelvic fixation and reduction of the pubic symphysis.
骨盆环骨折常伴有潜在致命性损伤，在多发伤情况下，此类损伤的治疗是首要任务。因此，确定性的骨科治疗方法可能会被推迟，导致患者出现慢性且可能致残的畸形。这些畸形的治疗颇具挑战性，需要高度复杂且分阶段的手术重建。髂腹股沟入路已广泛应用于这些手术中，因为它能实现半骨盆的松解与活动，在某些情况下还能对骶髂关节进行前路固定。然而，在大多数情况下，稳定的骨盆环重建需要通过另外两种手术入路（后路纵行和 Pfannestiel 入路）来辅助该入路。这一需求显著增加了手术时间以及诸如神经血管损伤和手术伤口感染等并发症的风险。本研究提出了一种用于骶髂关节前后路松解的后路截骨技术，无需髂腹股沟入路。该技术通过后路纵行入路实施；在进行脊柱骨盆固定和耻骨联合复位之前，它能实现半骨盆的充分活动以及垂直和旋转畸形的矫正。
