Martin Murphy P, Rojas David, Mauffrey Cyril
Department of Orthopaedics, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
Eur J Orthop Surg Traumatol. 2018 Jul;28(5):893-898. doi: 10.1007/s00590-017-2104-8. Epub 2017 Dec 5.
Tile C pelvic ring injuries are challenging to manage even in the most experienced hands. The majority of such injuries can be managed using percutaneous reduction techniques, and the posterior ring can be stabilized using percutaneous transiliac-transsacral screw fixation. However, a subgroup of patients present with inadequate bony corridors, significant sacral zone 2 comminution or significant lateral/vertical displacement of the hemipelvis through a complete sacral fracture. Percutaneous strategies in such circumstances can be dangerous. Those patients may benefit from prone positioning and open reduction of the sacral fracture with fixation through tension band plating or lumbo-pelvic fixation. Soft tissue handling is critical, and direct reduction techniques around the sacrum can be difficult due to the complex anatomy and the fragile nature of the sacrum making clamp placement and tightening a challenge. In this paper, we propose a mini-invasive technique of indirect reduction and temporary stabilization, which is soft tissue friendly and permits maintenance of reduction during definitive fixation surgical.
Tile C型骨盆环损伤即使由经验最丰富的医生处理也颇具挑战。此类损伤大多可采用经皮复位技术处理，而后环可通过经皮髂骨-骶骨螺钉固定实现稳定。然而，有一小部分患者存在骨通道不足、骶骨2区严重粉碎或半骨盆通过完全性骶骨骨折出现明显的侧方/垂直移位。在这种情况下，经皮治疗策略可能很危险。这些患者可能受益于俯卧位以及通过张力带钢板固定或腰骶骨盆固定进行骶骨骨折的切开复位。软组织处理至关重要，由于骶骨解剖结构复杂且质地脆弱，使得在骶骨周围进行直接复位技术困难，放置和拧紧夹具成为一项挑战。在本文中，我们提出一种间接复位和临时稳定的微创技术，该技术对软组织损伤小，并允许在确定性固定手术期间维持复位。
