Tang Chun-Hui, Yao Gao-Wen, Wang Lin, Tu Hong-Liang, Luo Wei
Department of Orthopaedics, the First Hospital of Neijiang City, Neijiang 641000, Sichuan, China;
Department of Orthopaedics, the First Hospital of Neijiang City, Neijiang 641000, Sichuan, China.
Zhongguo Gu Shang. 2017 Jul 25;30(7):660-663. doi: 10.3969/j.issn.1003-0034.2017.07.016.
To evaluate the feasibility of minimally invasive internal fixation of pelvic anterior and posterior ring for the treatment of type C pelvic fracture, and to explore its operative techniques and therapeutic efficacy.
From December 2010 to December 2015, 18 patients with type C pelvic fracture were treated by reconstructive plates fixation through minimally invasive ilioinguinal approach for pelvic anterior ring injuries, and by invasive percutaneous sacroiliac joint screw fixation for pelvic posterior ring injuries. There were 11 males and 7 females ranging from 29 to 68 years old with an average age of 43.6 years old. According to Tile classification, there were 14 cases of type C1, 3 cases of type C2, 1 case of Type C3. To be specific, 12 cases with hemi-fracture of rami ossa pubis accompanied with fracture of the sacrum, 2 cases with hemi-fracture of rami ossa pubis accompanied with sacro-iliac joint dislocation, 3 cases with bilateral-fracture of rami ossa pubis combined with pubic symphysis separation accompanied with single-fracture of the sacrum, 1 case with bilateral-fracture of rami ossa pubis combined with bilateral-fracture of sacro-iliac joint were included. Operation time, intra-operative blood loss, injuries of lumbosacral nerves and iliac blood vessels, and fracture reduction were observed.
All wounds were primary healing. No complications such as infection, deep venous thrombosis, injuries of lumbosacral nerves and iliaca vessels or heterotopic ossification occurred. According to Matta criterion of fracture reduction, 14 cases got excellent results, 3 good and 1 fair. Sixteen patients were followed up in a period varying from 6 to 33 months with 16.7 months on average. And according to functional score of Majeed, 13 cases obtained excellent results, 2 good and 1 fair, with an average score of 92.13±5.44.
Internal fixation with reconstructive plates through the ilioinguinal approach and with percutaneous iliosacral screw for type C pelvic facture on pelvic anterior ring and pelvic posterior ring respectively have advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Thus, this technique is safe and practicable, yielding satisfying results.
评估骨盆前后环微创内固定治疗C型骨盆骨折的可行性，探讨其手术技巧及治疗效果。
2010年12月至2015年12月，对18例C型骨盆骨折患者采用微创髂腹股沟入路重建钢板固定骨盆前环损伤，经皮骶髂关节螺钉固定骨盆后环损伤。男11例，女7例；年龄29～68岁，平均43.6岁。根据Tile分型：C1型14例，C2型3例，C3型1例。其中耻骨支半骨折伴骶骨骨折12例，耻骨支半骨折伴骶髂关节脱位2例，双侧耻骨支骨折合并耻骨联合分离伴骶骨单骨折3例，双侧耻骨支骨折合并双侧骶髂关节骨折1例。观察手术时间、术中出血量、腰骶神经及髂血管损伤情况及骨折复位情况。
所有切口均一期愈合。未发生感染、深静脉血栓形成、腰骶神经及髂血管损伤、异位骨化等并发症。根据Matta骨折复位标准，优14例，良3例，可1例。16例患者获随访，随访时间6～33个月，平均16.7个月。根据Majeed功能评分标准，优13例，良2例，可1例，平均得分92.13±5.44。
采用髂腹股沟入路重建钢板及经皮骶髂螺钉分别对C型骨盆骨折的骨盆前环和后环进行内固定，具有手术时间短、创伤小、出血少等优点，技术安全可行，效果满意。
