Yuan Yi, Wang Tao, Yuan Jun, Qu Gangbo, Hao Pandeng, Zeng Zhijiang, Luo Bing, Yang Jiafu
Department of Orthopaedics, Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou Sichuan, 646000, P.R.China.
Department of Orthopaedics, Zhenxiong County People's Hospital, Zhenxiong Yunnan, 657200, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Feb 15;32(2):139-144. doi: 10.7507/1002-1892.2201709002.
To evaluate the feasibility and effectiveness of percutaneous cannulated screw fixation for the treatment of Day type Ⅱ pelvic crescent fracture.
The clinical data of 14 patients with Day type Ⅱ pelvic crescent fractures underwent closed reduction and percutaneous cannulated screw fixation between January 2009 and July 2016 were retrospectively analysed. There were 9 males and 5 females, aged 17-65 years (mean, 38 years). The causes of injury included traffic accident in 8 cases, falling from height in 3 cases, bruise injury in 3 cases; all were closed fractures. According to Tile classification, there were 8 cases of type B, 6 cases of type C. There were 13 cases combined with fracture of the anterior pelvic ring, including 8 cases of superior and inferior ramus of pubis fracture, 1 case of superior ramus of pubis fracture with symphysis separation, and 4 cases of symphysis separation. The interval of injury and admission was 1- 72 hours (mean, 16 hours), and the interval of injury and operation was 3-8 days (mean, 5 days). After operation, the reduction of fracture was evaluated by the Matta evaluation criteria, the clinical function was assessed by Majeed function assessment.
The operation time was 35-95 minutes (mean, 55 minutes), cumulative C-arm fluoroscopy time was 3-8 minutes (mean, 5 minutes), no iatrogenic vascular injury and pelvic organ damage occurred. Postoperative X-ray films at 2 days indicated that 2 cases of vertical shift and 2 cases of mild rotation were not completely corrected. Postoperative CT examination at 3 days indicated that 2 pubic joint screws broke through the obturator bone cortex. None of the pubic ramus screws entered into the acetabulum, but a screw of superior pubic branch broke through the posterior cortical of superior pubic branch, a screw of posterior ilium column broke through the medial bone cortex of the ilium, and no clinical symptom was observed. One patient suffered from wound infection in the pubic symphysis, then healed after 2 weeks of wound drainage, the other wounds healed by first intention. According to Matta criterion for fracture reduction, the results were excellent in 9 cases, good in 4 cases, and fair in 1 case with an excellent and good rate of 92.9%. All patients were followed up 8-24 months (mean, 14 months). All fractures healed at 4 months and restored to the normal walking at 6 months after operation, 3 patients suffered from slight pain in the sacroiliac joints and slight claudication when they were tired or walked for a long time and unnecessary for special treatment. One patient felt pain in the back of the iliac spine when he was lying down. During the follow-up, no screw loosening or other internal fixation failure occurred. At last follow-up, according to Majeed functional evaluation criteria, the results were excellent in 7 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 85.7%.
The percutaneous cannulated screw fixation is a safe treatment for Day type Ⅱ pelvic crescent fracture, which has a reliable fixation and good effectiveness.
评估经皮空心螺钉固定治疗DayⅡ型骨盆新月形骨折的可行性和有效性。
回顾性分析2009年1月至2016年7月期间14例接受闭合复位和经皮空心螺钉固定的DayⅡ型骨盆新月形骨折患者的临床资料。其中男性9例，女性5例，年龄17 - 65岁（平均38岁）。损伤原因包括交通事故8例，高处坠落3例，挤压伤3例；均为闭合性骨折。根据Tile分型，B型8例，C型6例。合并骨盆前环骨折13例，其中耻骨上下支骨折8例，耻骨上支骨折合并耻骨联合分离1例，耻骨联合分离4例。受伤至入院时间为1 - 72小时（平均16小时），受伤至手术时间为3 - 8天（平均5天）。术后采用Matta评估标准评估骨折复位情况，采用Majeed功能评估法评估临床功能。
手术时间为35 - 95分钟（平均55分钟），累计C型臂透视时间为3 - 8分钟（平均5分钟），未发生医源性血管损伤及盆腔脏器损伤。术后2天X线片显示2例垂直移位和2例轻度旋转未完全纠正。术后3天CT检查显示2枚耻骨联合螺钉穿破闭孔骨皮质。耻骨支螺钉均未进入髋臼，但1枚耻骨上支螺钉穿破耻骨上支后皮质，1枚髂后柱螺钉穿破髂骨内侧骨皮质，未出现临床症状。1例耻骨联合处伤口感染，经伤口引流2周后愈合，其余伤口均一期愈合。根据Matta骨折复位标准，结果为优9例，良4例，可1例，优良率为92.9%。所有患者均获随访，随访时间8 - 24个月（平均14个月）。所有骨折均在术后4个月愈合，6个月恢复正常行走，3例患者骶髂关节轻度疼痛，劳累或长时间行走时有轻度跛行，无需特殊治疗。1例患者仰卧时髂后上棘处疼痛。随访期间未发生螺钉松动或其他内固定失败情况。末次随访时，根据Majeed功能评估标准，结果为优7例，良5例，可2例，优良率为85.7%。
经皮空心螺钉固定是治疗DayⅡ型骨盆新月形骨折的一种安全方法，固定可靠，效果良好。
