Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
Department of Orthopedics Trauma, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China.
Eur J Trauma Emerg Surg. 2020 Aug;46(4):865-871. doi: 10.1007/s00068-018-1050-4. Epub 2018 Nov 15.
Pubic symphysis diastasis with an incidence of approximately 20% in pelvic fractures is a severe lesion which needs to be treated properly. The objective of this retrospective study was to describe and evaluate the clinical and radiological outcomes including its advantages and limitations of this modified minimal invasive technique.
Totally 29 patients with pubic symphysis diastasis, with or without posterior ring instability, were treated by modified pedicle screw-rod fixation (modified PSRF) between January 2010 and December 2016. The duration from injury to surgery, operation time, intraoperative blood loss as well as complications were recorded. During follow-up, the functional outcomes were assessed according to the Majeed evaluation criteria 1 year postoperatively. The evaluation of the postoperative reduction quality was carried out according to Matta criteria.
According to Tile classification, there were 9 cases of Type B1 underwent only anterior-modified PSRF and 20 cases of Type C1 experienced anterior-modified PSRF combined with posterior fixation. The duration from injury to operation, operation time and intraoperative blood loss were 3.27 days (range 1-6 days), 42.07 min (range 38-45 min), and 46.14 ml (range 40-55 ml). The results of reduction quality were rated as excellent in 16, good in 11 and fair in 2 based on Matta criteria. The Majeed functional scores ranged from 68 to 95 and there were excellent in 15, good in 12 and fair in 2. No patients experienced incision infection. Slight loosening of middle-two screws was verified during follow-up in one patient. Two patients underwent femoral nerve palsy. Irritation to the LFCN was detected in four patients.
Modified PSRF can be performed as an alternative to manage pubic symphysis diastasis due to its merits of minimal invasive, less blood loss, less soft tissue injuries as well as shorter operation time, even with the early weight-bearing.
Researchregistry3905.
耻骨联合分离在骨盆骨折中的发病率约为 20%，是一种严重的损伤，需要进行适当的治疗。本回顾性研究的目的是描述和评估包括其优点和局限性在内的临床和影像学结果，介绍一种改良微创技术。
2010 年 1 月至 2016 年 12 月，采用改良经皮骶髂螺钉-棒固定术（改良 PSRF）治疗 29 例耻骨联合分离患者，其中合并或不合并后环不稳定。记录手术时间、术中出血量、手术时间及并发症等。术后随访时，根据 Majeed 评分标准评估功能结果。术后根据 Matta 标准评估复位质量。
根据 Tile 分类，9 例 B1 型患者仅行前改良 PSRF，20 例 C1 型患者行前改良 PSRF 联合后固定。受伤至手术时间、手术时间和术中出血量分别为 3.27 天（1-6 天）、42.07 分钟（38-45 分钟）和 46.14 毫升（40-55 毫升）。根据 Matta 标准，复位质量评定结果为优 16 例，良 11 例，可 2 例。Majeed 功能评分 68-95 分，优 15 例，良 12 例，可 2 例。无切口感染病例。1 例患者随访时发现中 2 枚螺钉轻微松动。2 例患者发生股神经麻痹。4 例患者出现 LFCN 刺激。
改良 PSRF 可作为耻骨联合分离的一种治疗方法，具有微创、出血量少、软组织损伤少、手术时间短等优点，甚至可以早期负重。
Researchregistry3905.
