University Hospitals of North Midlands NHS Trust, Royal Stoke Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG, United Kingdom.
University Hospitals of North Midlands NHS Trust, Royal Stoke Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG, United Kingdom.
Injury. 2021 Oct;52(10):2725-2729. doi: 10.1016/j.injury.2020.02.094. Epub 2020 Feb 19.
Anterior pubic symphyseal plate fixation is the recommended treatment for disruption of pubic symphysis in an unstable pelvic ring injury. The rigid construct offered by locking symphyseal plate has the theoretical advantage of allowing patients to weight bear early. However, there are concerns of catastrophic failure about the locked plate construct. The purpose of the study was to establish if locking plate fixation for pubic symphysis disruption was effective to allow patients to mobilise weight bearing immediately after surgery.
Retrospective analysis of a prospectively collected database from a single centre was performed. The study period was from 2008 to 2017. Radiographic evidence of fixation failure, revision surgery, removal of metalwork and follow up duration was noted.
We identified 46 patients (F:M 8:38) with a mean age of 46 years (range 14 to 74 years). Based on the mechanism of injury patients were classified into Antero-posterior compression (28), Vertical shear [10], lateral compression [4] and combined mechanism [4]. Either a 4-hole or 6-hole locking plate was used in all patients, depending on fracture extension. Posterior fixation was required in 28 (61%) patients. All patients were allowed to fully or partial weight bear. The mean radiological follow-up period was 31 weeks with 13 (28%) patients having evidence of radiological failure. Revision was performed in 1 (2%) patient, in whom the screws had pulled out of the bone. The most common mode of failure was either the screw backing out from the plate or broken screw. Among the 4 (8%) patients who had their metalwork removed, 1 (2%) had delayed onset of infection, 2 (4%) had symptoms related to backed out screw and 1 (2%) opted electively to have metalwork removed.
With our series of patients, we have found that using locking plate for pubic symphyseal diastasis is safe and effective in allowing patients to weight bear early. A low complication rate and need for re-operation is demonstrated.
耻骨联合前板固定是不稳定骨盆环损伤中耻骨联合分离的推荐治疗方法。锁定耻骨联合板提供的刚性结构具有允许患者早期负重的理论优势。然而，锁定板结构存在灾难性故障的担忧。本研究旨在确定锁定板固定耻骨联合分离是否有效，以使患者能够在手术后立即进行负重活动。
对来自单一中心的前瞻性收集数据库进行回顾性分析。研究时间为 2008 年至 2017 年。记录固定失败、翻修手术、金属去除和随访时间的影像学证据。
我们确定了 46 名患者（女性：男性为 8:38），平均年龄为 46 岁（范围为 14 至 74 岁）。根据损伤机制，患者分为前-后压缩（28 例）、垂直剪切[10 例]、侧方压缩[4 例]和混合机制[4 例]。所有患者均使用 4 孔或 6 孔锁定板，具体取决于骨折延伸情况。28 例（61%）患者需要后路固定。所有患者均允许完全或部分负重。平均影像学随访时间为 31 周，13 例（28%）患者出现影像学失败证据。1 例（2%）患者进行了翻修，其中螺钉从骨中拔出。最常见的失败方式是螺钉从板上退出或螺钉断裂。在 4 例（8%）取出金属的患者中，1 例（2%）发生迟发性感染，2 例（4%）出现与螺钉退出相关的症状，1 例（2%）择期取出金属。
在我们的患者系列中，我们发现使用锁定板治疗耻骨联合分离可安全有效地允许患者早期负重。证明了低并发症率和再手术的需要。
