Liu Yuancheng, Zhan Xiaorui, Huang Fuming, Wen Xiangyuan, Chen Yuhui, Yang Cheng, Fan Shicai
The Third Affiliated Hospital of Southern Medical University, No.183 Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, China.
BMC Musculoskelet Disord. 2020 Mar 4;21(1):147. doi: 10.1186/s12891-020-3172-1.
Pelvic fractures are rare in toddlers but are often associated with other injuries that make treatment difficult. Conservative treatment has been used with moderate success, but it is unclear if surgical correction could confer additional benefits and improve patient outcomes. The purpose of this study was to report authors' experience using the lateral-rectus approach (LRA) for surgical correction of unstable pelvic fractures in two toddlers.
We retrospectively analyzed the cases of two toddlers with unstable pelvic fractures who underwent surgery through the LRA between April 2016 and October 2018. Patients' characteristics, fracture type, mechanism of injury, Injury Severity Score (ISS), operative time, intra-operative blood loss, and post-operative complications were assessed. Pelvic asymmetry, degree of deformity, Cole scoring criteria and modified Barthel Index (MBI) were used to evaluate radiographic and functional outcomes.
Successful surgical treatment was performed using the LRA, external fixation, and sacroiliac screw fixation. Surgery duration was 180 min on average, with an average intra-operative bleeding of 250 ml. There were no iatrogenic nerve injuries or infections. Pelvic asymmetry a week after surgery was 0.5 cm on average and dropped to 0.3 cm on average at the end of the follow-up period. The deformity index of the pelvis dropped from an average of 0.035 a week after surgery to 0.02 at the end of the follow-up period. The mean MBI was 100 in the last follow-up, and Cole scoring criteria categorized both patients as being in excellent condition. All patients achieved radiological bone union without discrepancy in length of the lower limbs. Neither patient had loss of reduction nor evidence of low back pain during the mean follow-up period of 22 months.
Pelvic fracture in toddlers is rare, and surgical treatment requires careful consideration. The lateral-rectus approach was proven as a viable alternative for managing unstable pelvic fractures in toddlers, with minimal blood loss and risk of nerve injury. Furthermore, anterior external fixation and posterior sacroiliac screw fixation would be adequate for this population, with excellent final outcome.
骨盆骨折在幼儿中较为罕见，但常伴有其他损伤，这使得治疗变得困难。保守治疗已取得一定成功，但尚不清楚手术矫正是否能带来额外益处并改善患者预后。本研究的目的是报告作者使用外侧直肌入路（LRA）对两名幼儿不稳定骨盆骨折进行手术矫正的经验。
我们回顾性分析了2016年4月至2018年10月期间通过LRA接受手术的两名幼儿不稳定骨盆骨折病例。评估了患者的特征、骨折类型、损伤机制、损伤严重程度评分（ISS）、手术时间、术中失血量和术后并发症。采用骨盆不对称、畸形程度、科尔评分标准和改良巴氏指数（MBI）来评估影像学和功能结果。
使用LRA、外固定和骶髂螺钉固定成功进行了手术治疗。手术时间平均为180分钟，术中平均出血250毫升。没有医源性神经损伤或感染。术后一周骨盆不对称平均为0.5厘米，随访期末平均降至0.3厘米。骨盆畸形指数从术后一周的平均0.035降至随访期末的0.02。最后一次随访时平均MBI为100，科尔评分标准将两名患者均归类为状况极佳。所有患者均实现了放射学骨愈合，下肢长度无差异。在平均22个月的随访期内，两名患者均未出现复位丢失或腰痛迹象。
幼儿骨盆骨折罕见，手术治疗需要谨慎考虑。外侧直肌入路被证明是治疗幼儿不稳定骨盆骨折的一种可行替代方法，失血极少且神经损伤风险低。此外，前路外固定和后路骶髂螺钉固定对该人群足够，最终结果良好。
