Wang Hai, Ye Junjian, Lin Zhangxiong, Wu Gui, Xie Yun
Department of Orthopedic Trauma & Ankle Surgery, Fujian Trauma Medical Center, First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350004, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Sep 15;34(9):1106-1113. doi: 10.7507/1002-1892.202002053.
To evaluate the effectiveness of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in pubic branch fractures.
The clinical data of 42 patients with pubic branch fractures treated by hollow screw fixation between March 2008 and March 2019 were analyzed retrospectively. According to the operation method, they were divided into the traditional operation group (20 cases in group A, fixed with traditional retrograde pubic screws) and the modified operation group (22 cases in group B, fixed with percutaneous retrograde pubic screws assisted by hollow pedicle opener). There was no significant difference ( >0.05) between the two groups in terms of gender, age, cause of injury, fracture classification, comorbidity, and time from injury to operation. The operation time, blood loss, incision length, screw length, and complications were recorded and compared between the two groups. The fracture reduction was evaluated according to Matta standard on the next day after operation, and the function was evaluated by Majeed score at 12 months after operation.
The operation was successfully completed in both groups. The operation time, blood loss, and incision length of group B were significantly less than those of group A ( <0.05); there was no significant difference in screw length between the two groups ( =0.793, =0.437). All patients were followed up 8-24 months, with an average of 16.8 months. There was no complication in the two groups, such as injury of blood vessels and nerves, fracture of internal fixation, screw entering into joint cavity, and nonunion of fracture. There was no significant difference in the fracture healing time between the two groups ( =-1.068, =0.299). There were 2 cases of incision infection, 1 case of incision fat liquefaction, 2 cases of lower extremity deep vein thrombosis in group A, the incidence of complications was 25.0%; there was only 1 case of lower extremity deep vein thrombosis in group B, the incidence of complication was 4.5%, which was lower than that in group A, but the difference was not significant ( =2.104, =0.147). In group A, 1 case was found to be dislocated, but in group B, there was no dislocated fracture. There was no significant difference between the two groups in the evaluation of Matta imaging on the next day after operation and the evaluation of Majeed function at 12 months after operation ( >0.05).
Percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener is effect for the pubic branch fractures with the advantage of smaller incision, shorter operation time, and less bleeding compared with traditional methods.
评估空心椎弓根开口器辅助下经皮逆行耻骨螺钉植入术治疗耻骨支骨折的疗效。
回顾性分析2008年3月至2019年3月采用空心螺钉固定治疗的42例耻骨支骨折患者的临床资料。根据手术方法，将其分为传统手术组（A组20例，采用传统逆行耻骨螺钉固定）和改良手术组（B组22例，采用空心椎弓根开口器辅助下经皮逆行耻骨螺钉固定）。两组患者在性别、年龄、受伤原因、骨折分型、合并症及受伤至手术时间等方面差异无统计学意义（>0.05）。记录并比较两组患者的手术时间、出血量、切口长度、螺钉长度及并发症情况。术后次日根据Matta标准评估骨折复位情况，术后12个月采用Majeed评分评估功能恢复情况。
两组手术均顺利完成。B组手术时间、出血量及切口长度均明显少于A组（<0.05）；两组螺钉长度差异无统计学意义（=0.793，=0.437）。所有患者均获随访8～24个月，平均16.8个月。两组均未出现血管神经损伤、内固定断裂、螺钉进入关节腔及骨折不愈合等并发症。两组骨折愈合时间差异无统计学意义（=-1.068，=0.299）。A组出现切口感染2例、切口脂肪液化1例、下肢深静脉血栓形成2例，并发症发生率为25.0%；B组仅出现下肢深静脉血栓形成1例，并发症发生率为4.5%，低于A组，但差异无统计学意义（=2.104，=0.147）。A组发现1例骨折移位，B组未出现骨折移位。两组术后次日Matta影像学评估及术后12个月Majeed功能评估差异无统计学意义（>0.05）。
空心椎弓根开口器辅助下经皮逆行耻骨螺钉植入术治疗耻骨支骨折疗效确切，与传统方法相比，具有切口小、手术时间短、出血少等优点。
