Department of Orthopedic Surgery, Sports Traumatology and Trauma Surgery, Staedtisches Klinikum Wolfenbuettel, Alter Weg 80, 38302, Wolfenbuettel, Germany.
Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Goettingen, Goettingen, Germany.
Eur J Trauma Emerg Surg. 2021 Feb;47(1):37-45. doi: 10.1007/s00068-020-01498-8. Epub 2020 Oct 26.
Fragility fractures of the pelvis (FFP) are common in older patients. We evaluated the clinical outcome of using a minimally invasive posterior locked compression plate (MIPLCP) as therapeutic alternative.
53 Patients with insufficiency fractures of the posterior pelvic ring were treated with MIPLCP when suffering from persistent pain and immobility under conservative treatment. After initial X-ray, CT-scans of the pelvis were performed. In some cases an MRI was also performed to detect occult fractures. Postoperatively patients underwent conventional X-ray controls. Data were retrospectively analyzed for surgical and radiation time, complication rate, clinical outcome and compared to the literature.
Patients (average age 79.1 years) underwent surgery with operation time of 52.3 min (SD 13.9), intra-operative X-ray time of 9.42 s (SD 9.6), mean dose length product of 70.1 mGycm (SD 57.9) and a mean hospital stay of 21.2 days (SD 7.7). 13% patients (n = 7) showed surgery-related complications, such as wound infection, prolonged wound secretion, irritation of the sacral root or clinically inapparent screw malpositioning. 17% (n = 9) showed postoperative complications (one patient died due to pneumonia 24 days after surgery, eight patients developed urinal tract infections). 42 patients managed to return to previous living situation. 34 were followed-up after a mean period of 31.5 (6-90) months and pain level at post-hospital examination of 2.4 (VAS) with an IOWA Pelvic Score of 85.6 (55-99).
We showed that MIPLCP osteosynthesis is a safe surgical alternative in patients with FFP 3 and FFP 4. This treatment is another way of maintaining a high level of stability in the osteoporotic pelvic ring with a relatively low complication rate, low radiation and moderate operation time and a good functional outcome.
骨盆脆性骨折（FFP）在老年患者中较为常见。我们评估了使用微创后路锁定加压钢板（MIPLCP）作为治疗选择的临床效果。
对 53 例保守治疗后持续性疼痛和活动受限的后骨盆环不稳定性骨折患者，采用 MIPLCP 进行治疗。初始 X 线检查后，行骨盆 CT 扫描。在某些情况下，还进行 MRI 以检测隐匿性骨折。术后患者行常规 X 线检查。回顾性分析手术和放射时间、并发症发生率、临床结果，并与文献进行比较。
患者（平均年龄 79.1 岁）手术时间为 52.3 分钟（标准差 13.9），术中 X 线时间为 9.42 秒（标准差 9.6），平均剂量长度乘积为 70.1mGycm（标准差 57.9），平均住院时间为 21.2 天（标准差 7.7）。13%（n=7）的患者出现与手术相关的并发症，如伤口感染、伤口分泌物延长、骶神经根刺激或临床无症状的螺钉位置不当。17%（n=9）出现术后并发症（1 例患者术后 24 天死于肺炎，8 例患者发生尿路感染）。42 例患者恢复到之前的生活状态。34 例患者在平均 31.5（6-90）个月后随访，出院后疼痛水平为 2.4（VAS），爱荷华骨盆评分（IOWA）为 85.6（55-99）。
我们表明，MIPLCP 内固定是 FFP 3 和 FFP 4 患者的一种安全手术选择。这种治疗方法是维持骨质疏松性骨盆环高稳定性的另一种方法，具有相对较低的并发症发生率、低放射剂量、适中的手术时间和良好的功能结果。
