Kamatani Yoshiyuki, Okuda Akinori, Maegawa Naoki, Matsumori Hiroaki, Shigematsu Hideki, Kawamura Kenji, Fukushima Hidetada, Tanaka Yasuhito
Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan.
Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan.
Trauma Case Rep. 2021 Oct 1;36:100540. doi: 10.1016/j.tcr.2021.100540. eCollection 2021 Dec.
Surgery with both anterior and posterior fixation is recommended for unstable pelvic ring fractures; nonetheless, the surgical method remains controversial. Crab-shaped fixation is a minimally invasive and strong posterior fixation method using spinal instruments that can reduce vertical dislocations. The use of pelvic internal fixator as a minimally invasive anterior fixation method has been reported. It is recommended in cases where there is an open wound in the lower abdomen or damage to the pelvic organs. Conversely, to the best of our knowledge, there has been no report on the combined use of crab-shaped fixation and pelvic internal fixator to date. We performed a minimally invasive 360-degree fixation using a combination of crab-shaped fixation and pelvic internal fixator for an unstable pelvic ring fracture (AO-C2) and sacral fracture (Denis zone II) with 15-mm vertical dislocation. The sacral fracture was accompanied by a large bone fragment in the spinal canal, which was suspected to have caused neuropathy. Therefore, in addition to posterior fixation, we performed decompression and removed the bone fragment. Postoperative computed tomography revealed that the sacral vertical dislocation was reduced to 7.5 mm. The patient started getting out of bed on postoperative day 2. His neuropathy improved after surgery. Owing to abdominal discomfort, pelvic internal fixator was extracted at 3 months postoperatively. Bone fusion was completed, and posterior fixation was removed at 9 months postoperatively. Two years after, the patient walks independently and has returned to work. Minimally invasive 360-degree pelvic ring fixation is a treatment option for an unstable pelvic ring fracture (AO-C2).
对于不稳定骨盆环骨折，建议采用前后联合固定手术；尽管如此，手术方法仍存在争议。蟹形固定是一种使用脊柱器械的微创且坚固的后固定方法，可减少垂直脱位。已有报道将骨盆内固定器作为一种微创前固定方法。在存在下腹部开放性伤口或盆腔器官损伤的情况下推荐使用。相反，据我们所知，迄今为止尚无关于联合使用蟹形固定和骨盆内固定器的报道。我们对一例伴有15毫米垂直脱位的不稳定骨盆环骨折（AO-C2）和骶骨骨折（Denis II区）患者，联合使用蟹形固定和骨盆内固定器进行了微创360度固定。骶骨骨折伴有椎管内大骨块，怀疑已导致神经病变。因此，除了后固定外，我们还进行了减压并取出了骨块。术后计算机断层扫描显示骶骨垂直脱位减少至7.5毫米。患者术后第2天开始下床活动。术后其神经病变有所改善。由于腹部不适，术后3个月取出了骨盆内固定器。术后9个月完成骨融合并取出后固定装置。两年后，患者能够独立行走并已重返工作岗位。微创360度骨盆环固定是不稳定骨盆环骨折（AO-C2）的一种治疗选择。
