Eakin John L, Grewal Ishvinder S, Fene Evan S, Sathy Ashoke K, Starr Adam J
Department of Orthopaedic Surgery, Parkland Memorial Hospital, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Clin Orthop Trauma. 2022 Feb 12;26:101806. doi: 10.1016/j.jcot.2022.101806. eCollection 2022 Mar.
Percutaneous techniques are commonly used to treat pelvic ring disruptions but are not mainstream for fixation of pubic symphysis disruption worldwide. Potential advantages include less blood loss and lower risk of surgical site infection, especially in the morbidly obese or multiply injured patient. This study was performed to describe the clinical and radiographic outcomes of patients after percutaneous reduction and screw fixation of pubic symphysis disruption and to evaluate the preliminary safety and efficacy of this technique and its appropriateness for further study as an alternative method of fixation.
A retrospective review was performed to identify all patients who underwent percutaneous fixation of pubic symphysis disruption by two surgeons at an academic Level I trauma center over a 3-year period. Patients underwent percutaneous reduction and fixation of the pubic symphysis using 1 or 2 fully or partially threaded 5.5, 6.5, or 7.3 mm cannulated screws in a transverse or oblique configuration. Associated posterior ring injuries were fixed with -sacral and/or iliosacral screws. The primary outcome of interest was loss of reduction, defined as symphysis distance greater than 15 mm measured on final AP pelvis radiograph. Secondary outcomes collected by chart review were operative time, blood loss, vascular or urologic injury, sexual dysfunction, infection, implant loosening or breakage, and revision surgery.
Twelve patients met criteria and primary and secondary outcomes were collected. Mean clinical and radiographic follow-up were 15 months each. One patient lost reduction. Mean operative time and blood loss were 124 min and 29 cc, respectively. No vascular or urologic injuries occurred. Two patients reported sexual dysfunction. No patients became infected or required revision surgery. Four patients underwent implant removal. Seventeen additional patients were excluded due to short follow-up and limited outcomes were collected. Two of these patients lost reduction. Three underwent implant removal.
These data support percutaneous reduction and screw fixation of pubic symphysis disruption as a potentially safe and effective method of treatment that warrants further investigation.
经皮技术常用于治疗骨盆环损伤，但在全球范围内并非耻骨联合损伤固定的主流方法。其潜在优势包括失血更少、手术部位感染风险更低，尤其是在病态肥胖或多处受伤的患者中。本研究旨在描述耻骨联合损伤经皮复位和螺钉固定术后患者的临床和影像学结果，并评估该技术的初步安全性和有效性以及作为一种替代固定方法进行进一步研究的适用性。
进行一项回顾性研究，以确定在一所一级学术创伤中心，由两位外科医生在3年期间对所有接受耻骨联合损伤经皮固定的患者。患者采用1枚或2枚直径5.5、6.5或7.3毫米的全螺纹或部分螺纹空心螺钉，以横向或斜向方式对耻骨联合进行经皮复位和固定。相关的后环损伤用骶骨和/或髂骶螺钉固定。主要关注的结果是复位丢失，定义为在最终骨盆前后位X线片上测量的耻骨联合间隙大于15毫米。通过病历审查收集的次要结果包括手术时间、失血量、血管或泌尿系统损伤、性功能障碍、感染、植入物松动或断裂以及翻修手术。
12例患者符合标准并收集了主要和次要结果。平均临床和影像学随访时间均为15个月。1例患者出现复位丢失。平均手术时间和失血量分别为124分钟和29毫升。未发生血管或泌尿系统损伤。2例患者报告性功能障碍。无患者发生感染或需要翻修手术。4例患者取出了植入物。另外17例患者因随访时间短而被排除，收集到的结果有限。其中2例患者出现复位丢失。3例患者取出了植入物。
这些数据支持耻骨联合损伤经皮复位和螺钉固定作为一种潜在安全有效的治疗方法，值得进一步研究。
