Huang Shu-Ming, Lan Shu-Hua, Xing Hai-Lin, Wang Chong, Xie Pan-Pan, Chu Xu-Feng, Ye Fang, Wu Quan-Zhou, Ye Ji-Fei
Department of Orthopaedics, the Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang, China.
Zhongguo Gu Shang. 2022 Apr 25;35(4):309-16. doi: 10.12200/j.issn.1003-0034.2022.04.002.
To assess the clinical efficacy of minimally invasive technology with trajectory screw fixation for fragility fractures of pelvic(FFP).
A retrospective case control study was performed to analyze the clinical data of 35 patients with FFP who were treated and followed up between January 2016 and December 2019. There were 12 males and 23 females, aged from 65 to 99 years with an average of(75.4±7.8) years old. There were 13 cases of type Ⅱb, 7 cases of type Ⅱc, 8 cases of type Ⅲa, 2 cases of type Ⅲb, 2 cases of type Ⅲc, 1 case of type Ⅳb, and 2 cases of type Ⅳc according to Rommens FFP comprehensive classification. All patients received the treatment of minimally invasive technology with trajectory screws fixation. According to the different methods of anterior pelvic ring fixation, FFP patients were divided into two groups:12 cases were fixed with the pedicle screw rod system in the anterior pelvic subcutaneous internal fixator (INFIX) group;23 cases were fixed with hollow screws of the pubic symphysis, superior ramus of pubis or acetabular anterior column in the screw group. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, length of hospital stay, cost of internal fixation, pre- and post-operative visual analogue scale(VAS) were compared between the two groups. The fracture reduction quality was evaluated according to the Matta criteria, and the clinical function was evaluated by the Majeed functional scoring system respectively.
All patients were followed up for 12 to 39(16.5±5.4) months after surgery. There was no statistically significant difference in the operation time, intraoperative blood loss, intraoperative fluoroscopy time, and length of hospital stay between the two groups(>0.05). As for the cost of internal fixation, the cost of internal fixation in the screw group [2 914 (2 914, 4 371) yuan] was significantly lower than that of the INFIX group [6 205 (6 205, 6 205) yuan] (<0.05). No significant difference was observed in the incidence of postoperative complications between the two groups (>0.05). There was no significant difference in VAS assessment at admission, 1 week, and 3 months after surgery between the two groups(>0.05). However, the VAS assessment at 1 week and 3 months after surgery of the two groups were significantly better than those at admission(<0.05). There was no significant difference in the quality of fracture reduction after the operation and the efficacy evaluation at the last follow-up between the two groups(>0.05).
For the treatment of fragility fractures, minimally invasive technology with trajectory screw fixation can achieve good clinical efficacy. It has the advantages of being relatively minimally invasive, less bleeding, relieving the pain. It deserves clinical application.
评估采用轨迹螺钉固定的微创技术治疗骨盆脆性骨折（FFP）的临床疗效。
进行一项回顾性病例对照研究，分析2016年1月至2019年12月期间接受治疗并随访的35例FFP患者的临床资料。其中男性12例，女性23例，年龄65至99岁，平均（75.4±7.8）岁。根据Rommens FFP综合分类，Ⅱb型13例，Ⅱc型7例，Ⅲa型8例，Ⅲb型2例，Ⅲc型2例，Ⅳb型1例，Ⅳc型2例。所有患者均接受轨迹螺钉固定的微创技术治疗。根据骨盆前环固定方法的不同，将FFP患者分为两组：12例采用骨盆皮下前路内固定器（INFIX）组的椎弓根螺钉系统固定；23例采用耻骨联合、耻骨上支或髋臼前柱空心螺钉固定于螺钉组。比较两组的手术时间、术中出血量、术中透视次数、住院时间、内固定费用、术前及术后视觉模拟评分（VAS）。根据Matta标准评估骨折复位质量，分别采用Majeed功能评分系统评估临床功能。
所有患者术后随访12至39（16.5±5.4）个月。两组在手术时间、术中出血量、术中透视时间和住院时间方面差异无统计学意义（>0.05）。在内固定费用方面，螺钉组的内固定费用[2 914（2 914，4 371）元]明显低于INFIX组[6 205（6 205，6 205）元]（<0.05）。两组术后并发症发生率差异无统计学意义（>0.05）。两组在入院时、术后1周和3个月时的VAS评估差异无统计学意义（>0.05）。然而两组术后1周和3个月时的VAS评估均明显优于入院时（<0.05）。两组术后骨折复位质量及末次随访时疗效评估差异无统计学意义（>0.05）。
对于脆性骨折的治疗，采用轨迹螺钉固定的微创技术可取得良好的临床疗效。具有相对微创、出血少、缓解疼痛等优点，值得临床应用。
