Department of Orthopaedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China.
BMC Surg. 2022 Jun 3;22(1):216. doi: 10.1186/s12893-022-01659-z.
Pubic ramus fracture was an injury of anterior pelvic ring, the anterior pelvic ring plays an important role in maintaining the stability of the pelvis. The purpose of this study was to investigate the effect and indication of percutaneous retrograde pubic screw fixation assisted by hollow pedicle finder for pubic ramus fractures.
The clinical data of 68 patients with pubic ramus fracture treated with cannulated screw from March 2008 to March 2020 were retrospectively analyzed. According to the surgical methods, they were divided into traditional surgery group (32 cases in group A, with traditional retrograde pubic screw fixation) and modified surgery group (36 cases in group B, with percutaneous retrograde pubic screw fixation assisted by hollow open circuit device). Operation time, blood loss, incision length, screw length and complications were recorded and compared between the two groups. On the second day after surgery, the maximum fracture displacement over plain radiographs, entrance radiographs and exit radiographs of the pelvis was evaluated according to Matta criteria to evaluate the postoperative fracture reduction. Majeed score was used to evaluate the hip function at 12 months after surgery.
The operations were successfully completed in both groups. The operation time, blood loss and incision length in group B were significantly less than those in group A (P < 0.05). There was no significant difference in screw length between the two groups (t = 0.797, P = 0.431). All patients were followed up for 8-38 months (mean 21.8 months). There were no vascular and nerve injury, fracture of internal fixator, screw entry into joint cavity, fracture nonunion and other complications in both groups. The fracture healing time of the two groups was 23.1 ± 2.1 weeks in group A while 22.7 ± 2.1 weeks in group B, respectively, and there was no statistical difference in the fracture healing time between the two groups (P > 0.05). In group A, there were 3 cases of incision infection, 1 case of incision fat liquefaction and 2 cases of lower extremity deep venous thrombosis, and the complication rate was 18.8%. There was only 1 case of lower extremity deep vein thrombosis in group B, and the complication rate was 2.8%, which was significantly lower than that in group A. The fracture in one case after surgery was found to be displaced in group A and no fracture was found in group B. There was no significant difference between the two groups in Matta imaging evaluation on the next day after surgery and Majeed function evaluation at 12 months after surgery (P > 0.05).
Percutaneous retrograde pubic ramus screw fixation assisted by hollow pedicle finder is effective in the treatment of pelvic pubic ramus fracture. It has the advantages of less incision, shorter operation time, less blood loss and lower incidence of complications compared with traditional methods. However, correct surgical indications should be required when we apply this surgical method.
耻骨支骨折是骨盆前环损伤，前环在维持骨盆稳定性方面起着重要作用。本研究旨在探讨空心导针辅助经皮逆行耻骨螺钉固定治疗耻骨支骨折的效果和适应证。
回顾性分析 2008 年 3 月至 2020 年 3 月采用空心螺钉治疗的 68 例耻骨支骨折患者的临床资料。根据手术方法分为传统手术组（A 组，32 例，行传统逆行耻骨螺钉固定）和改良手术组（B 组，36 例，行空心开路器辅助经皮逆行耻骨螺钉固定）。记录并比较两组患者的手术时间、出血量、切口长度、螺钉长度和并发症。术后第 2 天，根据 Matta 标准评估骨盆入口位、出口位和正位 X 线片上的最大骨折移位，评价术后骨折复位情况。术后 12 个月采用 Majeed 评分评价髋关节功能。
两组手术均顺利完成。B 组患者的手术时间、出血量和切口长度均明显少于 A 组（P<0.05）。两组患者的螺钉长度比较差异无统计学意义（t=0.797，P=0.431）。所有患者均获随访，随访时间 8~38 个月，平均 21.8 个月。两组均无血管神经损伤、内固定器断裂、螺钉进入关节腔、骨折不愈合等并发症。A 组骨折愈合时间为 23.1±2.1 周，B 组为 22.7±2.1 周，两组骨折愈合时间比较差异无统计学意义（P>0.05）。A 组切口感染 3 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 18.8%；B 组仅发生 1 例下肢深静脉血栓形成，并发症发生率为 2.8%，明显低于 A 组。术后发现 A 组 1 例骨折移位，B 组无骨折移位。术后第 2 天和术后 12 个月的 Matta 影像学评估及 Majeed 功能评估两组间比较差异均无统计学意义（P>0.05）。
空心导针辅助经皮逆行耻骨螺钉固定治疗骨盆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、出血量少、并发症发生率低等优点。但应用该手术方法时应严格掌握手术适应证。
