Liu C G, Zhang K, Li D Y, Li D S, Li R, Wei X, Zhuang Y, Wang H
Graduate Department of Xi'an Medical University, Xi 'an 710068, China.
Department of Orthopaedics and Trauma, Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an 710054, China.
Zhonghua Wai Ke Za Zhi. 2022 Sep 1;60(9):866-872. doi: 10.3760/cma.j.cn112139-20211117-00539.
To examine the influence of sacroiliac joint reduction quality on the clinical effect of bionic reduction and internal fixation for pelvic ring injury. From January 2014 to February 2019,the clinical data of 78 patients diagnosed with pelvic ring injury involving sacroiliac joints and treated with bionic reduction and internal fixation at Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University were retrospectively analyzed.There were 48 males and 30 females,aged (48.3±8.3)years (range:28 to 68 years).After bionic reduction and internal fixation,the patients were grouped according to the maximum displacement distance (d) of sacroiliac joint residual on the damaged side measured by CT examination. Patients with d≤5 mm were included in anatomical bionic reduction group,and patients with d>5 mm were included in non-anatomical bionic reduction group.In non-anatomical bionic reduction group,according to the direction of residual displacement,the patients were divided into separation displacement group and anterior-posterior displacement group. The X-ray examination was performed immediately and at the last follow-up after operation.If sacroiliac joint was relocated,or internal plant loosening,displacement,fracture and re-displacement of fracture,it was defined as internal fixation failure.Majeed pelvic fracture scoring system was used to evaluate the postoperative functional status of the two groups,and visual analogue scale (VAS) was used to evaluate the postoperative pain.Comparison between groups was performed by completely random design ANOVA,χ test,Fisher's exact test,Mann-Whitney and Kruskal-Wallis test. According to the CT examination,28 cases were included in anatomical bionic reduction group,and 50 cases were included in non-anatomical bionic reduction group.In non-anatomical bionic reduction group,27 cases were divided into separation displacement group and 23 cases were in anterior-posterior displacement group.There was no significant difference in general data among anatomical bionic reduction group,separation displacement group and anterior-posterior displacement group (>0.05). The follow-up time was (37.8±6.6) months (range:25 to 51 months). At the last follow up,the excellent and good rate of Majeed score in anatomical bionic reduction group was 96.4%(27/28),which was better than that in separation displacement group(74.1%(20/27)) and anterior-posterior displacement group (30.4%(7/23)),the difference was statistically significant (-6.479,<0.01;-6.256,<0.01); and the good rate of the separation displacement group was better than that of the anterior-posterior displacement group(-3.607,<0.01).The VAS of anatomical bionic reduction group (17 cases with 0 point, 11 cases with 1 to 3 points) were lower than that of the displacement group (6 cases with 0 point,16 cases with 1 to 3 points,5 cases with 4 to 6 points) and anterior-posterior displacement group (3 cases with 0 point,7 cases with 1 to 3 points,13 cases with 4 to 6 points),the difference was statistically significant (-3.515,<0.01;-3.506,<0.01),and there was no difference between separation displacement group and anterior-posterior displacement group.Total of 8 cases of internal fixation failure occurred,and the failure rate of anatomical bionic reduction group (0,0/28) was lower than that of the separation displacement group (11.1%,3/27) and anterior-posterior displacement group (21.7%,5/23) (=0.111,=0.014),and there was no difference between separation displacement group and anterior-posterior displacement group(=0.444). In the bionic reduction and internal fixation of pelvic fracture involving sacroiliac joint injury,the functional status,pain and internal fixation failure rate of patients with anatomical bionic reduction of sacroiliac joint are significantly better than those in the non-anatomical bionic reduction.The functional recovery of patients with separation displacement is better than that of the patients with anterior and posterior displacement.
探讨骶髂关节复位质量对骨盆环损伤仿生复位内固定临床疗效的影响。回顾性分析2014年1月至2019年2月在西安交通大学医学院附属红会医院采用仿生复位内固定治疗的78例诊断为累及骶髂关节的骨盆环损伤患者的临床资料。其中男性48例，女性30例，年龄（48.3±8.3）岁（范围：28至68岁）。仿生复位内固定后，根据CT检查测量的患侧骶髂关节残留最大位移距离（d）对患者进行分组。d≤5mm的患者纳入解剖学仿生复位组，d>5mm的患者纳入非解剖学仿生复位组。在非解剖学仿生复位组中，根据残留位移方向，将患者分为分离位移组和前后位移组。术后立即及末次随访时行X线检查。若骶髂关节复位不良，或内植物松动、移位、骨折及骨折再移位，则定义为内固定失败。采用Majeed骨盆骨折评分系统评估两组术后功能状态，采用视觉模拟评分法（VAS）评估术后疼痛。组间比较采用完全随机设计的方差分析、χ检验、Fisher确切概率法、Mann-Whitney检验和Kruskal-Wallis检验。根据CT检查，解剖学仿生复位组28例，非解剖学仿生复位组50例。在非解剖学仿生复位组中，27例分为分离位移组，23例为前后位移组。解剖学仿生复位组、分离位移组和前后位移组一般资料比较差异无统计学意义（>0.05）。随访时间为（37.8±6.6）个月（范围：25至51个月）。末次随访时，解剖学仿生复位组Majeed评分优良率为96.4%（27/28），优于分离位移组（74.1%（20/27））和前后位移组（30.4%（7/23）），差异有统计学意义（-6.479，<0.01；-6.256，<0.01）；分离位移组优良率优于前后位移组（-3.607，<0.01）。解剖学仿生复位组VAS评分（0分17例，1至3分11例）低于位移组（0分6例，1至3分16例，4至6分5例）和前后位移组（-3.515，<0.01；-3.506，<0.01），差异有统计学意义，分离位移组与前后位移组比较差异无统计学意义。共发生内固定失败8例，解剖学仿生复位组失败率（0，0/28）低于分离位移组（11.1%，3/27）和前后位移组（21.7%，5/23）（=0.111，=0.014），分离位移组与前后位移组比较差异无统计学意义（=0.444）。在累及骶髂关节损伤的骨盆骨折仿生复位内固定中，骶髂关节解剖学仿生复位患者的功能状态、疼痛及内固定失败率明显优于非解剖学仿生复位患者。分离位移患者的功能恢复优于前后位移患者。
