Cui Dong-Qing, Chen Bin, Sun Hai-Yu
Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China.
Zhongguo Gu Shang. 2024 May 25;37(5):530-4. doi: 10.12200/j.issn.1003-0034.20230637.
Anterior subcutaneous internal fixation (INFIX) is one of the current representatives of minimally invasive fixation of injuries to the anterior pelvic ring. The nail insertion point of this technique is located at the anterior inferior iliac spinous screw, with an angle of 30° outward and 20° backward. Screw in at an angle, and note that the screw head should be above the deep fascia and maintain a safe distance of 20 to 25 mm from the bone surface. Its improved versions include 3 or 4 nails INFIX with added pubic tubercle screws, unilateral INFIX, short-rod INFIX, and double INFIX. These improvements further enhance stability. The lateral femoral cutaneous nerve (LFCN) is relatively easy to be damaged during anatomy, so special attention should be paid during the operation. Biomechanical stability has advantages over external fixation, and its application is flexible. It is not limited to pubic ramus fracture, symphyseal separation, etc. It also plays an important role in combined anterior and posterior ring fixation. It can be combined with posterior sacroiliac screws, iliac lumbar screws, etc. Fixed etc. Good clinical results have also been reported in children, pregnant women, and people with contraindications for subcutaneous connecting rods. In addition, the current application of robots, reduction frames and other technologies has greatly reduced the difficulty of reduction and improved the quality of closed reduction, making it possible to fix complex pelvic fracture. This technique has high reduction quality and is as effective as traditional steel plates. A common complication is LFCN injury. Careful exposure and adjustment of the position and depth of internal fixation during surgery can effectively avoid this complication.
前路皮下内固定(INFIX)是当前骨盆前环损伤微创固定的代表技术之一。该技术的钉插入点位于髂前下棘,向外成角30°,向后成角20°。以一定角度拧入螺钉,注意螺钉头应位于深筋膜上方,并与骨面保持20至25毫米的安全距离。其改进版本包括添加耻骨结节螺钉的3钉或4钉INFIX、单侧INFIX、短棒INFIX和双侧INFIX。这些改进进一步增强了稳定性。股外侧皮神经(LFCN)在解剖过程中相对容易受损,因此手术时应特别注意。生物力学稳定性优于外固定,应用灵活。它不仅限于耻骨支骨折、耻骨联合分离等,在前后环联合固定中也发挥着重要作用。它可与骶髂关节后螺钉、髂腰螺钉等联合固定等。在儿童、孕妇以及有皮下连接杆禁忌证的人群中也报道了良好的临床效果。此外,目前机器人、复位架等技术的应用大大降低了复位难度,提高了闭合复位质量,使得复杂骨盆骨折的固定成为可能。该技术复位质量高,与传统钢板效果相当。常见并发症是LFCN损伤。手术中仔细暴露并调整内固定的位置和深度可有效避免该并发症。