摘要
目的探讨骨盆复位架在闭合复位和微创固定骨盆骨折的手术方法和临床疗效。方法回顾性分析2017年7月—2019年6月华中科技大学同济医学院附属同济医院创伤外科采用陈华和唐佩福改进的石家庄亿成科技有限公司生产的微创骨盆复位架系统治疗不稳定骨盆骨折患者41例,男性14例,女性27例;年龄14~70岁,平均41.4岁。Tile分型:B型15例,C型26例;Young-Burgess分型:侧方挤压2型(LC 2)损伤15例,垂直剪切(VS)损伤22例,混合型(CM)损伤4例;道路交通伤29例,坠落伤11例,重物砸伤1例。受伤至手术时间3~45d,平均10.1d。手术使用骨盆复位架复位,各通道螺钉技术、INFIX、外固定支架或钢板固定骨盆前后环。记录手术时间和术中出血量,观察并发症情况。根据Matta标准评价骨折复位情况,根据末次随访Majeed评分系统和Gibbons骶神经损伤分级分别对临床功能和神经功能进行评价。结果除1例闭合复位失败改为开放手术,余40例闭合复位成功。手术时间45~316min,平均169.4mim;术中出血量10~300mL,平均49.3mL;至2020年1月,患者获7~24个月随访,平均14.1个月;所有患者3~6个月骨折愈合,未出现伤口脂肪液化、感染、伤口不愈合、内固定物松动、骨折再次移位等并发症。后环采用骶髂螺钉固定29例,LC 2髂骨螺钉固定6例,骶髂螺钉和LC 2螺钉联合固定5例。前环采用耻骨支螺钉固定11例,INFIX固定17例,外固定支架固定2例和钢板固定3例;耻骨支螺钉联合钢板固定1例;前环未固定6例。术后骨折复位按Matta评分:优21例,良16例,可3例。末次随访时Majeed评分:优36例,良4例。2020年1月末次随访时Gibbons骶神经损伤分级:术前合并神经损伤患者6例,完全恢复5例,未恢复1例。结论与常规切开复位手术比较,骨盆复位架治疗骨盆骨折创伤小、出血少、切口相关并发症发生率低,临床疗效满意。
Objective To investigate the effectiveness and surgical method of closed reduction and minimally invasive fixation of pelvic fractures with external pelvic reduction frame.Methords A retrospective analysis was carried out in 41 patients with unstable pelvic fractures treated with external pelvic reduction frame produced by Shijiazhuang Yicheng Technology Company improved by Chen Hua and Tang Peifu in the Trauma Surgery Department of our hospital from Jul.2017 to Jun.2019.There were 14 males and 27 females with an average age of 41.4 years(range,14-17 years).All were unstable pelvic fractures.According to Tile classification of pelvic fractures:there were 15 cases of type B,26 cases of type C;According to Young-Burgess classification:there were 15 cases of LC 2,22 cases of VS,and 4 cases of CM.There were 29 cases of traffic accidents,11 cases of fall injuries,and 1 case of heavy injuries.Injury to surgery time was 3-45 days,with an average age of 10.1 days.All operations were performed using external pelvic reduction frame,and the anterior and posterior pelvic rings were fixed with each channel screw technique,INFIX,external fixator or steel plate.The operation time and intraoperative blood loss were recorded,and the complications were observed.Postoperative fracture reduction was evaluated according to the Matta criteria,and clinical function and neurological function were evaluated according to the Majeed scoring system and Gibbons nerve injury classification at the last follow-up.Results Except for 1 case of closed reduction failure,which was changed to open surgery,the remaining 40 cases received successful closed reduction.Among these 40 cases,the operation time was 45-316 minutes,with an average of 169.4 minutes.The intraoperative blood loss was 10-300mL,with an average of 49.3mL.By Jan.2020,all patients were followed up for 7-24 months,with an average of 14.1 months.All patients healed after 3 to 6 months without any complications such as liquefaction of wound fat,infection,unhealed wounds,loose internal fi
作者
李悦
李辉
李天宇
何立
罗杨兴
胡迎华
张谦
尹恩志
李占飞
白祥军
易成腊
Li Yue;Li Hui;Li Tianyu;He Li;Luo Yangxing;Hu Yinghua;Zhang Qian;Yin Enzhi;Li Zhanfei;Bai Xiangjun;Yi Chengla(Department of Traumatic Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《创伤外科杂志》
2021年第1期5-9,共5页
Journal of Traumatic Surgery
关键词
骨盆骨折
复位架
闭合复位
微创固定
pelvic fracture
reduction frame
closed reduction
minimally invasive fixation
