【摘要】：目的:通過隨訪,評價髂腰固定術(shù)治療骨盆C型骨折和復(fù)雜骶骨骨折的臨床療效,總結(jié)治療經(jīng)驗。方法:回顧性分析我院2014年3月至2016年12月之間,采用椎弓根螺釘系統(tǒng)經(jīng)后路行髂腰固定術(shù)治療的骨盆C型骨折和復(fù)雜的骶骨骨折患者19例,年齡:12~61歲,平均年齡34.1歲:。骨盆骨折根據(jù)tile分型:C1型3例,C2型5例,C3型11例;骶骨骨折根據(jù)denis分型,I型5例,II型7例,III型7例,合并有神經(jīng)損傷的患者有2例。本組病例中骨盆后環(huán)損傷均采用經(jīng)后路髂腰固定術(shù)治療,前環(huán)損傷采用鋼板螺釘系統(tǒng)固定;術(shù)前若通過影像學(xué)檢查、體格檢查高度懷疑有神經(jīng)卡壓的患者行后路直接減壓或者通過對骨折塊的復(fù)位進(jìn)行間接減壓。通過Matta評分系統(tǒng)來評價骨盆復(fù)位的質(zhì)量,Majeed評分系統(tǒng)來評價臨床療效。結(jié)果:19例患者全部獲得隨訪,平均隨訪時間12.5月。本組患者骨折愈合時間15周~32周,平均19周;術(shù)前移位最大為21.80mm,平均8.76mm,術(shù)后垂直移位最大為12.57mm,平均4.20mm,骨盆垂直移位復(fù)位平均達(dá)4.57mm,根據(jù)Matta評分,優(yōu)17例,良1例,可1例,差0例,優(yōu)良率94.7%。末次隨訪Majeed評分60~98分,優(yōu)6例,良11例,可2例,差0例,優(yōu)良率89.4%。術(shù)后出現(xiàn)骶尾部深部感染患者2例,通過反復(fù)清創(chuàng)和敏感抗生素的使用,感染得到控制,骨折愈合后才取出內(nèi)固定系統(tǒng)。在取出內(nèi)固定系統(tǒng)中,19例患者中影像學(xué)檢查或術(shù)中發(fā)現(xiàn)螺釘松動的有5例,1例患者連接棒斷裂;4例患者因螺釘從髂后上棘突出而感覺骶尾部異物感或不適。術(shù)前術(shù)后影像學(xué)Matta評分結(jié)果采用SPSS 19.0統(tǒng)計軟件包進(jìn)行分析。結(jié)論:采用髂腰固定術(shù)治療骨盆C型骨折和復(fù)雜的骶骨骨折療效明顯,可恢復(fù)骨盆垂直方向的穩(wěn)定性,利于患者的早期活動及負(fù)重。術(shù)后有螺釘松動、連接棒斷裂和螺釘突出等并發(fā)癥,骨折愈合后常規(guī)需取出內(nèi)固定系統(tǒng)。
[Abstract]:Objective: to evaluate the clinical efficacy of iliolumbar fixation in the treatment of pelvic C-type fracture and complex sacral fracture. Methods: from March 2014 to December 2016, 19 patients with pelvic C fracture and complex sacral fracture treated by pedicle screw fixation were retrospectively analyzed. The average age is 34.1 years:. According to tile classification of pelvic fractures, there were 3 cases of C1 type, 5 cases of C2 type, 11 cases of C3 type, and 5 cases of sacral fracture according to denis classification, 5 cases of type I, 7 cases of type II, 7 cases of type III, and 2 cases of patients with nerve injury. The pelvic posterior ring injury was treated by posterior iliolumbar fixation, and the anterior ring injury was fixed by plate and screw system. If the imaging examination was passed before the operation, the patients who were highly suspected of nerve compression were treated with posterior direct decompression or indirect decompression through the reduction of the fracture mass. The quality of pelvic reduction was evaluated by Matta scoring system, and the clinical efficacy was evaluated by Majeed scoring system. Results: all 19 patients were followed up with an average follow-up time of 12.5 months. The fracture healing time ranged from 15 weeks to 32 weeks (mean 19 weeks). The maximum displacement was 21.80 mm (mean 8.76 mm) before operation, 12.57 mm (average 4.20 mm) and 4.57 mm (mean vertical displacement) after operation. According to Matta score, 17 cases were excellent, 1 case was good, 1 case was fair, and 0 cases were bad. The excellent and good rate is 94.7%. In the last follow-up, the Majeed score was 60-98, excellent in 6 cases, good in 11 cases, fair in 2 cases and poor in 0 cases. The excellent and good rate was 89.4%. There were 2 cases of deep sacrococcygeal infection after operation. The infection was controlled by repeated debridement and the use of sensitive antibiotics. The internal fixation system was removed only after fracture healing. Of the 19 patients, 5 had loosened screws, 1 had broken connecting rods, and 4 felt foreign sacrococcygeal sensation or discomfort due to the protrusion of the screws from the posterior superior iliac spine. Preoperative and postoperative imaging Matta scores were analyzed by SPSS 19.0 statistical software package. Conclusion: iliolumbar fixation is effective in the treatment of C-type fracture of pelvis and complicated sacral fracture, which can restore the vertical stability of pelvis and facilitate the early movement and weight-bearing of the patient. There were some complications such as screw loosening, fracture of connecting rod and screw protrusion after operation, and internal fixation system should be removed after fracture healing.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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