摘要
目的探讨微创经皮钢板内固定与皮下前环内置外架固定治疗骨盆前环骨折的临床疗效。方法回顾性分析2014年1月至2018年9月期间河南省人民医院创伤骨科收治的46例骨盆骨折患者资料。根据治疗方式不同分为两组:经皮钢板组20例,男12例,女8例;年龄为(47.8±2.4)岁;骨折按Tile分型:B1型6例,B2型9例,B3型4例,C1型1例;采用微创经皮钢板内固定。内置外架组26例,男16例,女10例;年龄为(49.6±1.2)岁;骨折按Tile分型:B1型9例,B2型8例,B3型5例,C1型2例,C2型2例;采用皮下前环内置外架固定。比较两组患者的手术或术后并发症(包括医源性神经损伤、感染、内固定失效、骨不愈合等)、末次随访时骨折复位质量及疗效等。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。46例患者术后获9~18个月(平均13.5个月)随访。经皮钢板组和内置外架组患者股外侧皮神经损伤发生率分别为5.0%(1/20)、7.7%(2/26),术后感染发生率分别为5.0%(1/20)、3.8%(1/26),皮下异物感发生率分别为5.0%(1/20)、7.7%(2/26)。末次随访时骨折复位质量按Matta评分标准评定:经皮钢板组优7例,良11例,可2例,优良率为90.0%;内置外架组优9例,良13例,可4例,优良率为84.6%。末次随访时根据Majeed骨盆功能评分系统评定疗效:经皮钢板组优10例,良7例,可2例,差1例,优良率为85.0%;内置外架组优13例,良10例,可3例,优良率为88.5%。以上项目两组之间比较差异均无统计学意义(P>0.05)。经皮钢板组患者股神经麻痹发生率为0(0/20),显著低于内置外架组[3.8%(1/26)],差异有统计学意义(P<0.05)。结论经皮钢板内固定和皮下前环内置外架固定治疗骨盆前环骨折的临床疗效相似,可根据术者经验和患者具体情况选择适宜的固定方式。
Objective To compare pedicle screw internal fixation(PSIF)and subcutaneous anterior pelvic internal fixation(APIF)in the treatment of pelvic anterior ring fractures.Methods A retrospective study was conducted of a consecutive series of 46 patients who had undergone surgery for anterior ring pelvic fractures at Department of Orthopaedic Surgery,The People’s Hospital of Henan Province from January 2014 to September 2018.Of them,20 were treated by PSIF and 26 by APIF.In the PSIF group,there were 12 males and 8 females with an age of 47.8±2.4 years,and 6 cases of B1,9 cases of type B2,4 cases of type B3 and one case of type C1 by the Tile’s classification;in the APIF group,there were 16 males and 10 females with an age of 49.6±1.2 years,and 9 cases of B1,8 cases of type B2,5 cases of type B3,2 cases of type C1 and 2 cases of type C2 by the Tile’s classification.The 2 groups were compared in terms of surgical or postoperative complications(including iatrogenic nerve injury,infection,implant failure and fracture nonunion),fracture reduction and therapeutic efficacy at the final follow-up.Results There were no significant differences between the 2 groups of patients in their preoperative general data,indicating they were compatible(P>0.05).The 46 patients were followed up for 9 to 18 months(mean,13.5 months).In the PSIF and APIF groups,the incidences of injury to the lateral femoral cutaneous nerve were 5.0%(1/20)and 7.7%(2/26),those of infection 5.0%(1/20)and 3.8%(1/26),and those of skin discomfort 5.0%(1/20)and 7.7%(2/26),respectively.According to the Matta criteria,the fracture reduction at the last follow-up was evaluated as excellent in 7,as good in 11 and as fair in 2 in the PSIF group,giving an excellent and good rate of 90.0%,and as excellent in 9,as good in 13 and as fair in 4 in the APIF group,giving an excellent and good rate of 84.6%.According to the Majeed criteria,the pelvic function at the final follow-up was evaluated as excellent in 10,as good in 7,as fair in 2 and as poor in one in the PSIF group,giving an excellent and good rate of 85.0%,and as excellent in 13,as good in 10,and as fair in 3 in the APIF group,giving an excellent and good rate of 88.5%.There were no significant differences between the 2 groups in all the comparisons above(P>0.05).The incidence of femoral nerve parasthesia was 0(0/20)for the PSIF group,significantly lower than that for the APIF groups(3.8%,1/26)(P<0.05).Conclusion As both PSIF and APIF lead to similar clinical efficacy in the treatment of pelvic anterior ring fracture,either of them can be selected as an appropriate surgical procedure depending on the patient’s situation and surgeon’s experience.
作者
王建超
高嵩
刘继军
田书建
Wang Jianchao;Gao Song;Liu Jijun;Tian Shujian(Department of Orthopaedic Surgery,The People's Hospital of Henan Province,Zhengzhou University,Zhengzhou 450003,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2019年第12期1041-1046,共6页
Chinese Journal of Orthopaedic Trauma
基金
河南省科技厅基础与前沿资助项目(132300410417.0)。
关键词
骨盆
骨折
骨折固定术
内
骨板
外科手术
微创性
Pelvis
Fractures
bone
Fracture fixation
internal
Bone plates
Surgical procedures
minimally invasive
