切开复位微型钢板内固定治疗尾骨骨折脱位

摘要

目的:评价治疗尾骨骨折脱位的手术方法及疗效.方法:选择2002年5月至2010年3月治疗的尾骨骨折脱位患者56例,按手术与否分为手术组和手法组.其中手术组27例,男7例,女20例,平均年龄(48.1±0.6)岁(29～62岁),采用手术切开复位微型钢板内固定治疗；手法组29例,男8例,女21例,平均年龄(47.5±0.9)岁(19～54岁),采用非手术治疗.两组患者治疗前均对其进行X线检查,确诊为尾骨骨折脱位.对治疗前后的临床症状和视觉模拟评分(VAS)进行统计学分析.结果:两组患者在性别、年龄、BMI及VAS评分差异无统计学意义,具有可比性.术后56例患者均获得随访,随访时间12～25个月,平均17.2个月.手术组Ⅰ/甲切口为26例,Ⅱ/甲切口为1例；临床症状在出院时的显效率为92.6％,末次随访时的显效率为100％；VAS评分的改善率为97.6％,改善率评定为优；经手术治疗的27例患者术后1～2年取出内固定,无任何不适症状,VAS评分均为0分.手法组29例患者,临床症状在出院时的显效率为72.4％,末次随访时的显效率为82.8％.VAS评分的改善率72.1％,改善率评定为良.两组间的临床结果差异有统计学意义(P＜0.05).结论:尾骨骨折脱位应及时治疗,对于手法复位失败、复位后X线显示不稳定和直肠刺激症状较重的患者,应积极采取切开复位微型钢板内固定治疗,可以取得比较满意的效果.%Objective:To explore the therapeutic methods of fracture and dislocation of coccyx and evaluate its curative effects.Methods:From May 2002 to March 2010,56 patients with fracture and dislocation of coccyx were divided into surgical treatment group and non-surgical treatment group.There were 7 males and 20 females in surgical treatment group with an average age of(48.1±0.6) years (ranged,29 to 62 years),treated with open reduction and mini-plate internal fixation.There were 8 males and 21 females in non-surgical treatment group with an average age of (47.5±0.9) years (ranged,19 to 54 years),treated with manipulative reduction.All patients were underwent X-ray examination and were finally diagnosed before treatment.Clinical symptoms and Visual Analogue Scales(VAS) of all patients were statistically analyzed before and after treatment.Results:There was no significant difference between two groups in gender,age,BMI index and VAS evaluation.All patients were followed up from 12 to 25 months with an average of 17.2 months.In surgical treatment group,there were 26 cases with Ⅰ/a incision and 1 case with Ⅱ/a incision;the excellent rate of clinical symptom was respectively 92.6％ and 100％ at leaving hospital and final follow-up; the improvement rate of VAS was 97.6％ and was excellent resu internal fixtures were removed at the 1 to 2 years after treatment and no unwell symptoms occurred;VAS of all patients in the group was 0 point.In non-surgical treatment group,the excellent rate of clinical symptom was respectively 72.4％ and 82.8％ at leaving hospital and final follow-up;the improvement rate of VAS was 72.1％ and was good result.There was significant difference in clinical results between two groups (P＜0.05).Conclusion:The results indicated that fracture and dislocation of coccyx should be treated in time.For the treatment of patients with manipulative reduction failures,instability reduction by X-ray examination and serious rectal irritation,open reduction and mini-plate internal fixation can obtain satisfactory results.