平行克氏针通道后路微创接骨板固定治疗骨盆骨折后环不稳定

摘要

目的 探讨平行克氏针通道后路微创接骨板固定治疗骨盆骨折后环不稳定的临床疗效.方法 回顾性分析2013年1月至2016年12月期间柳州市工人医院创伤中心收治的29例骨盆骨折后环不稳定患者资料.男22例,女7例;年龄为19 ～ 65岁,平均44.2岁.骨折按Tile分型:B型10例,C型19例.受伤至手术时间为4～14d,平均8.7d.所有患者均采用平行克氏针通道后路微创U型接骨板固定治疗.记录患者的手术切口长度、术中出血量、手术时间、骨折复位质量、疗效及并发症发生情况等. 结果 本组患者术中单侧切口长为2.3～3.4 cm,平均2.99 cm;术中出血量为47～88 mL,平均69.9 mL;后路置入接骨板时间为17 ～ 34 min,平均25.2 min.术后1例患者失访,其余28例患者术后获14 ～ 26个月(平均18.3个月)随访.骨折愈合时间为8～15个月,平均10.1个月.末次随访时骨折复位质量根据Matta评分标准评定:优17例,良9例,可1例,差1例,优良率为92.9％.末次随访时根据Majeed骨盆功能评分系统评定骨盆功能:优20例,良7例,可1例,优良率为96.4％;根据Pohlemann功能评分系统评定疗效:优14例,良1 1例,可2例,差1例,优良率为89.3％. 结论 平行克氏针通道后路微创接骨板固定治疗骨盆骨折后环不稳定具有手术安全性高、创伤小、疗效好及并发症少等优点.%Objective To explore the clinical efficacy of minimally invasive posterior reconstructive plating by parallel Kirschner wires in the treatment of unstable posterior pelvic fractures.Methods From January 2013 to December 2016,29 patients with unstable posterior pelvic fracture were treated at Trauma Center,Liuzhou Workers' Hospital.They were 22 men and 7 women,aged from 19 to 65 years (mean,44.2 years).By the Tile classification,10 cases were classified as type B and 19 as type C.The delay from injury to surgery ranged from 4 to 14 days (mean,8.7 days).All the patients received minimally invasive posterior fixation with a U-shaped reconstructive plate and parallel Kirschner wires.The length of incision,intraoperative bleeding,operation time,quality of fracture reduction,curative effects and complications at the last follow-up were recorded.Results The length of intraoperative unilateral incision ranged from 2.3 to 3.4 cm (average,2.99 cm);the volume of intraoperative bleeding ranged from 47 to 88 mL (average,69.9 mL);the average operation time ranged from 17 to 34 min (average,25.2 min).One patient was lost to the follow-up.The other 28 patients were followed up for 14 to 26 months (average,18.3 months).The fracture healing time ranged from 8 to 15 months (average,10.1 months).According to the Matta criteria for fracture reduction,17 cases were rated as excellent at the last follow-up,9 as good,one as fair and one as poor,giving an excellent to good rate of 92.9％.According to the Pohlemann functional scoring,14 cases were rated as excellent,11 as good,2 as fair and one as poor,giving an excellent to good rate of 89.3％.Conclusion In the treatment of unstable posterior pelvic fractures,minimally invasive posterior reconstructive plating by parallel Kirschner wires presents advantages of high security,limited surgical trauma,good curative effects and limited postoperative complications.