微创经皮骨盆前环内固定治疗不稳定性前环损伤的疗效及早期并发症分析

摘要

目的 探讨微创经皮骨盆前环内固定术(minimal invasive subcutaneous internal fixator, INFIX)治疗不稳定性骨盆前环损伤的术后疗效及早期并发症.方法 回顾性分析2016年1月至2017年12月应用INFIX治疗42例骨盆前环不稳患者资料.其中男27例,女15例;年龄18~67岁,平均45.4岁;交通伤26例,坠落伤10例,压伤3例,跌倒伤3例.骨盆骨折按Tile分型:B2型24例,B3型16例,C1型1例,C2型1例;按Young?Burgess分型:侧方挤压型Ⅰ级20例,侧方挤压型Ⅱ级18例,侧方挤压型Ⅲ级1例,前后挤压型Ⅰ级1例,前后挤压型Ⅱ级1例,垂直剪切力型1例.其中14例合并四肢骨折,11例合并需手术处理的胸腹部损伤,16例合并颅脑损伤.对于前后挤压型Ⅱ级和侧方挤压型Ⅰ级骨折,单纯采用IN?FIX固定骨盆前环;对于侧方挤压型Ⅱ、Ⅲ级或垂直剪切力型骨折,在后环固定后,再使用INFIX固定前环.术后应用Mat?ta影像学标准评价复位质量;随访时记录大腿外侧麻木疼痛情况、股四头肌力量,术后6个月时采用Majeed评分评价临床疗效.结果 42例患者均获得随访,随访时间6~12个月,平均9.3个月.术后Matta影像学标准评价,优28例,良14例,优良率100%.术后发生股外侧皮神经损伤6例(14.3%,6/42)、股神经损伤2例(4.8%,2/42),均予营养神经药物和高压氧治疗后症状缓解;切口感染1例(2.4%,1/42),予抗感染、拆除内固定物后感染控制,创面愈合;臀上动脉损伤1例(2.4%,1/42),予加压止血治疗后出血得到控制.术后早期(术后3个月内)并发症发生率为23.8%(10/42).术后6个月Matta影像学评价无一例出现复位丢失;Majeed评分72~96分,平均84.96分,其中优32例,良10例,优良率100%(42/42).结论 INFIX治疗不稳定性骨盆前环损伤,虽然术后疗效满意,但早期并发症发生率较高,其中神经损伤发生概率最高.%Objective To investigate the incidence of complications following minimal invasive subcutaneous internal fixator (INFIX) for the treatment of anterior pelvic ring instability, and to analyze control measures. Methods Data of 42 patients with anterior pelvic ring instability who were treated by anterior subcutaneous internal fixation in our hospital from January 2016 to December 2017 were retrospectively analyzed. There were 15 females and 27 males with an average age of 45.4 years (range, 18-67 years). There were 26 traffic injuries, 10 falling injuries, 3 crush injuries and 3 low energy injuries. According to Tile classi?fication, 24 cases of B2 type, 16 cases of B3 type, 1 case of C1 type and 1 case of C2 type. According to Young?Burgess classifica?tion, there were 20 cases of LCI, 18 cases of LCII, 1 case of LCIII, 1 case of APCI, 1 case of APCII, and 1 case of VS. Fourteen cas?es were combined with limb fractures, and 11 cases were combined with thoracic or abdominal injuries requiring surgical treat?ment, while 16 cases were with brain injuries. For type APC2, LC1, and some LC2 fractures, fixation for the anterior pelvic ring is enough with INFIX technique alone. For some LC2, LC3, or VS fractures, the anterior and posterior ring were both fixed. Postoper?ative reduction was evaluated by Matta radiological criteria. Lateral thigh numbness and pain, quadriceps muscle power were re? corded during follow?up, and clinical efficacy was evaluated by Majeed score at 6 months after operation. Results All the 42 pa?tients were followed up for 6 to 12 months, with an average of 9.3 months. Matta standard evaluation for fracture reduction showed that 28 cases were excellent, 14 cases good, and the excellent and good rate was 100% . The early complication rate (within 3 month after operation) was 23.8% (10/42) including 6 cases of lateral femoral cutaneous nerve injury and 2 cases of femoral nerve injury. The symptoms were obviously relieved after the treatment of nutrient nerve and hyperbaric oxygen; 1 case had incision in?fection which was healed after anti?infection therapy and internal plant removal; 1 case suffered from superior gluteal artery injury which was controlled by pressure hemostasis. Six months after surgery, no case had lost reduction. At 6 months follow?up, the Ma?jeed score was 72-96, with an average of 84.96, of which 32 were excellent and 10 were good, thus the excellent and good rate was 100% (42/42). Conclusion INFIX is an effective internal fixation method for the treatment of unstable anterior pelvic ring inju?ry. However, it has a high rate of early complications, among which nerve injury has the highest incidence.