不同植入物置入内固定治疗陈旧性骨盆骨折***☆

摘要

背景：陈旧性骨盆骨折畸形愈合多因骨盆骨折后不能及时治疗所致，致残率较高。目的：探讨陈旧性骨盆骨折畸形愈合不同植入物置入内固定治疗的效果。方法：解放军总医院骨科2008年1月至2011年1月收治陈旧性骨盆骨折畸形愈合患者9例，内固定治疗时间为伤后87-165 d，平均116.7 d。9例患者骨盆旋转畸形均大于30°。治疗前行走时持续性疼痛5例，严重疼痛不能行走2例，轻度间歇疼痛2例；双下肢不等长4例，患侧短缩平均2.25 cm。治疗操作均在球囊导管临时完全阻断髂总动脉下进行，采用扩大的髂腹股沟入路，骨盆后环畸形的处理包括髂骨截骨5例，骶骨外缘(1.5 cm 内)截骨1例，骶髂关节切开翻转融合3例。结果与结论：9例患者植入物置入内固定治疗后获得随访12-48个月，平均随访24.8个月。骨折愈合时间为16-24周，平均愈合时间为20.6周。治疗后均未发生坐骨神经牵拉损伤。根据 Mears DC 报道治疗后评估标准，解剖复位6例(6/9，67%)，满意复位3例(3/9，33%)。通过对9例患者随访发现，经扩大的髂腹股沟入路行骨盆植入物置入内固定联合截骨矫形治疗陈旧性骨盆骨折畸形愈合，可有效矫正畸形，重建骨盆稳定性。%BACKGROUND: The treatment not in time after pelvic fracture is the main reason for old pelvic fracture malunion which with higher morbidity. OBJECTIVE: To explore the effect of different implants internal fixation on old pelvic fracture malunion. METHODS: Nine patients with old pelvic fracture malunion were selected from the Department of Orthopedics, General Hospital of Chinese PLA between January 2008 and January 2011; the nine patients were treated with internal fixation at 87-165 days after injury, averaged 116.7 days. The pelvic rotational deformity of nine patients was more than 30°. Pre-treatment walking persistent pain occurred in five patients, two patients had serious pain and could not walk, mild intermittent pain in two patients. Four patients had lower limbs discrepancy, and the average ipsilateral shortening was 2.25 cm. The treatment was performed when the iliac artery completely temporary blocked by bal oon catheter with expanded ilioinguinal approach. For the treatment of posterior pelvic ring deformity, five patients received iliac osteotomy, one patient received outer edge sacrum osteotomy (in 1.5 cm) and three patients received sacroiliac joint incision flip and fusion. RESULTS AND CONCLUSION: Al the nine patients were fol owed-up for 12-48 months after implants internal fixation, and the average fol ow-up time was 24.8 months. The fracture healing time was 16-24 weeks, and the average healing time was 20.6 weeks. No sciatic nerve stretch injury occurred after treatment. According to the evaluation criteria reported by Mears DC after treatment, anatomic reduction was in six patients (6/9, 67%), satisfactory reduction in three patients (3/9, 33%). The fol ow-up of the nine patients showed that implants internal fracture combined with osteotomy for the treatment of old pelvic fracture through expanded ilioinguinal approach can effectively correct the deformity and reconstruct the pelvic stability.