有限切开结合经皮螺钉治疗 C 型骨盆骨折的疗效分析

摘要

目的：观察有限切开结合经皮拉力螺钉治疗C型骨盆骨折的临床疗效。方法选取2010－05—2013－12间42例TILE C型骨盆骨折患者做为观察组，术前行股骨髁上骨牵引闭合复位后，于X线透视下行有限切开耻骨钢板固定联合骶髂关节拉力螺钉固定。同时选取2008－01—2010－01间的38例C型骨盆骨折行传统切开复位内固定术的患者作为对照组，比较2组患者手术时间、术中出血量。术后随访3～6个月，比较2组骨折复位情况、愈合时间、患肢功能和并发症发生情况。结果观察组手术时间和术中出血量均低于对照组，2组比较，差异有统计学意义（ P＜0.05）。2组骨折解剖复位率差异无统计学意义（ P＞0.05）。观察组愈合时间（2.5±0.3）个月，低于对照组（3.1±0.4）个月。 Majeed评分观察组优良率96％（40／42），高于对照组82％（31／38。观察组无1例发生髋内翻畸形、腰骶神经损伤、下肢深静脉血栓和脂肪栓塞等并发症，对照组并发症发生率7.9％（3／38），其中2例发生神经损伤，1例发生深静脉血栓，2组比较，差异有统计学意义（ P＜0.05）。结论有限切开结合经皮拉力螺钉治疗C型骨盆骨折，手术创伤小、并发症少、固定牢靠、术后功能恢复好。%Objective To observe the clinical effect of limited incision combined with percutaneous lag screw for type C pelvic frac-ture.Methods Totally 42 patients with TILE type C pelvic fra cture selected in our department from 2010 May to 2013 in December, done closed traction reduction of femoral supracondylar, in X-ray fluoroscopy conduct limited internal fixation combined with iliosacral screw fixa-tion, at the sam;e time select the 2008 January-2010 January 38 patients with type C pelvic fractures treated with traditional open reduction and internal fixation patients as control group compared, the amount of bleeding and operation time, postoperative follow-up of 3~6 months, compared two groups fracture reduction, healing time, limb function and complications.Results The observation group operation time and bleeding volume during operation were lower than that of the control group( P<0.05) .X-ray examination of two groups of anatomical reduction rate of the fracture showed no significant difference(P>0.05), the healing time of observation group was (2.5 ±0.3) months, lower than that of the control group (3.1 ±0.4) months(P<0.05);the Majeed score in observation group, the excellent and good rate was 96%(40/42), more than that of control group 82%(31/38) .Complications, observation group no one a case of hip varus, lumbosacral nerve injury, deep ve-nous thrombosi of lower extremity and fat embolism, and 2 cases in the control group had the nerve injury, 1 case of deep vein thrombosis, the incidence was 7.9%(3/38), the difference was statistically significant(P<0.05).Conclusion Limited incision combined with percutaneous lag screw for type cpelvic fracture,the operation has little trauma, less complications, reliable fixation, good postoperative function recovery, can be popularized in clinic.