Objective To compare the outcome of plate fixation and percutaneous screw technique in the treatment of traumatic diastasis of the pubic symphysis. Methods Ninety patients with traumatic symphysis pubis diastasis were treated from Jan. 2003 to Dec. 2009 at two Level 1 regional trauma centers. Forty five patients were treated by percutaneous screw fixation. Forty five patients were treated by plate and screws fixation. The fracture type, surgical incision length, blood loss, fixation failure, malunion rate, revision surgery rate and functional scores were compared. Results Eighty-three patients were followed up, with mean time of 21 months (18 to 26 ) . Seven cases were not followed up due to other factors. There was no difference in the fracture type, and Injury Severity Score between the two groups ( P > 0. 05 ) . There was less blood loss ( P < 0. 01) , minimal trauma ( P < 0. 01) and better postoperative function ( P = 0. 01) in the percutaneous screw fixation group while compared with the plate fixation group. There were no significant differences in the fixation quality ( P = 0. 32) ,fixation failure rate( P =0. 39) , malunion rate ( P =0. 15) and revision surgery rate( P = 0. 27 ) between the two groups. Conclusion Percutane-rnbetter functional outcome. Moreover,its fixation reliability is similar to the plate fixation method.%目的 探讨C型骨盆骨折前后环联合重建固定治疗的方法并观察其疗效.方法 29例C型骨盆骨折,C1型14例,C2型11例,C3型4例.骨盆前环骨折采用前方耻骨联合、髂腹股沟或改良stoppa入路,应用钢板螺钉或外固定器固定;骨盆后环骨折采用髂腹股沟入路钢板螺钉或经皮骶髂螺钉固定.结果 随访6~38个月,平均14个月.29例均达骨性愈合.骨盆后环复位情况根据Tornetta和Matta评定标准,本组优20例,良6例,可3例;优良率89.7%.功能评估参照Majeed评分系统,优16例,良9例,可3例,差1例;优良率86.2%.其中前环钢板螺钉/外固器+后环骶髂螺钉固定组:优10例,良7例,可1例,差1例;优良率89.5%;前后环均钢板螺钉固定组:优6例,良2例,可2例;优良率80.0%,两组间比较差异没有统计学意义.结论 前后环联合重建固定是治疗C型骨盆骨折的理想方法;应根据骨折情况选择合适的手术入路及固定方式;后环闭合复位经皮骶髂螺钉固定微创、疗效好.
展开▼
