目的 探讨骨盆骨折后环不稳的手术方法、操作要点及临床疗效.方法 回顾2008年1月~2010年12月我科收治并手术治疗的44例骨盆骨折后环不稳患者的临床资料;其中男性35例,女性9例;年龄18~27岁,平均38.8岁.道路交通伤17例,高处坠落伤21例,砸伤6例;按Tile分型:C1.1型20例,C1.2型8例,C1.3型11例,C2型5例;合并前环不稳者先行前环骨折复位内固定后,在C型臂X线机引导下经皮微创置入骶髂空心拉力螺钉内固定35例,行后路经皮微创双侧髂骨钢板固定3例,行经腹直肌旁切口腹膜外入路切开复位钢板内固定6例.分析其治疗效果.结果 44例均顺利完成手术,手术时机选择伤后5~18d.术后X线及CT扫描重建显示骨折复位固定好,3例后路手术中有1例出现伤口感染,经换药后愈合;44例均痊愈出院,无神经损伤等手术并发症发生.结论 骨盆后环不稳定骨折的复位固定是重建骨盆环稳定性的重要环节;C型臂X线机透视下经皮空心螺钉固定手术操作简单、时间短、出血少、损伤少、内固定稳定,是首选的手术方法;对术前牵引复位不满意者可选择后路或前路复位固定.%Objective To study the operation methods of combinations of posterior and anterior pelvic ring fixation for treatment of type C pelvic fractures and observe the clinical effects. Methods Totally 29 patients with type C pelvic fracture,including 14 cases of type Cl ,11 cases of type C2 and 4 cases of type C3,were treated with steel plate and screw or external fixator for anterior pelvic ring through pubic symphysis approach, ilioinguinal approach or modified Stoppa approach; posterior pelvic ring fracture was treated with steel plate and screw using anterior ilioinguinal approach or posterior percutaneous sacroiliac approach. Results After follow-up visit for 6 to 38 months (14 months in average) ,all of 29 patients got bony united. The evaluation for posterior pelvic ring through X-ray according to Tornetta and Matta criteria showed excellent in 20 cases,good in 6 cases and fair in 3 cases,the excellent and good rate was 89.1% . The evaluation of functional outcome according to Majeed system showed 16 cases of excellent,9 cases of good,3 cases of fair and 1 case of poor,the excellent and good rate was 86. 2% ; among them, patients treated with steel plate and screw or external fixator for anterior pelvic ring combined posterior percutaneous sacroiliac screw for posterior pelvic ring,10 cases were excellent,7 cases were good.l case was fair and 1 case was poor,the excellent and good rate was 89. 5% . And patients treated with steel plate and screw for both anterior and posterior pelvic ring,6 cases were excellent,2 cases were good and 2 cases were fair,the excellent and good rate was 80. 0% . No significant difference was found between the 2 groups. Conclusion Combinations of posterior and anterior pelvic ring fixation for type C pelvic fracture is an ideal method. Proper surgical approach and fixation method should be adopted according to different types of pelvic ring fracture. Closed reduction and percuta-neous sacroiliac screw foxation for posterior pelivic ring may be mini-invasive and can achieve excellent results.
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