两种内固定方法治疗骨盆后环损伤的疗效比较

孙家元，陈伟，刘磊等.两种内固定方法治疗骨盆后环损伤的疗效比较[J].中华创伤杂志.2013, 29(3):249-253

微创可调式接骨板,Majeed评分

孙家元，陈伟，刘磊，张奇，许斌，侯志勇，李旭，张英泽

河北医科大学第三医院骨科研究所,石家庄,050051

2013

249-253

知网,万方

目的 对比分析微创可调式接骨板(minimally invasive adjustable plate,MIAP)与重建接骨板治疗骨盆后环损伤的疗效. 方法 选择2008年10月-2011年9月收治的36例骨盆后环损伤的患者,均行切开复位内固定治疗.采用MIAP内固定治疗16例(A组),其中男8例,女8例；年龄(40.2±13.7)岁.其中交通伤19例,坠落伤12例,压砸伤5例.采用重建接骨板内固定治疗20例(B组),其中男9例,女11例；年龄(34.4±10.0)岁.术前ISS评分:A组平均14.4分(9 ～ 29分),B组11.8分(4～ 25分).骨盆后环损伤AO分型:A组B型9例,C型7例；B组B型14例,C型6例.分别于伤后(8.3±5.1)d及(8.3±3.8)d行手术治疗,记录手术时间、术中透视时间、出血量、切口长度、骨折愈合时间、术后Majeed功能评价等数据,比较两种内固定方法的疗效. 结果 36例患者获得平均23.4个月(12 ～45个月)随访.根据Majeed评分评价术后髋关节功能恢复:A组为(85.6±8.1)分,优良率为94％；B组为(80.1±9.0)分,优良率为85％.B组术后骨折畸形愈合1例,伤口感染1例. 结论 应用MIAP治疗骨盆后环损伤具有手术时间短、切口小、出血量少、固定可靠等优点,疗效优于重建接骨板. Objective To compare the efficacy of minimally invasive adjustable plate (MIAP) and reconstruction plate in treatment of posterior pelvic ring injuries.Methods The study involved 36 patients with posterior pelvic ring injuries treated with open reduction and internal fixation in our hospital from October 2008 to September 2011.Sixteen patients were treated with MIAP (Group A),including 8 males and 8 females,at mean age of (40.2 ± 13.7) years and 20 were treated with reconstruction plate (Group B),including 9 males and 11 females,at mean age of (34.4 ± 10.0) years.Preoperative mean injury severity score (ISS) was 14.4 points (range,9-29) in Group A and 11.8 points (range,4-25) in Group B.According to AO classification,Group A had nine patients with type B and seven with type C injuries,and Group B had 14 patients with type B and six with type C injuries.Groups A and B had operation at (8.3 ± 5.1) days and (8.3 ± 3.8) days after injury respectively.The two internal fixations were compared in aspects of operation time,intraoperative fluoroscopy time,intraoperative blood loss,length of incision,fracture healing time and postoperative Majeed function score.Results All patients were available for follow-up of mean 23.4 months (range,1245 months).According to Majeed standard,Group A scored (85.6 ± 8.1) points,with excellence rate of 94％ and Group B scored (80.1-9.0) points,with excellence rate of 85％.Fracture malunion occurred in one patient and incision infection in one in Group B postoperatively.Conclusion MIAP has advantages of short operation time,small incision,little blood loss and strong fixation and is more effective than reconstruction plate in treatment of posterior pelvic ring injuries.