CAJ | 학술논문

目的探讨前路重建钢板固定治疗不稳定性骨盆后环损伤的适应证、优缺点及其疗效. 方法回顾性分析2004年8月-2010年7月应用前路重建钢板固定治疗的不稳定性骨盆后环损伤、临床资料完整并获得至少1年随访的36例患者,其中男25例,女11例；年龄13～62岁,平均35.8岁.骶髂关节前脱位2例,后脱位34例.按Tile分类:B1型3例,B2型1例,C1 -1型17例,C1 -2型12例,C2型2例,C3型1例. 结果全部患者获得随访平均2.3年(1～6年).术后脂肪液化浅表感染2例,经换药、少量多次输血愈合.术中损伤股外侧皮神经8例,通过经神经营养药物治疗后5例完全恢复,其中3例仍遗留大腿外侧麻木.L5神经根牵拉损伤1例,经神经营养药物治疗3个月后恢复.复位质量根据Matta和Tornetta标准:优23例,良11例,可2例,优良率为94％.无复位丢失或内固定失败患者.临床疗效按照Majeed评分系统:优17例,良14例,可4例,差1例,优良率为86％.术前合并骶丛损伤的7例患者中,3例完全恢复,2例部分恢复,2例无恢复.结论前路重建钢板固定具有手术适应证广、暴露简单、感染率低、复位满意和固定牢靠等优点,可获得满意的临床疗效,是治疗不稳定性骨盆后环损伤的主要方法之一.
목적 탐토전로중건강판고정치료불은정성골분후배손상적괄응증、우결점급기료효. 방법 회고성분석2004년8월-2010년7월응용전로중건강판고정치료적불은정성골분후배손상、림상자료완정병획득지소1년수방적36례환자,기중남25례,녀11례；년령13～62세,평균35.8세.저가관절전탈위2례,후탈위34례.안Tile분류:B1형3례,B2형1례,C1 -1형17례,C1 -2형12례,C2형2례,C3형1례. 결과 전부환자획득수방평균2.3년(1～6년).술후지방액화천표감염2례,경환약、소량다차수혈유합.술중손상고외측피신경8례,통과경신경영양약물치료후5례완전회복,기중3례잉유류대퇴외측마목.L5신경근견랍손상1례,경신경영양약물치료3개월후회복.복위질량근거Matta화Tornetta표준:우23례,량11례,가2례,우량솔위94％.무복위주실혹내고정실패환자.림상료효안조Majeed평분계통:우17례,량14례,가4례,차1례,우량솔위86％.술전합병저총손상적7례환자중,3례완전회복,2례부분회복,2례무회복.결론 전로중건강판고정구유수술괄응증엄、폭로간단、감염솔저、복위만의화고정뢰고등우점,가획득만의적림상료효,시치료불은정성골분후배손상적주요방법지일.
Objective To discuss the surgical indications,relative merits and clinical outcomes of anterior reconstruction plate fixation for treating unstable posterior pelvic ring injuries. Methods A retrospective study was done on clinical data of 36 patients with unstable posterior pelvic ring injuries treated with anterior reconstruction plate fixation from August 2004 to July 2010 and followed up for minimum one year.There were 25 males and 11 females,at mean age of 35.8 years ( range,13-62 years).There were two patients with anterior dislocation of the sacroiliac joint and 34 with posterior dislocation.According to Tile classification,there were four patients with type B fractures ( B1:3,B2:1 ) and 32 with type C fractures (C1-1:17,C1-2:12,C2:2,C3:1 ). Results All patients were followed up for average 2.3 years ( range,1-6 years).Fat liquefaction and superficial infection were founded in two patients who were cured by dressing change and frequent but low-dose blood transfusion.Eight patients were subjected to iatrogenic lateral femoral cutaneous nerve injury.Meanwhile,five of them was recovered after treatment with neurotrophic drugs,but there were still three patients leaving lateral thigh numbness.One patient had L5 nerve root injury due to pull force,and was recovered after three months of neurotrophic drug therapy.According to Matta and Tometta criteria,the reduction results were excellent in 23 patients,good in 11 and fair in four,with excellence rate of 94％.No reduction loss or implant failure occurred.According to Majeed scoring system,the clinical outcomes were excellent in 17 patients,good in 14,fair in four and poor in one,with excellence rate of 86％.Of the seven patients pre-operatively associated with sacral plexusinjury,three obtained full recovery,two got partial recovery and two were free from recovery. Conclusion The anterior reconstruction plate fixation takes advantages of wide surgical indications,simple exposure,low infection rate,satisfactory reduction and solid fixation and may be a main treatment method for unstable posterior pelvic ring injuries.