CAJ | 학술논문

目的探讨应用通用脊柱内固定系统(USS)联合骶骼螺钉的三角固定技术治疗Tile C 型骨盆骨折的疗效. 方法 2009年1月至2010年12月采用USS联合骶髂螺钉的三角固定技术治疗22例(25侧)Tile C型骨盆骨折患者,男13例,女9例；年龄21～48岁,平均31.2岁；骨折按照Tile 分型:C1型9例,C2型7例,C3型6例.受伤至手术时间为5～21 d,平均11.2 d.根据Matta标准对骨折复位质量进行评价,根据Majeed功能评分标准及Gibbons骶神经损伤分级分别对临床功能和神经功能进行评价.结果术中出血量平均为450 mL(100～800 mL),住院时间平均为16 d(12～26 d).22例患者术后获平均14个月(4～26个月)随访.2例患者术后出现切口感染,经清创、抗感染治疗后治愈.本组患者无复位丢失及内固定松动、断裂等并发症发生.所有患者骨折均获愈合,15例已取出内固定物.根据Matta评分标准评价骨折复位质量:解剖复位18侧,满意复位6侧,复位差1侧.末次随访时根据Majeed功能评分标准评定疗效:优13例,良6例,可2例,差1例,优良率为86.4％.末次随访时13例术前合并神经损伤的患者按Gibbons骶神经损伤分级:Ⅰ级6例,Ⅱ级4例,Ⅲ级2例,Ⅳ级1例. 结论 USS联合骶髂螺钉的三角固定技术治疗Tile C型骨盆骨折是一种较好的固定方法,增强了骨折的固定强度,能同时行神经探查、减压,还可早期负重,术后功能恢复好.
목적 탐토응용통용척주내고정계통(USS)연합저격라정적삼각고정기술치료Tile C 형골분골절적료효. 방법 2009년1월지2010년12월채용USS연합저가라정적삼각고정기술치료22례(25측)Tile C형골분골절환자,남13례,녀9례；년령21～48세,평균31.2세；골절안조Tile 분형:C1형9례,C2형7례,C3형6례.수상지수술시간위5～21 d,평균11.2 d.근거Matta표준대골절복위질량진행평개,근거Majeed공능평분표준급Gibbons저신경손상분급분별대림상공능화신경공능진행평개.결과 술중출혈량평균위450 mL(100～800 mL),주원시간평균위16 d(12～26 d).22례환자술후획평균14개월(4～26개월)수방.2례환자술후출현절구감염,경청창、항감염치료후치유.본조환자무복위주실급내고정송동、단렬등병발증발생.소유환자골절균획유합,15례이취출내고정물.근거Matta평분표준평개골절복위질량:해부복위18측,만의복위6측,복위차1측.말차수방시근거Majeed공능평분표준평정료효:우13례,량6례,가2례,차1례,우량솔위86.4％.말차수방시13례술전합병신경손상적환자안Gibbons저신경손상분급:Ⅰ급6례,Ⅱ급4례,Ⅲ급2례,Ⅳ급1례. 결론 USS연합저가라정적삼각고정기술치료Tile C형골분골절시일충교호적고정방법,증강료골절적고정강도,능동시행신경탐사、감압,환가조기부중,술후공능회복호.
Objective To explore the operative techniques and effectiveness of triangular osteosynthesis for the treatment of Tile C1-3 pelvic ring injuries following sacral fracture. Methods From January 2009 to December 2010,22 patients with Tile C1-3 pelvic ring injuries following sacral fracture were treated with triangular osteosynthesis using a combination of Universal Spinal System (USS) and iliosacral screws in our hospital.Tbey were 13 males and 9 females,aged 21 to 48 years (average,31.2 years).By Tile classification,there were 9 cases of type C1,7 cases of type C2 and 6 cases of type C3.The average time from injury to definitive operation was 11.2 days (range,from 5 to 21 days).The reduction quality was evaluated according to the Matta criteria,functional outcome according to the Majeed criteria and nerve functional outcome according to the Gibbons criteria. Results The average blood loss was 450 mL(range,from 100 to 800 mL).The average hospital stay was 16 days (range,from 12 to 26 days).All patients were followed up for an average of 14 months (range,from 4 to 26 months).Local infection was seen in 2 patients and healed with aggressive debridement and antibiotics.Reduction loss or hardware failure was not seen in this series.All fractures were healed at the final radiological follow-up.Implant removal was performed in 15 patients.Reduction was excellent in 18 sides,good in 6 sides and fair in one side.The functional outcome at the last follow-up was excellent in 13 cases,good in 6 cases,fair in 2 cases and poor in one case.Of the 13 patients with preoperative neurologic impairment,6 achieved grade Ⅰ,4 grade Ⅱ,2 grade Ⅲ and one grade Ⅳ at the last follow-up. Conclusion As a relatively new fixation strategy for Tile C1-3 pelvic ring injuries following sacral fracture,triangular osteosynthesis using a combinatiou of USS and iliosacral screws can provide rigid fixation and permit early full weight-bearing post-operation because nerve decompression can be performed at the same time.