CAJ | 학술논문

目的探讨经皮空心钉固定治疗创伤性耻骨联合分离的手术方法及临床疗效.方法 2003年2月至2010年12月,治疗46例伴耻骨联合分离的不稳定骨盆骨折,男27例,女19例；年龄18～61岁,平均34.6岁.按Tile分型:B1.1型4例,B1.2型7例,B2型2例,B3型2例,C1.1型7例,C1.2型7例,C1.3型10例,C2型5例,C3型2例.行闭合复位经皮耻骨联合螺钉内固定后,再行后环固定,包括经皮骶髂螺钉、经皮髂骨后部螺钉固定.除4例B1.1型骨折仅固定耻骨联合外,余均同时行后环固定.结果手术时间15～65 min,平均45 min;出血量10～50 ml,平均25 ml.46例患者均置入1枚耻骨联合螺钉,35例术后行骨盆CT检查,其中3例发现螺钉侵入盆腔,但未引起任何临床症状.术后无一例发生切口及钉道感染.46例患者均获得随访,随访时间5～48个月,平均23.5个月；随访期间未发现明显的复位丢失.根据Matta和Tornetta标准,末次随访时优43例,良3例.31例(67.39％)患者恢复原工作,6例因合并损伤而改变原工作,9例尚处于恢复期.28例患者无骶髂关节疼痛；13例仅在用力时有耻骨联合部或耻骨微痛,但不影响日常生活；5例有不同程度的骶髂关节疼痛.结论闭合复位经皮空心钉固定治疗创伤性耻骨联合分离安全可行,操作简便,损伤小,疗效满意.
목적 탐토경피공심정고정치료창상성치골연합분리적수술방법급림상료효.방법 2003년2월지2010년12월,치료46례반치골연합분리적불은정골분골절,남27례,녀19례；년령18～61세,평균34.6세.안Tile분형:B1.1형4례,B1.2형7례,B2형2례,B3형2례,C1.1형7례,C1.2형7례,C1.3형10례,C2형5례,C3형2례.행폐합복위경피치골연합라정내고정후,재행후배고정,포괄경피저가라정、경피가골후부라정고정.제4례B1.1형골절부고정치골연합외,여균동시행후배고정.결과 수술시간15～65 min,평균45 min;출혈량10～50 ml,평균25 ml.46례환자균치입1매치골연합라정,35례술후행골분CT검사,기중3례발현라정침입분강,단미인기임하림상증상.술후무일례발생절구급정도감염.46례환자균획득수방,수방시간5～48개월,평균23.5개월；수방기간미발현명현적복위주실.근거Matta화Tornetta표준,말차수방시우43례,량3례.31례(67.39％)환자회복원공작,6례인합병손상이개변원공작,9례상처우회복기.28례환자무저가관절동통；13례부재용력시유치골연합부혹치골미통,단불영향일상생활；5례유불동정도적저가관절동통.결론 폐합복위경피공심정고정치료창상성치골연합분리안전가행,조작간편,손상소,료효만의.
Objective To study the technique and therapeutic effect of percutaneous cannulate screw fixation to treat the traumatic diastasis of the pubic symphysis.Methods From February 2003 to December 2010,46 patients (27 men and 19 women,mean age of 34.6 years) with unstable pelvic fractures and diastasis of the pubic symphysis were admitted.All the patients were treated by closed reduction and percutaneous cannulate screw fixation of the symphysis pubis.Then to complete the fixation of posterior ring,by percutaneous screw inserted through the sacroiliac joint or posterior iliac wing.According to Tile's classification,the patients were classified into type B1.1 in 4 cases,B1.2 in 7,B2 in 2,B3 in 2,C1.1 in 7,C1.2 in 7,C1.3 in 10,C2 in 5 and C3 in 2.All patients were performed posterior ring fixation except 4 cases of type B1.1.Anteroposterior,inlet and outlet X-ray radiographs and CT scans of the pelvis were taken preoperatively to evaluate the stability and deformities,and after surgery the plain radiographs and CT scans were taken to evaluate the reduction and the location of screws.Results The average operative time was 45 min (range,15-65 min),and the average intraoperative blood loss was 25 ml (range,15-50 ml).Each patient was inserted one screw in the symphysis pubis.Thirty-five patients underwent postoperative pelvic CT scan and 3screws of them penetrated the wall of symphysis pubis.The average follow-up period was 23.5 months (range,5-48 months).In the follow-up period,no infection and displacement were found.The last follow-up result:according to Matta and Tornetta's standard,the result was excellent in 43 cases and good in 3.Among all patients,31 cases (67.39％) had returned to their original works,6 were to give up their original works as complicating injuries; 28 cases had no pain,13 cases had slight pain of the symphysis pubis while to make an effort,5 cases had pain of sacroiliac joint.There were no iatrogenic injury of nerve.Conclusion Closed reduction and percutaneous cannulate screw fixation of the traumatic diastasis of the pubic symphysis is a safe,feasible and easy manipulated method.The operative injuries is small and the clinical outcome is satisfactory.