CAJ | 학술논문

目的探讨仰卧位经皮骶髂置钉固定术治疗骨盆后环损伤的可行性、手术方法及疗效.方法在10具尸体操作的基础上,2004年10月至2007年10月对14例骨盆后环损伤行仰卧位经皮骶髂置钉固定术.男7例,女7例;年龄28～75岁,平均41.6岁.Tile B型损伤4例,C型损伤10例.患者仰卧位,于"C"型臂X线机透视下以髂前上棘上2 cm与腋后线交点及髂前上棘与髂后上棘连线中、后1/3交点为进钉点,若两点距离较大,则在透视下确定最佳进钉点.进钉角度为向前20°～30°角,向尾端倾斜5°～15°.经皮骶髂置入一枚直径7.2 mm空心钛螺钉固定.术后摄骨盆正位、骶骨侧位X线片,并行骶髂关节CT扫描,观察螺钉在S1椎体的位置.结果 14例均获随访,平均随访16个月.术后3个月骨盆骨折均临床愈合.14例共置入15枚空心钛螺钉,未发生与置钉有关的并发症.随访期间无神经损伤、螺钉松动及断裂现象,无骨盆畸形及骶髂部疼痛.Majeed疗效评定标准优良率为92.9%.结论采用体表双定位法,可提高仰卧位骶髂置钉固定术的安全性;仰卧位经皮骶髂置钉固定术治疗骨盆后环损伤方便、可行.
목적 탐토앙와위경피저가치정고정술치료골분후배손상적가행성、수술방법급료효.방법 재10구시체조작적기출상,2004년10월지2007년10월대14례골분후배손상행앙와위경피저가치정고정술.남7례,녀7례;년령28～75세,평균41.6세.Tile B형손상4례,C형손상10례.환자앙와위,우"C"형비X선궤투시하이가전상극상2 cm여액후선교점급가전상극여가후상극련선중、후1/3교점위진정점,약량점거리교대,칙재투시하학정최가진정점.진정각도위향전20°～30°각,향미단경사5°～15°.경피저가치입일매직경7.2 mm공심태라정고정.술후섭골분정위、저골측위X선편,병행저가관절CT소묘,관찰라정재S1추체적위치.결과 14례균획수방,평균수방16개월.술후3개월골분골절균림상유합.14례공치입15매공심태라정,미발생여치정유관적병발증.수방기간무신경손상、라정송동급단렬현상,무골분기형급저가부동통.Majeed료효평정표준우량솔위92.9%.결론 채용체표쌍정위법,가제고앙와위저가치정고정술적안전성;앙와위경피저가치정고정술치료골분후배손상방편、가행.
Objective To explore the feasibility, operative procedure and the result for the tech-nique of sacroiliac percutaneous screws fixation in dorsal position for treatment of pelvic posterior ring in-juries. Methods From October 2004 to October 2007, 14 patients with the pelvic posterior ring injuries were treated with width 7.2 mm sacroiliac cannulated screws fixation under monitoring of "C"-arm, which in-cluded 7 males and 7 females, with the mean age of 41.6 years (range, 28-75 years). According to the Tile classification, there were 4 cases for type B, 10 for type C. During the operation, the patients were kept on domal position. The inserting point was the intersection point of anterior 2 cm of superior iliac spine and posterior axillary line, or the posterior-middle 1/3 point of the line between anterior superior iliac spine and posterior superior iliac spine. The screw inclined anterior 20°～30°, 5°～15° toward foot. The pelvic preceding ring injuries and the other bone joint damages were dealt with at the same time. After the operation, screen the X-ray polished section of the pelvic A-P position and the lumbar vertebrae lateral position, and scan pelvic posterior ring by CT, watch the screw entering position in S1 centrum. Results All 14 patients were available at follow up with mean duration of 16 months (range, 6-36 months). All cases attained bone union in 3 months. Fifteen hollow titanium screws inserted into 14 patients. There were no nerve injuries and breakage or loosening of the screws, and no pelvic deformities and pain of sacroiliac. According to Majeed e-valuation, the excellent and good rate was 92.9%. Conclusion To use two ways to decide position on per-cutaneous internal fixation using sacroiliac screw in dorsal position for treatment of pelvic posterior ring in-juries is safe, convenient and feasible.