CAJ | 학술논문

目的探讨有限切开复位内固定治疗Tile C型骨盆骨折的方法与疗效.方法回顾性分析2005年2月至2011年1月收治且获得随访的61例67侧Tile C骨盆骨折患者资料,男43例,女18例;年龄11～71岁,平均36岁.骨盆骨折按Tile分型:CI型51例,其中C11型22例,C12型8例,C13型21例；C2型4例；C3型6例.所有患者均采用有限切开复位内固定治疗:前方显露耻骨上支复位并在髂前上棘处开窗固定；后方采用沿髂后上棘的斜形切口暴露骨盆后环.评估术中出血情况及术后患者功能恢复情况. 结果前环手术的手术时间和出血量平均分别为49 min、76 mL;而后侧入路手术平均分别为63 min、227 mL. 61例患者术后获12～ 53个月(平均31个月)随访.根据Matta和Tornetta提出的标准评定术后骨折复位质量:优58侧(86.6％),良7侧(10.4％),一般2侧(3 0％).64侧骨折于术后12周获愈合,另3侧骨折于术后6个月获愈合.49例(80.3％)患者恢复伤前工作和生活,8例(13.1％)轻度步态异常但工作等正常,4例(6.6％)步态明显异常但尚能胜任普通体力工作.本组患者无医源性神经损伤发生. 结论通过有限切开复位和固定的方法,在不需要暴露神经、血管等结构的前提下,可以对Tile C型骨盆骨折进行良好的显露和安全、稳定的固定,疗效良好.
목적 탐토유한절개복위내고정치료Tile C형골분골절적방법여료효.방법 회고성분석2005년2월지2011년1월수치차획득수방적61례67측Tile C골분골절환자자료,남43례,녀18례;년령11～71세,평균36세.골분골절안Tile분형:CI형51례,기중C11형22례,C12형8례,C13형21례；C2형4례；C3형6례.소유환자균채용유한절개복위내고정치료:전방현로치골상지복위병재가전상극처개창고정；후방채용연가후상극적사형절구폭로골분후배.평고술중출혈정황급술후환자공능회복정황. 결과 전배수술적수술시간화출혈량평균분별위49 min、76 mL;이후측입로수술평균분별위63 min、227 mL. 61례환자술후획12～ 53개월(평균31개월)수방.근거Matta화Tornetta제출적표준평정술후골절복위질량:우58측(86.6％),량7측(10.4％),일반2측(3 0％).64측골절우술후12주획유합,령3측골절우술후6개월획유합.49례(80.3％)환자회복상전공작화생활,8례(13.1％)경도보태이상단공작등정상,4례(6.6％)보태명현이상단상능성임보통체력공작.본조환자무의원성신경손상발생. 결론 통과유한절개복위화고정적방법,재불수요폭로신경、혈관등결구적전제하,가이대Tile C형골분골절진행량호적현로화안전、은정적고정,료효량호.
Objective To investigate the efficacy of Tile C pelvic fractures treated with limited open reduction and internal fixation. Methods A total of 67 unstable pelvic fractures in 61 consecutive patients were treated with limited open reduction and internal fixation from February 2005 to January 2011 in our department.They were 43 males and 18 females,with a mean age of 36 years (range,11 to 71 years).According to the Tile classification,51 cases were of type C1 (22 cases of type C11,8 cases of type C12 and 21 cases of type C13),4 cases of type C2,and 6 cases of type C3.The superior ramus of pubis was exposed for reduction and fracture fixation through the anterior approach,while the posterior pelvic ring was exposed using an oblique incision along the posterior superior iliac spine through the posterior approach.Intraoperative blood loss was measured and postoperative functional outcomes were evaluated at follow-ups. Results The average operation time and intraoperative blood loss by the anterior approach was 49 minutes and 76 mL respectively,while those by the posterior approach was 63 minutes and 227 mL.All the patients obtained an average follow-up of 31 months (range,12 to 53 months). The quality of reduction according to Matta's criteria was graded as excellent in 58 fractures (86.6％),good in 7 (10.4％) and moderate in 2 (3％).Sixty-four fractures healed at 12 weeks postoperatively,and 3 fractures healed at 6 months.Forty-nine patients (80.3％) resumed their former work and life.Eight patients showed mild gait irregularity that did not affect their normal work and life while 4 patients showed obvious gait irregularity that did not compromise their capability of doing common physical work.None of the patients lost self-care ability.No iatrogenic nerve injury was found in these cases. Conclusions Limited open reduction and internal fixation permits excellent exposure of the Tile C pelvic fracture and provides safe and stable fixation without the necessity to dissect neurovascular structures.