CAJ | 학술논문

目的探讨应用外固定架联合髂腰固定术治疗垂直不稳定型骨盆骨折的临床效果.方法对2008年1月至2009年3月收治的9例垂直不稳定型骨盆骨折患者进行手术治疗.男4例,女5例;年龄19～56岁,平均37岁.9例均为Tile C型骨折,其中C1.2型3例,C1.3型6例.采用后路患侧下腰椎旁切口入路,垂直移位复位后,椎弓根钉棒系统固定L4.5椎体和髂后上棘,前路双侧髂前上棘组合式外固定器固定.结果 9例患者术后获得12～18个月随访,平均14.3个月.术后X线片均示骨盆骨折复位满意,后环形态恢复良好;根据Matta骨盆骨折复位评定标准,优6例,良3例.术后2例患者骶丛损伤压迫症状解除,未出现医原性神经、血管损伤.下肢行走、蹲屈功能恢复满意.术后12个月Majeed评分:优7例,良2例.结论外固定架联合髂腰固定术治疗垂直不稳定型骨盆骨折疗效满意,且具有操作简便、并发症少的特点.
목적 탐토응용외고정가연합가요고정술치료수직불은정형골분골절적림상효과.방법 대2008년1월지2009년3월수치적9례수직불은정형골분골절환자진행수술치료.남4례,녀5례;년령19～56세,평균37세.9례균위Tile C형골절,기중C1.2형3례,C1.3형6례.채용후로환측하요추방절구입로,수직이위복위후,추궁근정봉계통고정L4.5추체화가후상극,전로쌍측가전상극조합식외고정기고정.결과 9례환자술후획득12～18개월수방,평균14.3개월.술후X선편균시골분골절복위만의,후배형태회복량호;근거Matta골분골절복위평정표준,우6례,량3례.술후2례환자저총손상압박증상해제,미출현의원성신경、혈관손상.하지행주、준굴공능회복만의.술후12개월Majeed평분:우7례,량2례.결론 외고정가연합가요고정술치료수직불은정형골분골절료효만의,차구유조작간편、병발증소적특점.
Objective To evaluate the clinical outcomes of external fixator with lumbopelvic distraction spondylodesis in treatment of vertically unstable pelvic fractures. Methods From January 2008 to March 2009, 9 patients (4 males and 5 females) with a vertically unstable pelvic fracture were treated with modular external fixator with lumbopelvic distraction spondylodesis. According to the classification of Tile, 9fractures were classified as type C. This fixation construct comprises a vertical lumbopelvic distraction component which fixed L4.5 and the posterior superior iliac spine and a transverse fixation which fixed anterior iliac spine with external fixator. Results All patients were followed up 12-18 months after surgery, with an average of 14.3 months. Postoperative X-ray showed satisfactory reduction of pelvic fracture. Pelvic fractures healed in all patients without loss of reduction 3-6 months after operation. According to Matta reduction evaluation criteria, 6 patients were excellent and 3 good. For the two patients with sacral neurological injuries,appropriate surgical decompression was performed to improve the symptom and minimize the deformity. No iatrogenic complications of neurovascular injury occurred. Patients now walk unassistedly without pain in the waist or legs, and with no shortening of lower limbs or claudication. By considering symptom and satisfactory scores, the Majeed functional assessment revealed that seven patients had excellent results and two good at one year. Conclusion External fixator with lumbopelvic distraction spondylodesis that allowed early mobilization and ambulation, with general applicability and definite safety, is an effective surgical technique for the treatment of vertically unstable pelvic fracture.