CAJ | 학술논문

目的探讨耻骨联合浮动损伤的临床特点及采用切开复位内固定治疗的效果.方法回顾性分析2008年l 月至2013年1月采用切开复位内固定治疗48例耻骨联合浮动损伤患者资料,男31例,女17例;年龄20～61岁,平均36.5岁;车祸伤35例,坠落伤8例,挤压伤5例.骨盆骨折AO分型:B型13例,C型35例.其中45例合并骨盆后环骨折,14例合并髋臼骨折,17例合并四肢骨折,11例合并胸腹部损伤,6例合并泌尿生殖系统损伤.受伤至手术时间3～25 d,平均7d.骨盆前环同定方法:重建钛板固定双侧耻骨支骨折41例,微创空心钉固定7例.同时固定后环损伤41例,其中12例采用骶髂前钢板同定,5例采川骶髂螺钉同定,18例采川髂骨后“M”型板固定,6例采川髂腰固定.结果 44例获得随访,随访时间12～36个月,平均16个月,骨折全部临床愈合,愈合时间10～16周,平均12.6周.采川Matta标准评价骨折复位情况,其中优21例,良16例,可7例,优良率为84.1％(37/44).末次随访时Majeed评分为65～100分,平均81.5分,其中优30例,良10例,可4例,优良率为90.9％ (40/44).术后3天,2例患者发生脂肪液化,经换药2～3周后治愈;术后5～15 d,平均10d,8例发生下肢深静脉血栓,经给予低分子肝素等保守治疗1～6个月,平均3.5个月后血栓治愈;术后5～7d,平均6d,3例出现耻骨疼痛,给予抗炎止痛药物、理疗等治疗1年后疼痛解除.无一例发生钢板断裂脱出、感染及医原性神经、血管损伤等并发症.结论耻骨联合浮动伤是一类严重的骨盆骨折,多数合并后环损伤,影响骨盆稳定性,切开复位内固定可以稳定骨盆,有助于早期活动及功能锻炼,从而获得良好临床效果.
목적 탐토치골연합부동손상적림상특점급채용절개복위내고정치료적효과.방법 회고성분석2008년l 월지2013년1월채용절개복위내고정치료48례치골연합부동손상환자자료,남31례,녀17례;년령20～61세,평균36.5세;차화상35례,추락상8례,제압상5례.골분골절AO분형:B형13례,C형35례.기중45례합병골분후배골절,14례합병관구골절,17례합병사지골절,11례합병흉복부손상,6례합병비뇨생식계통손상.수상지수술시간3～25 d,평균7d.골분전배동정방법:중건태판고정쌍측치골지골절41례,미창공심정고정7례.동시고정후배손상41례,기중12례채용저가전강판동정,5례채천저가라정동정,18례채천가골후“M”형판고정,6례채천가요고정.결과 44례획득수방,수방시간12～36개월,평균16개월,골절전부림상유합,유합시간10～16주,평균12.6주.채천Matta표준평개골절복위정황,기중우21례,량16례,가7례,우량솔위84.1％(37/44).말차수방시Majeed평분위65～100분,평균81.5분,기중우30례,량10례,가4례,우량솔위90.9％ (40/44).술후3천,2례환자발생지방액화,경환약2～3주후치유;술후5～15 d,평균10d,8례발생하지심정맥혈전,경급여저분자간소등보수치료1～6개월,평균3.5개월후혈전치유;술후5～7d,평균6d,3례출현치골동통,급여항염지통약물、리료등치료1년후동통해제.무일례발생강판단렬탈출、감염급의원성신경、혈관손상등병발증.결론 치골연합부동상시일류엄중적골분골절,다수합병후배손상,영향골분은정성,절개복위내고정가이은정골분,유조우조기활동급공능단련,종이획득량호림상효과.
Objective To explore the clinical characteristics of the floating injury of symphysis pubis and clinical outcome of open reduction and internal fixation.Methods A retrospective study was conducted to analyze the 48 patients who had been treated in our department with open reduction and internal fixation for the floating injury of Symphysis pubis from January 2008 to January 2013.There were 31 males and 17 females,with an average age of 36.5 years (range,20 to 61 years).Thirty-five patients were injured in traffic accidents and 8 were injured by falling injuries,and the other 5 were crushed by maehine.Fortyfive cases were complicated with fractures of the posterior pelvis ring; 14 cases were complicated with acetabular fractures; 17 cases were complicated with extremity fractures; 1 1 cases were complicated with thoracic and abdominal injuries and 6 cases were associated with urogenital system injury.The average period from trauma to operation was 7 days (range,3 to 25 days).Operation was performed under general anesthesia.The bilateral pubic ramus fractures were fixed with reconstruction plate in 41 cases,and 7 cases were fixed with cannulated screw through minimally invasive method.Forty-one cases with posterior ring fractures were fixed simulaneously.Results There were 44 patients being followed up with an average period of 16 months (range,12 to 30 months).All the fractures of the pelvis were clinically healed with an average period of 12.6 weeks (range,10 to 16 weeks).According 图o the Majeed score system,the functional results were exc ellent in 30 cases,good in 10 cases,and fair in 4 cases; The average score was 81.5 (range,60 to 100).Two patients who had wound fat liquefaction at 3 days after operation were healed by dressing changing; 8 patients got deep vein thrombosis at 10 days (range,5 to 15 days) after operation were cured by conservative treatment; 3 patients got supra pubic pain at 6 days (range,5 to 7 days) after operation were healed by oral non steroidal anti-inflammatory analgesic drugs and physical therapy in one year.Conclusion Floating injury of symphysis pubis is a kind of severe pelvic fracture which affects the stability of pelvic ring.Open reduction and internal fixation is a good method to stabilize the pelvis ring and to get early rehabilitation.This may contribute to good clinical resuls and good function.