CAJ | 학술논문

目的探讨闭合复位经皮螺钉内固定治疗骨盆后方新月形骨折脱位的临床疗效. 方法回顾性分析2003年6月至2014年10月收治的78例骨盆后方新月形骨折脱位患者资料,男41例,女37例;年龄为18～68岁(平均37.9岁).骨折按Day分型:Ⅰ型18例,Ⅱ型35例,Ⅲ型25例.72例患者行闭合复位经皮螺钉内固定:对于Ⅰ型骨折,在仰卧位下行经髂前下棘至髂后上棘,或者俯卧位下经髂后上棘至髂前下棘的髂骨骨质较厚区域1～2枚平行螺钉(髂骨后部螺钉)垂直骨折线固定;Ⅱ型骨折采用俯卧位下1～2枚髂骨后部螺钉和1～2枚骶髂关节螺钉交叉固定;Ⅲ型骨折采用骶髂关节螺钉固定.6例闭合复位失败患者行切开复位内固定术. 结果 72例闭合复位患者后方新月形骨折脱位闭合复位内固定的时间平均为38 min,术中出血量平均为23 mL,手术切口长度平均为1.9cm,住院时间平均为5.2d.其中70例患者术后获平均14个月(6～ 24个月)随访.骨折复位质量根据Matta评分标准评定:优24例,良30例,可14例,差2例,优良率为77.1％;骨折愈合时间平均为12.0周.末次随访时根据Majeed评分系统评定患髋功能:优34例,良26例,可8例,差2例,优良率为85.7％.随访期间无一例患者发生骨折再移位、骨折不愈合及内固定物松动、断裂等并发症. 结论在Day分型的基础上,绝大部分骨盆后方新月形骨折脱位可采用微创经皮螺钉内固定治疗,且疗效良好.
목적 탐토폐합복위경피라정내고정치료골분후방신월형골절탈위적림상료효. 방법 회고성분석2003년6월지2014년10월수치적78례골분후방신월형골절탈위환자자료,남41례,녀37례;년령위18～68세(평균37.9세).골절안Day분형:Ⅰ형18례,Ⅱ형35례,Ⅲ형25례.72례환자행폐합복위경피라정내고정:대우Ⅰ형골절,재앙와위하행경가전하극지가후상극,혹자부와위하경가후상극지가전하극적가골골질교후구역1～2매평행라정(가골후부라정)수직골절선고정;Ⅱ형골절채용부와위하1～2매가골후부라정화1～2매저가관절라정교차고정;Ⅲ형골절채용저가관절라정고정.6례폐합복위실패환자행절개복위내고정술. 결과 72례폐합복위환자후방신월형골절탈위폐합복위내고정적시간평균위38 min,술중출혈량평균위23 mL,수술절구장도평균위1.9cm,주원시간평균위5.2d.기중70례환자술후획평균14개월(6～ 24개월)수방.골절복위질량근거Matta평분표준평정:우24례,량30례,가14례,차2례,우량솔위77.1％;골절유합시간평균위12.0주.말차수방시근거Majeed평분계통평정환관공능:우34례,량26례,가8례,차2례,우량솔위85.7％.수방기간무일례환자발생골절재이위、골절불유합급내고정물송동、단렬등병발증. 결론 재Day분형적기출상,절대부분골분후방신월형골절탈위가채용미창경피라정내고정치료,차료효량호.
Objective To investigate the clinical outcomes of closed reduction and internal fixation with percutaneous screws for crescent fracture-dislocation of the sacroiliac joint.Methods We reviewed 78 consecutive patients treated operatively for crescent fracture-dislocation of the sacroiliac joint from June 2003 to October 2014.They were 41 males and 37 females, with a mean age of 37.9 years (range, from 18 to 68 years).By Day classification, there were 18 cases of Type Ⅰ, 35 ones of Type Ⅱ, and 25 ones of Type Ⅲ.Closed reduction and percutaneous fixation was performed in 72 patients.For Type Ⅰ fractures, perpendicular to fracture line fixation was performed with 1-2 parallel iliac screws.For Type Ⅱ, crossed fixation was performed with 1-2 posterior iliac screws and 1-2 SIJ screws.For Type Ⅲ, fixation was performed with SIJ screws.Open reduction and internal fixation was performed in the 6 patients whose closed reduction failed.Results Time for closed reduction and internal fixation for posterior crescent fracture-dislocation averaged 38 minutes in the 72 patients;their intraoperative blood loss was 23 mL;their incision length was 1.9 cm;their hospitalization time averaged 5.2 days.Of them, 70 were followed up for an average time of 14 months (from 6 to 24 months).By Matta scoring criteria, the reduction was excellent in 24 cases, good in 30, fair in 14, and poor in 2, giving an excellent to good rate of 77.1％.The average fracture healing time was 12.0 weeks.By Majeed system, functional outcome at the last follow-up was excellent in 34 cases, good in 26, fair in 8, and poor in 2, giving an excellent to good rate of 85.7％.No complications like redislocation, nonunion and implant failure occurred during the follow-ups.Conclusion Based on the Day classification, closed reduction and percutaneous screw fixation is an effective treatment for the majority of crescent fracture-dislocations of the sacroiliac joint.