老年脆性骨盆骨折经皮逆行耻骨支螺钉固定△

Percutaneous retrograde pubic ramus screw for fixation of fragile fractures of pelvis in the elderly

摘要:

[目的]探讨老年骨盆脆性骨折（fragile fracture of pelvis, FFP）行经皮逆行耻骨支螺钉固定治疗耻骨支骨折的临床效果。[方法] 回顾性分析本院 2019 年 6 月—2020 年 12 月采用经皮逆行耻骨支螺钉固定的 25 例老年骨盆脆性骨折 （27 侧耻骨支），记录临床及影像结果。[结果] 所有患者均顺利完成手术，术中无神经、血管损伤的并发症发生。所有患者随访 （17.8± 0.7）个月，恢复完全负重活动时间平均（7.8±0.6）周。与术后 3 个月相比，末次随访时，Majeed 评分显著增加（P＜0.05），髋内-外旋 ROM、伸-屈 ROM 无显著变化 （P＞0.05）。末次随访疗效按 Majeed 标准临床结果评定为优 19 侧，良 7 侧，可 1 侧， 优良率 96.3%。影像方面，按 Matta 标准评价骨折复位质量，优 21 侧，良 6 侧，优良率 100.0%。影像骨折愈合时间＜8 周 11 侧，占 40.7%；8~12 周 16 侧，占 59.3%。与术后 3 个月相比，末次随访时 Tonnis 髋退变评级无显著变化 （P＞0.05）。[结论] 逆行耻骨支经皮螺钉治疗老年脆性骨盆骨折具有手术创伤小、失血少、并发症少、功能恢复快等优点。

Abstract:

[Objective] To explore the clinical outcomes of percutaneous retrograde pubic rami screw for fixation of fragile fracture of pelvis (FFP) in the elderly. [Methods] A retrospective study was conducted on 25 elderly patients (27 sides of pubic rami) who underwent percutaneous retrograde pubic rami screw for fixation of FFP in our hospital from June 2019 to December 2020. The clinical and imaging consequences were evaluated. [Results] All patients were operated smoothly without complications such as nerve and vascular injuries dur- ing the operation. All patients were followed up for (17.8±0.7) months, with the mean time to return to full weight-bearing activities of (7.8± 0.6) weeks. The Majeed scores significantly increased at the last follow-up compared with 3 months after surgery (P＜0.05), whereas the hip internal-external rotation range of motion (ROM) and extension-flexion ROM remained unchanged (P＞0.05). At the last follow-up, the clin- ical results were marked as excellent 19 sides, good 7 sides and fair 1 side with an excellent and good rate of 96.3% according to Majeed criteria. In terms of imaging, the reduction quality of fracture based on Matta criteria were excellent in 21 sides and good in 6 sides, with ex- cellent and good rate of 100.0%. Of them, 11 sides got fracture healing in 8 weeks, accounted for 40.7%, while the other 16 sides got heal- ing from 8 weeks to 12 weeks, accounted for 59.3%. There was no significant change in term of Tonnis classification for hip degeneration at the latest follow-up compared with those 3 months after surgery (P＞0.05). [Conclusion] The percutaneous retrograde pubic rami screw has the advantages of less trauma, less blood loss, fewer complications and faster functional recovery for treatment of FFP in the elderly.