两种固定Tile C型骨盆骨折前环的比较

Two types of fixation for the anterior ring in Tile type C pelvic fractures

摘要:

[目的] 比较经皮钉棒系统（钉棒） 与钢板治疗不稳定性骨盆环骨折的临床疗效。[方法] 回顾性分析2016 年1 月—2020 年12 月本科手术治疗57 例Tile C 型骨盆骨折患者。首先行后环复位内固定，依据术前医患沟通结果，30 例采取钉棒前环固定，27 例采取钢板前环固定。比较两组围手术期、随访及影像结果。[结果] 两组患者均顺利完成手术，术中无神经、血管损伤等严重并发症。钉棒组在手术时间[(59.1±12.2) min vs (77.2±18.3) min, P＜0.05]、切口总长度[(15.4±3.2) cm vs (27.5±4.3)cm, P＜0.05] 和术中失血量[(75.2±15.3) ml vs (350.4±50.6) ml, P＜0.05] 均显著少于钢板组，两组术中透视次数、切口愈合等级、住院时间的差异均无统计学意义（P＞0.05）。早期并发症，钉棒组为3.3%（1/30），钢板组为18.5%（5/27），差异无统计学意义（P=0.091）。所有患者随访12 个月以上。钉棒组恢复完全负重活动时间显著早于钢板组[(92.6±11.2) d vs (107.4±12.1) d, P＜0.05]。随时间推移，两组患者VAS 评分显著减少（P＜0.05），而Majeed 评分显著增加（P＜0.05）。术后3 个月[(77.5±5.6) vs(71.8±3.6), P＜0.05] 和6 个月[(88.7±3.6) vs (82.5±1.6), P＜0.05] 钉棒组的Majeed 评分显著优于钢板组。影像方面，相应时间点，两组间骨折复位质量、内固定位置的差异均无统计学意义（P＞0.05）。钉棒组骨折愈合时间显著早于钢板组（P＜0.05）。[结论] 经皮钉棒系统固定Tile C 型骨盆骨折前环具有手术时间短、手术创伤小、出血量少、骨盆愈合快等诸多微创优点。

Abstract:

[Objective] To compare the clinical efficacy of percutaneous screw-rod system versus plate in the treatment of unstable pel-vic ring fractures. [Methods] A retrospective study was conducted on 57 patients who underwent open reduction and internal fixation (OR-IF) for Tile type C pelvic fractures in our department from January 2016 to December 2020. After the ORIF for the posterior ring had beenperformed, 30 patients had the anterior ring fixed with screw-rod system, while the other 27 patients were with plate. The perioperative, fol-low-up and imaging documents were compared between the two groups. [Results] All the patients in both groups were operated on success-fully without nerve and vascular injury and other serious complications. The screw-rod group proved significantly superior to the plategroup in terms of operation time [(59.1±12.2) min vs (77.2±18.3) min, P＜0.05], total incision length [(15.4±3.2) cm vs (27.5±4.3) cm, P＜0.05] and intraoperative blood loss [(75.2±15.3) ml vs (350.4±50.6) ml, P＜0.05], nevertheless there were no significant differences in thenumber of intraoperative fluoroscopy, incision healing grade and hospitalf stay between the two groups (P＞0.05). The early complicationswere 3.3% (1/30) in the screw-rod group, whereas 18.5% (5/27) in the plate group, which was not statistically significant (P=0.091). All pa-tients were followed up for more than 12 months, and the screw-rod group resumed full weight-bearing activity significantly earlier than theplate group [(92.6±11.2) days vs (107.4±12.1) days, P＜0.05]. The VAS scores for pain decreased significantly (P＜0.05), while the Majeedscore increased significantly over time in both groups (P＜0.05). The screw-rod group was significantly better than the plate group in term ofMajeed score at 3 months [(77.5±5.6) vs (71.8±3.6), P＜0.05] and 6 months [(88.7±3.6) vs (82.5±1.6), P＜0.05]. Radiographically, there wereno significant differences in reduction quality according to Matta's criteria and internal fixation position between the two groups at any timepoints accordingly (P＞0.05). However, the screw-rod group got fracture healing on images significantly earlier than that of plate group (P＜0.05). [Conclusion] The percutaneous screw-rod system used for the anterior ring fixation in Tile type C pelvic fractures has advantages ofshortening operation time, minimizing surgical trauma, reducing bleeding, enhancing fracture healing of the pelvis over the traditional platefixation.