髂骨间固定与骶髂螺钉治疗B型骨盆骨折疗效比较△（开放获取）

Transiliac internal fixator versus sacroiliac screw for Tile type B pelvic fracturs

摘要:

[目的] 比较髂骨间固定（transiliac internal fixator, TIFI） 和骶髂螺钉（sacroiliac screw, SIS） 结合前环固定治疗B 型骨盆骨折的临床疗效。[方法] 回顾性分析2016 年10 月—2021 年7 月本院手术治疗47 例Tile B 型骨盆骨折患者的临床资料。根据医患沟通结果，23 例采用TIFI 结合微创前环钢板治疗（髂间组），24 例采用SIS 结合前环钢板固定（骶髂组）。比较两组围手术期、随访和影像学结果。[结果] 髂间组手术时间[(262.4±33.2) min vs (316.9±46.9) min, P＜0.001]、术中出血量[(107.6±13.0) ml vs (128.8±13.3) ml, P＜0.001]、透视次数[(13.0±3.1) 次vs (27.9±5.6) 次, P＜0.001] 均显著少于骶髂组，但切口总长度[(13.3±1.1) cm vs (10.7±1.2) cm, P＜0.001] 显著大于骶髂组。所有患者随访12 个月以上。两组患者下地行走时间、完全负重时间的差异无统计学意义（P＞0.05）。随时间推移，两组VAS 评分、Majeed 评分均显著改善（P＜0.05）。相同时间点，两组VAS 评分、Ma-jeed 评分的差异无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访时，两组患者Matta 评级显著改善（P＜0.05），相同时间点，两组间Matta 评级的差异无统计学意义（P＞0.05）。两组骨折愈合时间的差异无统计学意义（P＞0.05）。[结论] TIFI结合微创前环固定治疗B 型骨盆骨折具有手术时间短，出血量少，透视次数少及骨折复位满意等优点。

Abstract:

[Objective] To compare the clinical efficacy of transiliac internal fixator (TIFI) versus sacroiliac screw (SIS) combined withanterior ring fixation for type B pelvic fracture. [Methods] A retrospective study was conducted on 47 patients who had Tile type B pelvicfracture treated surgically in our hospital from October 2016 to July 2021. According to doctor-patient communication, 23 patients weretreated with TIFI combined with minimally invasive anterior ring plate (the TIFI group), while other 24 patients had the sacroiliac jointfixed with SIS combined with anterior ring plate ( the SIS group). The documents regarding perioperative period, follow-up and images werecompared between the two groups. [Results] The TIFI group proved significantly superior to the SIS group in terms of operation time[(262.4±33.2) min vs (316.9±46.9) min, P＜0.001], intraoperative blood loss [(107.6±13.0) ml vs (128.8±13.3) ml, P＜0.001] and fluoroscopytimes [(13.0±3.1) vs (27.9±5.6), P＜0.001], but the former consumed significantly longer total incision length than the latter [(13.3±1.1) cmvs (10.7±1.2) cm, P＜0.001]. All patients in both groups were followed up for more than 12 months, and there was no significant difference intime to regain ambulation and full weight bearing activity between the two groups (P＞0.05). The VAS scores and Majeed scores were signifi-cantly improved in both groups over time (P＜0.05), whereas which were not significantly different between the two groups at any time pointsaccordingly (P＞0.05). With respect of imaging, the Matta scale in both groups was significantly improved at the last follow-up comparedwith that preoperatively (P＜0.05), which was not statistically significant between the two groups at any corresponding same time points (P＞0.05). There was no significant difference in fracture healing time between the two groups (P＞0.05). [Conclusion] TIFI combined with mini-mally invasive anterior ring fixation in the treatment of Tile type B pelvic fracture has the advantages of shortening operation time, reducingbleeding, declining fluoroscopy and achieves satisfactory fracture reduction.