Tile B骨盆骨折外固定是否耻骨支置钉的比较△（开放获取）

External frame with or without pubic ramus pining for Tile type B pelvic fractures (Open Access)

摘要:

[目的] 比较外固定架治疗 Tile B 型骨盆骨折是否耻骨支置钉的临床效果。[方法] 回顾性分析 2019 年 1 月—2022 年 4 月外固定架治疗 42 例 Tile B 型骨盆骨折患者的临床资料，依据术前医患沟通结果，22 例采用髂骨-耻骨支联合置钉外固定 （耻骨钉组），另外 20 例单纯髂骨置钉外固定（无耻骨钉组）。比较两组围手术期、随访及影像资料。[结果]两组患者均顺利完成手术，未发生血管、神经损伤等并发症。耻骨钉组手术时间 [(36.8±5.8) min vs (24.5±5.1) min, P＜0.001]、切口总长度 [(6.1± 0.6) cm vs (4.1±0.5) cm, P＜0.001]、术中失血量 [(27.9±7.2) ml vs (17.1±6.8) ml, P＜0.001] 和术中透视次数 [(9.1±1.8) 次 vs (6.6±1.6) 次, P＜0.001] 均显著多于无耻骨钉组，但前者下地行走时间 [(22.8±2.4) d vs (41.9±3.8) d, P＜0.001]、住院时间 [(12.2±1.8) d vs (19.4± 2.8) d, P＜0.001]、完全负重活动时间 [(45.7±6.6) d vs (60.7±9.4) d, P＜0.001] 均显著优于无耻骨钉组 。随术后时间推移，两组 VAS 评分、髋伸屈 ROM、内外旋 ROM 和 Majeed 评分均显著改善 （P＜0.05）；术后 1 个月耻骨钉组在 VAS 评分 [(2.8±1.1) vs (4.2± 1.7), P=0.004]、髋伸屈 ROM [(147.8±13.3)° vs (139.5±11.9)°, P=0.038]、内外旋 ROM [(69.8±8.4)° vs (64.2±6.2)°, P=0.020] 和 Majeed 评分 [(76.1±9.3) vs (65.2±7.0), P＜0.001] 均显著优于无耻骨钉组。影像学方面，两组骨折复位质量和骨折愈合时间的差异无统计学意义（P＞0.05）。[结论]髂骨-耻骨支联合置钉外固定支架治疗 Tile B 型骨盆骨折的临床效果优于无耻骨钉支架。

Abstract:

[Objective] To compare the clinical consequences of external frame fixation of Tile type B pelvic fractures with or without pubic ramus pining. [Methods] A retrospective research was performed on 42 patients who were treated with external fixators for Tile type B pelvic fractures from January 2019 to April 2022. According to the results of preoperative patient-patient discussion, 22 patients received external frame with iliac crest and pubic ramus pining (PRP group), while the other 20 patients underwent external fixator with iliac crest pining alone (non-PRP group). The perioperative, follow-up and imaging documents of the two groups were compared. [Results] All the patients in both groups were operated smoothly, with no vascular, nerve injury and other complications. The PRP group was significantly greater than the non-PRP group in terms of operation time [(36.8±5.8) min vs (24.5±5.1) min, P＜0.001], the total length of incision [(6.1± 0.6) cm vs (4.1±0.5) cm, P＜0.001], intraoperative blood loss [(27.9±7.2) ml vs (17.1±6.8) ml, P＜0.001] and intraoperative fluoroscopy times [(9.1±1.8) times vs (6.6±1.6) times, P＜0.001], but the former proved significantly superior to the latter in terms of the time to resume walking [(22.8±2.4) days vs (41.9±3.8) days, P＜0.001], hospital stay [(12.2±1.8) days vs (19.4±2.8) days, P＜0.001] and the time recover full weight-bearing activity [(45.7±6.6) days vs (60.7±9.4) days, P＜0.001]. The VAS scores, hip flexion-extension range of motion (ROM), internal and external rotation ROM and Majeed scores were significantly improved in both groups with postoperative time (P＜0.05). The PRP group was significantly better than the non-PRP group regarding VAS score [(2.8±1.1) vs (4.2±1.7), P=0.004], hip extension-flexion ROM [(147.8±13.3)° vs (139.5±11.9)°, P=0.038], the internal-external rotation ROM [(69.8±8.4)° vs (64.2±6.2)°, P=0.020] and Majeed scores [(76.1±9.3) vs (65.2±7.0), P＜0.001] one month after operation. With respect of imaging, there were no statistically significant differences in fracture reduction quality and fracture healing time between the two groups (P＞0.05). [Conclusion] The clinical effect of external fixator with both iliac and pubic ramus pining is considerably better than that with iliac pining only for Tile type B pelvic fractures.