经皮骶髂螺钉固定技术治疗不稳定骨盆骨折的疗效评价

中国修复重建外科杂志2008年3月第22卷第3期·321·经皮骶髂螺钉固定技术治疗不稳定骨盆骨折的疗效评价

高伟强 王光林 刘华渝 吴刚 池雷霆 方跃 刘雷

【摘 要】 目的 评价经皮骶髂螺钉技术在不稳定骨盆骨折治疗中的安全性及疗效。 方法 2003年3月－2007年1月，收治15例Tile C型骨盆骨折患者。男6例，女9例；年龄21～56岁。车祸伤8例，高处坠落伤6例，压

砸伤1例。伤后至就诊时间4 h～3 d。耻骨骨折合并骶骨骨折7例，髂骨骨折合并骶骨骨折2例，耻骨骨折合并骶髂

关节脱位4例，前环耻骨骨折、后环骶骨骨折合并骶髂关节脱位2例。采用经皮骶髂螺钉技术固定骨盆后环，合并的前

环损伤中7例采用外固定支架固定，3例钢板固定，5例钢板联合外固定支架固定。 结果 15例住院16～33 d，平均22.4 d。除4例同时行髋臼骨折固定患者术中失血量1 000～1 500 mL，余失血约50 mL。手术时间60～305 min，平均153.6 min。15例均获随访6个月～3年，平均18个月。根据Matta评分标准，优14例，良1例。最后1次随访时，X线

片示患者骨折均愈合，平均28.8个月。1例骨折愈合后骶髂螺钉松动，3例腰骶部劳累后疼痛，2例轻度跛行，均未作特殊

处理。9例恢复原工作，3例改变工作，3例仍未工作。Majeed功能评分，优11例，良4例，优良率100%。 结论 经皮

骶髂螺钉固定技术可重建骨盆后环的稳定性，可获得良好的功能康复，同时手术并发症发生率低及创伤小，是不稳定骨盆

骨折后环稳定性重建的良好方法之一。

【关键词】 不稳定骨盆骨折 骶髂螺钉 经皮内固定

中图分类号： R683.3 R687.32 文献标志码：A

EVALUATION OF PERCUTANEOUS ILIOSACRAL SCREWS FOR UNSTABLE PELVIC FRACTURES / GAO Weiqiang, WANG Guanglin, LIU Huayu, WU Gang, CHI Leiting, FANG Yue, LIU Lei. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China. Corresponding author: WANG Guanglin, E-mail: wglfrank@

【Abstract】 Objective To evaluate the effectiveness of percutaneous fixation with iliosacral screw in the management

of unstable pelvic fractures.Methods From March2003to January2007,15patients with unstable pelvic fractures were treated by percutaneous fixation with iliosacral screws.There were6males and9females,aged21-56years.Fractures were caused by traffic accident in8cases,high falling in6cases and crushing injury in1case.The disease course ranged from4 hours to3days.Of15patients,7had fractures of pubium and sacrum;2had fractures of ilium and sacrum;4had dislocation of sacroiliac joint with fractures of pubic rami;and2had dislocation sacroiliac joint with fracture of sacrum of pubium.Anterior fixation was performed by means of plating in3cases,by external fixation in7cases,and by both in5cases.Results The blood loss was from1 000to1 500mL in4patients with acetabular fracture and about50mL in the others.The average operative time was153.6minutes(range,60-305minutes).Fifteen patients were followed up6months to3years with an average of18 months.According to Matta criterion for fracture reduction,the results were excellent in14cases and good in1case.After a follow-up of28.8months,fracture union was achieved in all patients.Screw loosening occurred in1case,pain of lumbosacral region in3cases after tiredness and mild claudication in2cases.Nine patients returned to their occupation,three patients changed occupation,and3patients could not work at last follow-up.According to Majeed functional scoring,the results were excellent in11cases and good in4cases.Conclusion Percutaneous iliosacral screw fixation is a useful method in treatment

of unstable pelvic fracture.

【Key words】Unstable pelvic fracture Iliosacral screws Percutaneous fixation

不稳定骨盆骨折多为高能量损伤所致，其诊治较为困难，目前骨盆环稳定性重建的主要采用手术治疗。骨盆是负重的主要结构，因此后环的解剖复位和固定是手术治疗的主要目标[1]。由于经皮骶髂螺钉固定技

作者单位：四川大学华西医院骨科（成都，610041）

通讯作者：王光林，副教授，硕士导师，研究方向：创伤骨科，E-mail: wglfrank@ 术具有手术创伤小和感染风险低的优点，已成为不稳定骨盆骨折手术治疗中的主要方法[1-2]。2003年3月－2007年1月，我们采用经皮骶髂螺钉固定技术治疗15例Tile C型骨盆骨折患者，疗效满意。报告如下。

1 临床资料

1.1 一般资料

本组男6例，女9例。年龄21～56岁，平均34.8