皮下内置外架系统微创治疗Tile C1、C2型骨盆骨折的临床疗效

Clinical Effect of Minimally Invasive Treatment of Tile C1 and C2 Pelvic Fractures with Subcutaneous Internal Fixator System

关键词:  骨盆  骨折  固定术  内置外架  骶髂螺钉

Key words:  pelvic  fractures  fixation  internal fixator  iliosacral screw

摘要:

探讨皮下内置外架(Internal Fixator,INFIX)系统微创治疗Tile C1、C2不稳定型骨盆骨折的应用及疗效。回顾性分析2017年1月至2021年1月期间收治的32例新鲜Tile C1、C2型骨盆骨折患者临床资料,骨盆后环损伤均采用骶髂螺钉固定,根据骨盆前环固定方式分为INFIX组和钢板组,比较两组患者手术时间、前环手术切口长度、术中出血量、手术并发症、术后视觉模拟评分(Visual Analogue Scale,VAS),术后应用Matta放射学标准评估骨折复位质量,末次随访时采用Majeed功能评分评定骨盆功能。结果表明:INFIX组手术时间、切口长度、术中出血量显著低于钢板组(P<0.05);术后2 d、1周、1个月INFIX组VAS明显低于钢板组(P<0.05),而术后3个月、6个月两组疼痛无明显差异(P>0.05);术后Matta放射学标准评估INFIX组优良率高于钢板组(P<0.05);末次随访骨盆Majeed功能评分INFIX组优良率与钢板组相似(P>0.05);两组患者手术并发症发生率无显著差异(P>0.05)。综上可知,INFIX与钢板螺钉内固定均可有效治疗Tile C1、C2型骨盆骨折,术后功能恢复均良好,但INFIX内固定治疗具有手术时间短、切口小、术中出血量少、术后疼痛少等微创优势。

Abstract:

This article aims to investigate the application and curative effect of the subcutaneous internal fixator (INFIX) system in minimally invasive treatment of Tile C1 and C2 unstable pelvic fractures.A retrospective cases control study was performed to analyze the data of 32 patients with Tile C1 and C2 pelvic fractures which were fresh and treated between January 2017 and January 2021.The posterior pelvic ring injuries were all fixed with sacroiliac screws.According to the fixation method of the anterior pelvic ring,the patients were divided into INFIX group and plate group.The operation time,incision length of anterior pelvic ring,intraoperative blood loss,postoperative complications and postoperative Visual Analogue Scale (VAS) were compared between the two groups.Matta criteria were applied to assess the quality of fracture reduction after operation and Majeed Pelvic Score was used to assess pelvic function at the last follow-up.The results showed that the operation time,incision length and intraoperative blood loss in the INFIX group were significantly lower than that in the plate group (P<0.05).The VAS score of the INFIX group was significantly lower than that in the plate group at 2 d,1 week and 1 month after operation (P<0.05),but there were no significant differences in the pain between the two groups at 3 months and 6 months after operation (P>0.05).According to Matta criteria,the excellent and good rate of the INFIX group was higher than that in the plate group after surgery (P<0.05).The excellent and good rate of pelvic function of the INFIX group was similar to that in the plate group at the last follow-up according to Majeed Pelvic Score (P>0.05).There was no significant differences in the incidence of surgical complications between the two groups (P>0.05). In summary,both INFIX and inside-fixed plate can treat Tile C1 and C2 pelvic fractures effectively and achieve good function.However,INFIX internal fixation has the advantages of short operation time,small incision,less intra-operative bleeding and less postoperative pain.