摘要
目的探讨耻骨支骨折进行微创钢板固定的力学稳定性和临床疗效。方法通过有限元分析，比较微创骨折钢板固定技术与传统钢板固定技术对耻骨支骨折钢板固定后稳定性的影响；并对2005—2012年101例126侧使用微创技术进行耻骨支骨折固定的患者进行回顾性分析，评估耻骨支骨折手术固定所需时间、术中出血情况及术后随访耻骨支骨折愈合情况。结果有限元分析结果显示，使用传统和微创两种技术进行耻骨支骨折钢板固定，盆骨上最大应力分别为7．35MPa和5．59MPa，最大位移分别为4．31mm和4．38mill，骨折断端间相对位移分别为0．029nlm和0．012mm；与未固定时比较，骨折端面位移分别减小26％和59％。临床结果显示，耻骨支骨折手术所需平均时间及平均出血量分别为65min及94ml。所有患者术后均获5～50个月（平均24．3个月）随访。根据Matta复位标准评估术后骨折复位质量：优118侧（93．7％），良8侧（6．3％）。117侧骨折于术后12周内获愈合，另9侧骨折于术后6个月获愈合。本组无医源性神经和血管损伤发生。结论使用钢板对耻骨支骨折进行微创固定是一项安全、有效的固定技术；其疗效满意，创伤小且更为美观。
Objective To investigate the mechanical stability and clinical outcome of minimally invasive plate osteosynthesis of pubic ramus fractures. Methods Stability of minimally invasive plate osteosynthesis and traditional open fixation of pubic ramus fractures was compared in finite element analy- sis. A retrospective analysis was performed on fractures of pubic rami （ 126 sides） in 101 consecutive pa- tients treated with minimally invasive plate osteosynthesis from 2005 to 2012. Operation time, intraopera- tive blood loss and follow-up of fracture healing were evaluated. Results In finite element analysis, traditional open fixation and minimally invasive plate osteosynthesis resulted in the maximum pelvic force of 7.35 MPa and 5.59 MPa, maximum fracture displacement of 4.31 mm and 4.38 mm and relative frac- ture gap displacement of 0. 029 mm and 0.012 ram. Displacement of fracture gap after minimally invasive plate osteosynthesis and traditional open fixation was reduced 26% and 59% respectively. In the clinical study, the surgery acquired for pubic ramus fractures averaged 65 minutes with mean blood loss of 94 ml. Follow-up duration was 5-50 months （ mean, 24.3 months）. Reduction of the fracture as assessed using Matta＇ s criteria was excellent in 118 sides （93.7%）, good in eight sides （6.3%）. Totally, the fracture was healed within postoperative 12 weeks in 117 sides and within postoperative 6 months in 9 sides. No iatrogenic nerve or vascular injury occurred. Conclusions Minimally invasive plate osteosynthesis is a safe and effective technique for fixation of pubic ramus fractures. Moreover, satisfactory results can be achieved together with less trauma and better cosmetic effect.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2013年第11期1074-1078,共5页
Chinese Journal of Trauma
关键词
耻骨
骨盆
骨折固定术
内
有限元分析
Pubic bone
Pelvis
Fracture fixation, internal
Finite element analysis
