摘要
目的探讨经腹直肌外侧入路显露、松解结合骨盆随意外架牵引复位治疗陈旧性Tile C型骨盆骨折的手术技巧及临床疗效。方法回顾性分析2017年6月至2018年6月采用经腹直肌外侧入路显露、松解结合骨盆随意外架牵引复位治疗7例陈旧性Tile C型骨盆骨折患者资料,男5例,女2例;年龄22~53岁,平均40岁;车祸伤3例,高处坠落伤3例,重物砸伤1例;再次就诊原因:患处疼痛7例、不能行走及坐立3例、双下肢不等长行走跛行3例。陈旧性骨盆骨折Tile分型:C1型4例,C2型2例,C3型1例。术前3D打印出1∶1等大完整骨盆模型,设计截骨或松解部位,手术经腹直肌外侧入路显露、松解,结合骨盆随意外架牵引复位钢板螺钉固定。记录手术时间、术中出血量及术后并发症。术后6个月时,采用视觉模拟评分(visual analogue score,VAS)评价疼痛情况;末次随访时采用Majeed评分评价临床疗效,Mears和Velyvis影像学标准评估骨折复位质量。结果7例患者手术时间140~280 min,平均190 min;术中出血700~2800 ml,平均1250 ml。其中6例为一次性完成最终固定手术,1例Tile C3型陈旧性骨盆骨折分两期完成手术。7例患者均获得随访,随访时间10~22个月;骨折均愈合,愈合时间6~12周,平均8周。术后6个月时,7例患者的VAS评分由术前的平均6.4分改善到平均0.7分;末次随访时,Majeed临床疗效评分由术前的平均60分改善到85分,Mears和Velyvis影像学标准评价满意率达85.7%(6/7)。术后1例出现闭孔神经症状,于3个月内恢复;1例患肢仍残留1 cm短缩畸形;无一例发生骨折再移位、骨不连等并发症。结论经腹直肌外侧入路前方显露能充分截断畸形愈合的骨盆,并能有效松解周围软组织,手术创伤小、神经血管损伤风险小;结合骨盆随意外架多方向牵引,能有效复位骨折脱位,从而矫正骨盆畸形,达到预期效果。
Objective To explore the surgical technique and the clinical efficacy of the lateral-rectus approach with traction reduction by the modified Starr pelvic reduction frame for Tile C pelvic nonunions and malunions.Methods Data of 7 patients with Tile C pelvic nonunions and malunions from June 2017 to June 2018 who were treated via the lateral-rectus approach combined with traction reduction by the modified Starr pelvic reduction frame were retrospectively analyzed.There were 5 males and 2 females,aged from 22 to 53(mean,40 years).The injury mechanism included 3 cases of car accident injury,3 of falling injury and 1 of crushing injury.The reasons for retreatment were pain in 7 cases,inability to walk and sit in 3,unequal length of lower limbs and lameness in 3.According to Tile classification,there were 4 cases of C1 type,2 of C2 type and 1 of C3 type.A complete pelvic model with equal size as the patient’s pelvis was 3D-printed out according to three-dimensional reconstruction CT.The osteotomy or release site was designed,and the preoperative plan was detailed.Expose and release via the lateral rectus approach combined with traction reduction was conducted using the modified Starr pelvic reduction frame.Operative time,intraoperative blood loss and postoperative complications were collected.Visual analogue scale(VAS)at 6 months after surgery were recorded.Majeed score was used to evaluate the clinical efficacy.The quality of fracture reduction was evaluated by the Mears-Velyvis radiological evaluation criterion at the latest follow-up.Results The operation time was 140-280 min,with an average of 190 min.The intraoperative blood loss was 700-2,800 ml,with an average of 1,250 ml.In 6 cases,the final fixation was performed at one time,while 1 case of Tile C3 type was performed in two stages.All patients were followed up for 10-22 months,and all the fractures healed.The mean time of bony union was 8 weeks(range,6-12 weeks).The VAS of the 7 patients was improved from an average of 6.4 points to an average of 0.7 points during 6 months postoperative follow-up.The Majeed clinical efficacy score of the latest follow-up was improved from the average 60 points preoperative to 85 points postoperative.According to the Mears-Velyvis radiological evaluation criterion,the satisfaction rate reached 85.7%(6/7).After operation,1 case occurred obturator nerve injury who recovered within 3 months,and 1 case remained limb shortening deformity of 1 cm.There was no fixation failure.Conclusion The anterior osteotomy via the lateral-rectus approach can fully cut off nonunions and malunions of the pelvis,effectively release the soft tissues around the osteotomy site,with minimal surgical trauma and low risks of neurovascular injuries.Combined the modified Starr pelvic reduction frame,it can effectively correct pelvic deformities,lower limb rotation and unequal length deformities to achieve the expected effect of surgery.
作者
杨晓东
向海波
温湘源
麦奇光
李涛
王华
杨诚
黄海
廖坚文
陈煜辉
樊仕才
Yang Xiaodong;Xiang Haibo;Wen Xiangyuan;Mai Qiguang;Li Tao;Wang Hua;Yang Cheng;Huang Hai;Liao Jianwen;Chen Yuhui;Fan Shicai(Department of Orthopaedics,the Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China;Department of Orthopaedics,Shaoguan First People's Hospital,Shaoguan 512000,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2020年第21期1435-1442,共8页
Chinese Journal of Orthopaedics
基金
国家自然科学基金(81772428,82072411)
广东省科技计划项目前沿与关键技术创新重大专项资金(2015B010125006)
广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(LC2016ZD032)。
关键词
骨盆
骨折
骨折固定术
内
Pelvis
Bone fractures
Fracture fixation,internal
