影響Tile C型骨盆損傷髂腰固定術后療效的相關因素分析_《中國修復重建外科雜志》

作者：

葛振新 ¹ , 王奔 ¹ , 張東正 ¹ , 劉兆杰 ² , 張銀光 ² , 賈健 ²

1天津醫科大學研究生院（天津，300200）;;
2天津醫院創傷骨科三病區;

關鍵詞：

骨盆損傷脊柱內固定系統骨折內固定術相關因素

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目的探討影響Tile C型骨盆損傷髂腰固定術后療效的相關因素。方法2007年3月－2010年3月，收治Tile C型骨盆損傷患者60例。其中男39例，女21例；年齡17～66歲，平均37歲。Tile分型：C1型27例，C2型20例，C3型13例。術前損傷嚴重程度計分法（ISS）評分12～66分，平均29.4分；傷后至手術時間2～25 d，平均8.1 d。均采用髂腰固定術治療，采用非條件logistic回歸模型探討患者年齡、性別、體重指數、術前合并傷、手術時機、功能鍛煉時間、骨折類型、術后并發癥、復位質量、骶神經損傷程度與術后療效的關系。結果60例均獲隨訪，隨訪時間12～56個月，平均27.3個月。術后切口感染、損傷12例，經清創、換藥后痊愈；余患者切口均Ⅰ期愈合。其他術后并發癥包括遲發型骶神經損害15例，行骶神經減壓6例，保守治療9例，病情緩解；髂后上棘處Schanz釘釘尾過度突出10例，局部疼痛不適3 例，取出內固定物后緩解；骶髂關節植骨不融合1例，給予加壓植骨，植骨融合；橫連桿斷裂5例，對術后功能無明顯影響；下肢深靜脈血栓形成6例，4例行濾網植入術，2例保守治療。患者骨盆骨折愈合時間3～6個月，平均3.9個月。末次隨訪時根據Matta標準評價骨折復位質量，獲優31例、良24例、可3例、差2例，優良率91.7%。Majeed評分為58～100分，平均86分；獲優28例、良12例、可16例、差4例，優良率66.7%。logistic回歸分析顯示，年齡、性別、體重指數、術后并發癥與術后療效無明顯相關；盡早手術治療（10 d內）、早期功能鍛煉（7 d以內）、復位質量越好、骶神經損傷程度越輕有利于術后功能恢復；術前合并損傷、骨盆損傷越重，術后療效越差。結論手術時機、術前合并傷、骨折類型、骨折復位質量、骶神經損傷程度、功能鍛煉時間均是影響Tile C型骨盆損傷髂腰固定術后療效的重要因素。

引用本文： 葛振新,王奔,張東正,劉兆杰,張銀光,賈健. 影響Tile C型骨盆損傷髂腰固定術后療效的相關因素分析. 中國修復重建外科雜志, 2012, 26(11): 1285-1290. doi: 復制

1.	Burgess AR. Fractures of the pelvis: Part I. the pelvic ring//Rockwood CA, Green DP, eds. Fractures in Adults. Philadelphia: JB Lippincott, 1996: 1399-1442.
2.	陳靜, 王滿宜, 張奇, 等. 三種內固定物固定骨盆后環損傷穩定性的生物力學比較. 中華骨科雜志, 2011, 31(11): 1232-1237.
3.	Papakostidis C, Kanakaris NK, Kontakis G, et al. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop, 2009, 33(2): 329-338.
4.	關驊, 石晶, 郭險峰, 等. 脊髓損傷神經學分類國際標準(2000年修訂). 中國康復理論與實踐, 2001, 7(2): 49-52.
5.	Tornetta P 3rd, Matta JM. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res, 1996, (329): 186-193.
6.	Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
7.	Tile M. Fractures of the Pelvis and Acetabulum. 3rd ed. Baltimore: Williams and Wilkins, 2003: 345.
8.	Barei DP, Shafer BL, Beingessner DM, et al. The impact of open reduction internal fixation on acute pain management in unstable pelvic ring injuries. J Trauma, 2010, 68(4): 949-953.
9.	陳紅衛, 王子陽, 黃洪斌, 等. 經皮重建鋼板與經皮骶髂螺釘固定治療Tile C型骨盆后環骨折. 中華骨科雜志, 2009, 29(11): 1019-1022.
10.	黃濤, 龐清江, 張前法, 等. 不穩定型骨盆骨折的手術重建. 中國修復重建外科雜志, 2005, 19(7): 554-557.
11.	Tile M. Acute pelvic fractures: I. causation and classification. J Am Acad Orthop Surg, 1996, 4(3): 143-151.
12.	Tile M. Internal fixation. Fractures of the pelvis and acetabulum. 2nd ed. Baltimore: Williams and Wilkins, 1995: 189-193.
13.	賈健, 王建民, 何楊, 等. 骨盆損傷中移位骶骨骨折的手術治療. 中華骨科雜志, 2009, 29(12): 1109-1115.
14.	Käch K, Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg, 1994, 97(1): 28-38.
15.	Jones CB, Sietsema DL, Hoffmann MF. Can lumbopelvic fixation salvage unstable complex sacral fractures? Clin Orthop Relat Res, 2012, 470(8): 2132-2141.
16.	Schildhauer TA, Bellabarba C, Nork SE, et al. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma, 2006, 20(7): 447-457.
17.	Kenzo U, Yasuo K, Takafumi Y, et al. Fracture of the pelvic ring: a retrospective review of 224 patients treated at a single institution. Eur J Orthop Surg Traumatol, 2011, 21(4): 251-257.
18.	Henderson RC. The long-term results of nonoperatively treated major pelvic disruptions. J Orthop Trauma, 1989, 3(1): 41-47.
19.	Schildhauer TA, Josten C, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma, 1998, 12(5): 307-314.
20.	Hoskins J, Lewis PB, Smith S, et al. Diagnosis and management of sacral fracture. Spine Surgery, 2011, 12(9): 1-8.
21.	Miranda MA, Riemer BL, Butterfield SL, et al. Pelvic ring injuries. A long term functional outcome study. Clin Orthop Relat Res, 1996, (329): 152-159.
22.	Sugimoto Y, Ito Y, Tomioka M, et al. Risk factors for lumbosacral plexus palsy related to pelvic fracture. Spine (Phila Pa 1976), 2010, 35(9): 963-966.
23.	Jang DH, Byun SH, Jeon JY, et al. The relationship between lumbosacral plexopathy and pelvic fractures. Am J Phys Med Rehabil, 2011, 90(9): 707-712.
24.	Tan GQ, He JL, Fu BS, et al. Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability. Injury, 2012, 43(8): 1318-1325.
25.	Suzuki T, Shindo M, Soma K, et al. Long-term functional outcome after unstable pelvic ring fracture. J Trauma, 2007, 63(4): 884-888.

1. Burgess AR. Fractures of the pelvis: Part I. the pelvic ring//Rockwood CA, Green DP, eds. Fractures in Adults. Philadelphia: JB Lippincott, 1996: 1399-1442.
2. 陳靜, 王滿宜, 張奇, 等. 三種內固定物固定骨盆后環損傷穩定性的生物力學比較. 中華骨科雜志, 2011, 31(11): 1232-1237.
3. Papakostidis C, Kanakaris NK, Kontakis G, et al. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop, 2009, 33(2): 329-338.
4. 關驊, 石晶, 郭險峰, 等. 脊髓損傷神經學分類國際標準(2000年修訂). 中國康復理論與實踐, 2001, 7(2): 49-52.
5. Tornetta P 3rd, Matta JM. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res, 1996, (329): 186-193.
6. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
7. Tile M. Fractures of the Pelvis and Acetabulum. 3rd ed. Baltimore: Williams and Wilkins, 2003: 345.
8. Barei DP, Shafer BL, Beingessner DM, et al. The impact of open reduction internal fixation on acute pain management in unstable pelvic ring injuries. J Trauma, 2010, 68(4): 949-953.
9. 陳紅衛, 王子陽, 黃洪斌, 等. 經皮重建鋼板與經皮骶髂螺釘固定治療Tile C型骨盆后環骨折. 中華骨科雜志, 2009, 29(11): 1019-1022.
10. 黃濤, 龐清江, 張前法, 等. 不穩定型骨盆骨折的手術重建. 中國修復重建外科雜志, 2005, 19(7): 554-557.
11. Tile M. Acute pelvic fractures: I. causation and classification. J Am Acad Orthop Surg, 1996, 4(3): 143-151.
12. Tile M. Internal fixation. Fractures of the pelvis and acetabulum. 2nd ed. Baltimore: Williams and Wilkins, 1995: 189-193.
13. 賈健, 王建民, 何楊, 等. 骨盆損傷中移位骶骨骨折的手術治療. 中華骨科雜志, 2009, 29(12): 1109-1115.
14. Käch K, Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg, 1994, 97(1): 28-38.
15. Jones CB, Sietsema DL, Hoffmann MF. Can lumbopelvic fixation salvage unstable complex sacral fractures? Clin Orthop Relat Res, 2012, 470(8): 2132-2141.
16. Schildhauer TA, Bellabarba C, Nork SE, et al. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma, 2006, 20(7): 447-457.
17. Kenzo U, Yasuo K, Takafumi Y, et al. Fracture of the pelvic ring: a retrospective review of 224 patients treated at a single institution. Eur J Orthop Surg Traumatol, 2011, 21(4): 251-257.
18. Henderson RC. The long-term results of nonoperatively treated major pelvic disruptions. J Orthop Trauma, 1989, 3(1): 41-47.
19. Schildhauer TA, Josten C, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma, 1998, 12(5): 307-314.
20. Hoskins J, Lewis PB, Smith S, et al. Diagnosis and management of sacral fracture. Spine Surgery, 2011, 12(9): 1-8.
21. Miranda MA, Riemer BL, Butterfield SL, et al. Pelvic ring injuries. A long term functional outcome study. Clin Orthop Relat Res, 1996, (329): 152-159.
22. Sugimoto Y, Ito Y, Tomioka M, et al. Risk factors for lumbosacral plexus palsy related to pelvic fracture. Spine (Phila Pa 1976), 2010, 35(9): 963-966.
23. Jang DH, Byun SH, Jeon JY, et al. The relationship between lumbosacral plexopathy and pelvic fractures. Am J Phys Med Rehabil, 2011, 90(9): 707-712.
24. Tan GQ, He JL, Fu BS, et al. Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability. Injury, 2012, 43(8): 1318-1325.
25. Suzuki T, Shindo M, Soma K, et al. Long-term functional outcome after unstable pelvic ring fracture. J Trauma, 2007, 63(4): 884-888.

《中國修復重建外科雜志》

影響Tile C型骨盆損傷髂腰固定術后療效的相關因素分析

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《中國修復重建外科雜志》

影響Tile C型骨盆損傷髂腰固定術后療效的相關因素分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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