【摘要】 目的探讨选择骨盆后环损伤内固定的重建方法。方法2000年5月~2005年6月,对40例骨盆后环骨折脱位患者采用内固定重建手术,其中男28例,女12例。年龄21~58岁。致伤原因:车祸伤23例,压砸伤11例,坠落伤6例。骨盆后环损伤情况:骶髂关节脱位22例,骶骨骨折伴脱位12例,髂翼侧骨折伴脱位6例。按D en is等(1988)分类标准,骶骨Ⅰ区骨折6例,Ⅱ区骨折3例,Ⅲ区骨折3例。其中合并骨盆前环骨折:耻骨联合分离14例,单侧耻骨上、下支骨折10例,双侧耻骨上、下支骨折8例,同侧髋臼骨折4例,同侧髋臼骨折合并对侧耻骨上下支骨折3例,对侧髋臼骨折1例。于伤后24 h~15 d手术。分别采用骶髂关节前路钢板内固定28例,骶髂关节后路螺钉内固定2例,采用G a lveston技术联合ISOLA系统内固定10例。结果40例均获随访6个月~3年。术前合并骶丛神经损伤3例,术后1例遗留会阴部麻木和尿失禁,1例遗留跛行;后尿道断裂3例,膀胱破裂2例,经手术修补后功能完全恢复;其余患者均恢复满意。结论对于骨盆后环骨折脱位,应根据骨盆后环骨折的类型,掌握内固定技术的适用范围,选择合适的内固定重建方法。更多还原

【Abstract】 Objective To explore the choice for the internal fixation in treatment of pelvic posterior lesions.Methods From May 2000 to June 2005,the treatment was given to 40 patients(28 males,12 females, aged 21-58 years) with pelvic posterior ring fracture and dislocation.Of the patients,23 had a traffic accident,11 had a crush injury and 6 had a fall.As for the state of an injury to the pelvic posterior ring,22 patients had disloation of the sacroiliac joint,12 had a sacrum fracture dislocation,and 6 had an ala iliac fracture and disloation of the sacroiliac joint.According to the Denis(1988) classification,fracture of the(sacral region Ⅰ was found in 6 cases,fracture of the scaral) region Ⅱ in 3 cases,and fracture of the scaral region Ⅲ in 3 cases.As for the complication of the pelvic front ring fracture:separation of the symphysis pubis was found in 14 cases,fraclure of the superior ramus and inferior ramus of the pubis on one side in 10 cases.The two-side superior ramus of publis and inferion ramus of pubis in 8 cases,homopleural acetabular fracture on one side in 4 cases,acetabular fracture on one side and contralateral superior ramus and inferior ramus fracture of the pubis in 3 cases,and acetabular fracture on the opposite side in 1 case.As for the operation,28 patients underwent the still-plate internal fixation of the sacroiliac joint from anterior at 24 h to 15 days after the injury,2 underwent the screw internal fixation of the sacroiliac joint from posterior,and remaining 10 underwent the internal fixation by the Galveston Technique associated with the ISOLA system.The therapeutic results were analyzed.Results The follow-up of the 40 patients for 6 months to 3 years revealed that before operation 3 had a sacral plexus nerve injury,and after operation 1 patient developed perineum numbness and urinary incontinence,1 developed claudication,3 developed posterior urethral fragmentation,and 2 developed urinary bladder rupture;however,they had a complete recovery after the reparative surgery.Conclusion In treatment of the pelvic posterior ring lesions,an appropriate internal fixation can be chosen according to the type of the pelvic fracture,applicability of internal fixation,condition of the patient,equipment available,and the doctor’s experience.更多还原