| 通道螺钉技术在骨盆环脆性骨折中的应用 |
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Received:September 22, 2021
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| 作者 | Author | 单位 | Unit | E-Mail |
| 黄淑明 |
HUANG Shu-ming |
丽水市中心医院 温州医科大学附属第五医院创伤骨科, 浙江 丽水 323000 |
Department of Orthopaedics,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui Municipal Central Hospital,Lishui 323000,Zhejiang,China |
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| 兰树华 |
LAN Shu-hua |
丽水市中心医院 温州医科大学附属第五医院创伤骨科, 浙江 丽水 323000 |
Department of Orthopaedics,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui Municipal Central Hospital,Lishui 323000,Zhejiang,China |
lsh2681225@163.com |
| 邢海林 |
XING Hai-lin |
丽水市中心医院 温州医科大学附属第五医院创伤骨科, 浙江 丽水 323000 |
Department of Orthopaedics,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui Municipal Central Hospital,Lishui 323000,Zhejiang,China |
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| 王翀 |
WANG Chong |
丽水市中心医院 温州医科大学附属第五医院创伤骨科, 浙江 丽水 323000 |
Department of Orthopaedics,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui Municipal Central Hospital,Lishui 323000,Zhejiang,China |
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| 谢盼盼 |
XIE Pan-pan |
丽水市中心医院 温州医科大学附属第五医院创伤骨科, 浙江 丽水 323000 |
Department of Orthopaedics,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui Municipal Central Hospital,Lishui 323000,Zhejiang,China |
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| 褚旭峰 |
CHU Xu-feng |
丽水市中心医院 温州医科大学附属第五医院创伤骨科, 浙江 丽水 323000 |
Department of Orthopaedics,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui Municipal Central Hospital,Lishui 323000,Zhejiang,China |
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| 叶方 |
YE Fang |
丽水市中心医院 温州医科大学附属第五医院创伤骨科, 浙江 丽水 323000 |
Department of Orthopaedics,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui Municipal Central Hospital,Lishui 323000,Zhejiang,China |
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| 吴泉州 |
WU Quan-zhou |
丽水市中心医院 温州医科大学附属第五医院创伤骨科, 浙江 丽水 323000 |
Department of Orthopaedics,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui Municipal Central Hospital,Lishui 323000,Zhejiang,China |
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| 叶积飞 |
and YE Ji-fei |
丽水市中心医院 温州医科大学附属第五医院创伤骨科, 浙江 丽水 323000 |
Department of Orthopaedics,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui Municipal Central Hospital,Lishui 323000,Zhejiang,China |
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| 期刊信息：《中国骨伤》2022年35卷，第4期，第309-316页 |
| DOI：10.12200/j.issn.1003-0034.2022.04.002 |
| 基金项目:浙江省医药卫生科技计划项目(编号:2015KYB450);丽水市科技局公益计划项目(编号:2019GYX24,2021SJZC011) |
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目的: 探讨通道螺钉技术治疗骨盆环脆性骨折的临床疗效。
方法: 回顾性分析2016年1月至2019年12月收治并获得随访的35例骨盆环脆性骨折患者临床资料,其中男12例,女23例;年龄65~99(75.4±7.8)岁。根据Rommens骨盆环脆性骨折综合类型系统进行分类,其中Ⅱb型13例,Ⅱc型7例,Ⅲa 型8例,Ⅲb 型2 例,Ⅲc 型2 例,Ⅳb型1例,Ⅳc型2例。所有患者前后环采用通道螺钉技术固定,根据骨盆前环固定方式不同分为2组:骨盆前方皮下内固定装置(anterior subcutaneous pelvic internal fixator,INFIX)组12例,采用椎弓钉棒系统固定;螺钉组23例,采用耻骨联合、耻骨上支或髋臼前柱空心螺钉固定。比较两组手术时间、术中出血量、术中透视次数、住院时间、内固定费用以及手术前后视觉模拟疼痛评分(visual analogue scale,VAS),同时比较术后骨折复位质量Matta评分、并发症发生情况以及末次随访时Majeed评分系统功能评价。
结果: 所有患者术后获得随访,时间为12~39(16.5±5.4)个月。两组患者在手术时间、术中出血量、术中透视次数、住院时间方面比较差异无统计学意义(P>0.05),而在内固定费用方面,螺钉组内固定费用2 914(2 914,4 371)元明显低于INFIX组6 205(6 205,6 205)元(P<0.05)。两组患者并发症发生率比较差异无统计学意义(P>0.05)。两组入院时、术后1周、3个月时VAS评分比较差异均无统计学意义(P>0.05),但两组病例术后1周、3个月VAS评分明显优于入院时(P<0.05)。两组患者术后骨折复位质量和末次随访时疗效评价比较差异无统计学意义(P>0.05)。
结论: 应用通道螺钉技术行前环INFIX或空心螺钉固定联合后环空心螺钉固定治疗骨盆环脆性骨折均可获得良好的临床疗效,手术创伤小,术中出血量少,能有效缓解疼痛,值得临床推广应用。 |
| [关键词]:骨盆 骨折 外科手术，微创性 骨折固定术，内 |
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| Effect analysis of trajectory screw technique in fragility fracture of pelvic ring |
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Abstract:
Objective: To assess the clinical efficacy of minimally invasive technology with trajectory screw fixation for fragility fractures of pelvic(FFP).
Methods: A retrospective case control study was performed to analyze the clinical data of 35 patients with FFP who were treated and followed up between January 2016 and December 2019. There were 12 males and 23 females,aged from 65 to 99 years with an average of(75.4±7.8) years old. There were 13 cases of type Ⅱb,7 cases of type Ⅱc,8 cases of type Ⅲa,2 cases of type Ⅲb,2 cases of type Ⅲc,1 case of type Ⅳb,and 2 cases of type Ⅳc according to Rommens FFP comprehensive classification. All patients received the treatment of minimally invasive technology with trajectory screws fixation. According to the different methods of anterior pelvic ring fixation,FFP patients were divided into two groups:12 cases were fixed with the pedicle screw rod system in the anterior pelvic subcutaneous internal fixator (INFIX) group;23 cases were fixed with hollow screws of the pubic symphysis,superior ramus of pubis or acetabular anterior column in the screw group. The operation time,intraoperative blood loss,intraoperative fluoroscopy times,length of hospital stay,cost of internal fixation,pre- and post-operative visual analogue scale(VAS) were compared between the two groups. The fracture reduction quality was evaluated according to the Matta criteria,and the clinical function was evaluated by the Majeed functional scoring system respectively.
Results: All patients were followed up for 12 to 39(16.5±5.4) months after surgery. There was no statistically significant difference in the operation time,intraoperative blood loss,intraoperative fluoroscopy time,and length of hospital stay between the two groups(P>0.05). As for the cost of internal fixation,the cost of internal fixation in the screw group[2 914 (2 914,4 371) yuan] was significantly lower than that of the INFIX group[6 205 (6 205,6 205) yuan] (P<0.05). No significant difference was observed in the incidence of postoperative complications between the two groups (P>0.05). There was no significant difference in VAS assessment at admission,1 week,and 3 months after surgery between the two groups(P>0.05). However,the VAS assessment at 1 week and 3 months after surgery of the two groups were significantly better than those at admission(P<0.05). There was no significant difference in the quality of fracture reduction after the operation and the efficacy evaluation at the last follow-up between the two groups(P>0.05).
Conclusion: For the treatment of fragility fractures,minimally invasive technology with trajectory screw fixation can achieve good clinical efficacy. It has the advantages of being relatively minimally invasive,less bleeding,relieving the pain. It deserves clinical application. |
| KEYWORDS:Pelvis Fractures Surgical procedures,minimal invasive Fracture fixation,internal |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 黄淑明,兰树华,邢海林,王翀,谢盼盼,褚旭峰,叶方,吴泉州,叶积飞.通道螺钉技术在骨盆环脆性骨折中的应用[J].中国骨伤,2022,35(4):309~316 |
| 英文格式: | HUANG Shu-ming,LAN Shu-hua,XING Hai-lin,WANG Chong,XIE Pan-pan,CHU Xu-feng,YE Fang,WU Quan-zhou,and YE Ji-fei.Effect analysis of trajectory screw technique in fragility fracture of pelvic ring[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(4):309~316 |
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