直视复位结合经皮骶髂关节螺钉固定治疗难复性骶髂关节脱位
Euthyphoria reduction combined with percutaneous iliosacral screw fixation for irreducible sacroiliac dislocation
目的 探讨直视复位结合经皮骶髂关节螺钉固定治疗难复性骶髂关节脱位的可行性及临床疗效.方法 回顾性分析2012年3月至2015年5月期间收治的29例难复性骶髂关节脱位患者资料.男18例,女11例;年龄为25 ~68岁,平均37.9岁.骨折Tile分型:C1型7例,C2型9例,C3型13例.受伤至手术时间为6~32 d,平均11.3d.所有患者均在直视下复位骶髂关节,然后采用经皮骶髂关节螺钉固定.结果 本组患者的手术时间为40 ~ 125 min,平均76.2 min;术中出血量为50~360 mL,平均148.6 mL.29例患者术后获24~41个月(平均28.9个月)随访.术后骨折复位质量按照Matta标准评定:优20例,良9例,优良率为100%.末次随访时29例患者的Majeed评分平均为90.1分(67 ~100分);优20例,良7例,可2例,优良率为93.1%.随访期间无一例患者发生螺钉松动、患肢跛行、神经损伤及骨化性肌炎等严重并发症.结论 直视复位结合经皮骶髂关节螺钉固定治疗难复性骶髂关节脱位可获得令人满意的临床疗效,同时该方法可提高手术安全性.
更多Objective To evaluate euthyphoria reduction combined with percutaneous iliosacral screw fixation in the treatment of irreducible sacroiliac dislocation.Methods From March 2012 to May 2015,29 patients with irreducible sacroiliac dislocation were treated using euthyphoria reduction followed by percutaneous iliosacral screw fixation.They were 18 men and 11 women,aged from 25 to 68 years (average,37.9 years).According to the Tile classification,there were 7 cases of type Cl,9 cases of type C2,and 13 cases of type C3.The intervals from injury to surgery ranged from 6 to 32 days (average,11.3 days).Results The operation time for this cohort ranged from 40 to 125 minutes (average,76.2 minutes).The intraoperative bleeding ranged from 50 to 360 mL (average,148.6 mL).Their follow-ups ranged from 24 to 41 months (average,28.9 months).According to the Matta criteria for reduction,20 cases were rated as excellent and 9 as good,yielding an excellent to good rate of 100%.Their Majeed scores at the final follow-up averaged 90.1 points (range,from 67 to 100 points),giving 20 excellent,7 good and 2 fair cases (with an excellent to good rate of 93.1%).No screw loosening or lameness of the affected limb was observed during follow-ups.Conclusions Euthyphoria reduction combined with percutaneous iliosacral screw fixation can lead to satisfactory outcomes in the treatment of irreducible sacroiliac dislocation.Additionally it may improve operative safety.
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