摘要目的 对比分析后路微创重建钢板与3D导航下经皮骶髂关节螺钉内固定治疗老年骨质疏松性骨盆后环骨折的临床疗效.方法 采用回顾性病例对照研究分析2014年1月-2018年6月解放军中部战区总医院收治的75例老年骨盆后环骨折患者临床资料,其中男32例,女43例;年龄60 ～83岁,平均67.7岁.钢板组24例,采用后路微创重建钢板内固定治疗;导航组51例,采用3D导航下经皮骶髂关节螺钉内固定治疗.比较两组手术时间、术中出血量、X线暴露时间及术后并发症发生率,同时比较两组术后视觉模拟评分(VAS),术后应用Matta放射学标准评估骨折复位质量,末次随访时采用Majeed功能评分评定骨盆功能.结果 患者均获随访6～24个月,平均13.5个月.钢板组手术时间、术中出血量及X线暴露时间分别为(126.1±20.6) min、(251.6±50.8)ml、(15.7 ±4.4)s,导航组分别为(49.7±17.5)min、(22.8±5.1)ml、(112.8±8.8)s(P均＜0.05).术后并发症发生率钢板组(4％)与导航组(4％)比较差异无统计学意义(P＞0.05).术后3d、1周、1个月导航组VAS[(3.3±0.7)分、(3.2±0.7)分、(2.4±0.6)分]明显优于钢板组[(7.2±0.7)分、(6.2±0.8)分、(4.5±0.7)分](P均＜0.05),而术后3个月、1年,两组间比较差异无统计学意义(P＞0.05).术后Matta放射学标准评估:钢板组优14例,良8例,可2例,优良率为92％;导航组优25例,良17例,可9例,优良率为82％ (P ＞0.05).末次随访时Majeed功能评分:钢板组优15例,良8例,可1例,优良率为96％;导航组优35例,良13例,可3例,优良率为94％ (P ＞0.05).结论 对于老年骨质疏松性骨盆后环骨折,3D导航下经皮骶髂关节螺钉内固定治疗较后路微创重建钢板内固定具有手术时间短、术中出血量少、X线暴露时间短、术后疼痛减轻等优势,更值得在临床中推广应用.

abstractsObjective To compare the clinical efficacy of posterior minimally invasive reconstruction plate and 3D-navigated percutaneous sacroiliac screw fixation of elderly patients with posterior pelvic ring fractures.Methods A retrospective cases control study was performed to analyze the data of 75 elderly patients with posterior pelvic ring fractures admitted from January 2014 to June 2018 in Central Hospital of the PLA.There were 32 males and 43 females,with the age range of 60-83 years (mean,67.7 years).Twenty-four patients in the plate group were treated by posterior minimally invasive reconstruction plate fixation,and 51 patients in the navigation group were treated by percutaneous sacroiliac screw internal fixation with 3 D navigation.The operation time,intraoperative blood loss,X-ray exposure time,complication rate and postoperative visual analogue scale (VAS) were compared between the two groups.Postoperative Matta radiographic criteria was used to assess fracture reduction quality,and Majeed criteria was used to assess pelvic function at the last follow-up.Results All 75 patients were followed up for 6-24 months (mean,13.5 months).The operation time,intraoperative blood loss and X-ray exposure time in the plate group were (126.1 ± 20.6) minutes,(251.6 ± 50.8) ml,and (15.7 ±4.4)s,showing significant differences in comparison with the navigation groups [(49.7 ± 17.5)minutes,(22.8 ±5.1) ml,and (112.8 ± 8.8) s] (P ＜0.05).The incidence of postoperative complications was not significantly different between the plate group (4％) and the navigation group (4％) (P ＞0.05).At day 3,one week,and one month postoperatively,the VAS in the navigation group was (3.3 ± 0.7) points,(3.2 ± 0.7) points,(2.4 ± 0.6) points,better than that in the plate group [(7.2 ± 0.7) points,(6.2 ± 0.8) points and (4.5 ± 0.7) points] (P ＜ 0.05).However,there was no significant difference between the two groups at 3 months and one year after operation (P ＞ 0.05).According to the Matta radiographic criteria,the excellent and good rate was 92％ in plate group (excellent in 14 cases,good in 8,and fair in 2),and was 82％ in the navigation group (excellent in 25 cases,good in 17 and fair in 9).There was no significant difference between the two groups (P ＞0.05).According to the Majeed criteria at the follow-up,the excellent and good rate was 96％ in the plate group (excellent in 15 cases,good in 8 and fair in 1),and was 94％ in the navigation group (excellent in 35 cases,good in 13 and fair in 3).The difference between the two groups was not statistically significant (P ＞ 0.05).Conclusion For elderly patients with osteoporotic posterior pelvic ring fractures,percutaneous sacroiliac screw fixation under 3D navigation has the advantages of shorter operation time,less bleeding,less radiation dose and less postoperative pain than minimally invasive reconstruction plate internal fixation,and hence deserves clinical application.