摘要目的 探讨应用通用脊柱内固定系统(USS)联合骶骼螺钉的三角固定技术治疗Tile C 型骨盆骨折的疗效. 方法 2009年1月至2010年12月采用USS联合骶髂螺钉的三角固定技术治疗22例(25侧)Tile C型骨盆骨折患者,男13例,女9例；年龄21～48岁,平均31.2岁；骨折按照Tile 分型:C1型9例,C2型7例,C3型6例.受伤至手术时间为5～21 d,平均11.2 d.根据Matta标准对骨折复位质量进行评价,根据Majeed功能评分标准及Gibbons骶神经损伤分级分别对临床功能和神经功能进行评价.结果 术中出血量平均为450 mL(100～800 mL),住院时间平均为16 d(12～26 d).22例患者术后获平均14个月(4～26个月)随访.2例患者术后出现切口感染,经清创、抗感染治疗后治愈.本组患者无复位丢失及内固定松动、断裂等并发症发生.所有患者骨折均获愈合,15例已取出内固定物.根据Matta评分标准评价骨折复位质量:解剖复位18侧,满意复位6侧,复位差1侧.末次随访时根据Majeed功能评分标准评定疗效:优13例,良6例,可2例,差1例,优良率为86.4％.末次随访时13例术前合并神经损伤的患者按Gibbons骶神经损伤分级:Ⅰ级6例,Ⅱ级4例,Ⅲ级2例,Ⅳ级1例. 结论 USS联合骶髂螺钉的三角固定技术治疗Tile C型骨盆骨折是一种较好的固定方法,增强了骨折的固定强度,能同时行神经探查、减压,还可早期负重,术后功能恢复好.

abstractsObjective To explore the operative techniques and effectiveness of triangular osteosynthesis for the treatment of Tile C1-3 pelvic ring injuries following sacral fracture. Methods From January 2009 to December 2010,22 patients with Tile C1-3 pelvic ring injuries following sacral fracture were treated with triangular osteosynthesis using a combination of Universal Spinal System (USS) and iliosacral screws in our hospital.Tbey were 13 males and 9 females,aged 21 to 48 years (average,31.2 years).By Tile classification,there were 9 cases of type C1,7 cases of type C2 and 6 cases of type C3.The average time from injury to definitive operation was 11.2 days (range,from 5 to 21 days).The reduction quality was evaluated according to the Matta criteria,functional outcome according to the Majeed criteria and nerve functional outcome according to the Gibbons criteria. Results The average blood loss was 450 mL(range,from 100 to 800 mL).The average hospital stay was 16 days (range,from 12 to 26 days).All patients were followed up for an average of 14 months (range,from 4 to 26 months).Local infection was seen in 2 patients and healed with aggressive debridement and antibiotics.Reduction loss or hardware failure was not seen in this series.All fractures were healed at the final radiological follow-up.Implant removal was performed in 15 patients.Reduction was excellent in 18 sides,good in 6 sides and fair in one side.The functional outcome at the last follow-up was excellent in 13 cases,good in 6 cases,fair in 2 cases and poor in one case.Of the 13 patients with preoperative neurologic impairment,6 achieved grade Ⅰ,4 grade Ⅱ,2 grade Ⅲ and one grade Ⅳ at the last follow-up. Conclusion As a relatively new fixation strategy for Tile C1-3 pelvic ring injuries following sacral fracture,triangular osteosynthesis using a combinatiou of USS and iliosacral screws can provide rigid fixation and permit early full weight-bearing post-operation because nerve decompression can be performed at the same time.