| Objectives: Pelvic fractures are very common in clinical practice, accounting forabout2.3%of human fractures of3.3%. After which if combined pelvic ring fractures,sacroiliac joint dislocation, sacral fractures, its injuries are more serious. With theawareness strengthen of sacroiliac joints and surrounding fractures can lead to pelvicring after losing its stability, as well as requirements for fracture healing of patients aregetting higher and higher, more unstable pelvic fracture patients took the surgeries. Thisarticle focuses on the study of unstable pelvic fracture treatments of patients, and thetreatments of these fractures surgical methods are so many, each has its advantagesand disadvantages.So we collected cases of unstable pelvic fractures were treatmentedby front plate and Sacroiliac screws, aimed to investigate the efficacy of these twosurgical methods of treatment, and comparative analysis of them.Methods: collected37cases of unstable pelvic fracture patients from September2008to July2013in our hospital which were retrospectively studied,37patients wereassociated with sacroiliac joint or surrounding bone damage, according to the Tilepelvic fracture type: B type:11cases, C type:26cases. Injury reasons: traffic accidentin20cases,10cases of injury falls, heavy crushing in7cases. All of the cases weretreated surgically. After the adoption of which18cases were into the iliac road, chooseclosed or open reduction of fractures according to the situation, the sacroiliac screwfixation (defined as group A), The group has9males and9females, age (40.1±13.6years); the second group of19cases (defined as group B), using the anterior approachof clinical pathways, underwent incision reconstruction, plate after a reset or the"T"-shaped plate is fixed, contains11males and8females, age (34.5±10.1) years old.The patients of group A take the prone position during surgery, use the tractionbed to pull limb, perform closed reduction under the "C" shaped arm, if the reset satisfactory, routine disinfection and pave the sheet, in the "C" shaped arm fluoroscopy,determine the correct needle point and adjust guide the direction of the needle, theneedle begins from llium, according to the sacroiliac joint, drill into the first sacral,Along the guide pin screwed into the sacroiliac screw, the same way the second goldsacroiliac screw fixation of the sacral vertebrae2. If the reset is not satisfied, then openreduction, routine disinfection and pave the sheet, do longitudinal incision from theposterior superior iliac spine to the posterior superior iliac spine, exposing the sacroiliacjoints and surrounding, reset, to determine the needle point and the direction of theneedle, make two sacroiliac screws to secure under the C-arm X ray. Group B patientshave adopted the supine position, after an ipsilateral sacral cushion can be placed on thefront incision begins iliac spine beyond, extending about10～15cm along the iliaccrest backward, turn cut the skin and subcutaneous tissue, stripped abdominal musclesfrom the iliac anteromedial, muscle iliac subperiosteal blunt dissection, the iliacmuscles and pelvic organ retractor inward continue to separate lateral attachment of theanterior sacral iliac ligament, which was stripped from the ilium, the sacroiliac jointsrevealed edge and sacrum. With traction and position, you can use the reset clamp reset,you can also screwed into the iliac tubercle a screw clamp screws and pull the reset.When reset upon obtaining satisfactory results, select the appropriate reconstructionplate or "T " shaped plate, placed in the sacroiliac joint fracture, screw fixation.Preoperative injury severity score (Injury Severity Score, ISS): group A’s averagescore is11.7points (from4to22points), group B’s average score is14.5points (from8to28points). Two groups of patients were treated with surgery in (8.3±4.0) days and(6.2±5.2)days, two groups of patients were recorded operative time, blood loss,incision length, ambulation time, healing time, infection situation and functionalevaluation of other aspects of rehabilitation after fracture data, and two sets of data wereanalyzed by SPSS19.0statistical software, P <0.05was considered statisticallysignificant, and thus compare the clinical efficacy of the two groups.Result:all the collected cases were followed up, the following time of groupA was11~42months, average24.1months; group B were followed up for12~41months,average22.9months. After operation, the patients with fracture healing aregood, without fracture delayed union or nonunion except1patients had abnormality. From the statistics, sacroiliac, compared with the operation time, bleeding volume and length of incision, screw internal fixation is better than the front plate int ernal fixation, the difference was statistically significant (P<0.05); compare ambulation time, healing time, infection situation and postoperative Majeed score, the difference was not statistically significant (P>0.05). Compared with majeed standard function: group A: excellent in11cases, good in6cases, fair in1cases, the excellent and good rate was94.4%; group B: excellent in8cases, good in8cases, fairin3cases, the excellent and good rate was84.2%. No statistically significant difference between the two groups of patients with excellent and good rate (χ2=1.004, P>0.05).Conclusion: compared with the front plate fixation in the treatment of unstablepelvic fractures, sacroiliac screw fixation have characteristics that the operation isminimally invasive, relatively simple, shorter operative time, less blood loss and so on,the two methods satisfactory clinical results, fix firmly. |
PDF Full Text Request