Repair of unstable pelvic fracture in 60 cases: pathway of metallic implants

doi:10.3969/j.issn.2095-4344.2015.09.017

Abstract

Abstract:

BACKGROUND: The unstable pelvic fracture is a common type of fracture, has the characteristics of complex disease and complications. Clinical treatment can use conservative or surgical methods. However, the most conservative treatment cannot achieve satisfactory therapeutic effects. Therefore, surgical treatment of different metal implants has become the main mode of treatment of unstable pelvic fracture.
OBJECTIVE: To explore the application value of metallic implants in the treatment of unstable pelvic fracture.
METHODS: A total of 60 patients with unstable pelvic fracture in the Department of Orthopedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA in China from September 2012 to September 2013 were selected and were given different treatments of metal implants operation after typed, including 8 cases of type B1, 20 cases of type B2, 9 cases of type B3, 15 cases of type C1 and 8 cases of type C2. According to different types of fracture, anterior and posterior approaches were performed. Generally, patients with type B received anterior approach, and those with type C received anterior + posterior approach. After treatment, antibiotics were used to prevent infection. Drainage tube was pulled out within 48-72 hours. Rehabilitation training was gradually performed at 3 days after treatment.
RESULTS AND CONCLUSION: All patients were followed up for 1-12 months after treatment. The excellent and good rate was 95%. Complications occurred in seven patients after operation. The complication rate was 12%. They received active symptomatic treatment and were cured. No serious complications appeared. Above results confirmed that unstable pelvic fracture patients obtained good repair effect using different metal implants, and have a certain value in clinical application.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Pelvis, Fractures, Bone, Fracture Fixation, Prostheses and Implants, Follow-Up Studies

CLC Number:

R318

Li Jie, Zhuang Yan-feng, Wang Bing-zhan. Repair of unstable pelvic fracture in 60 cases: pathway of metallic implants[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(9): 1410-1415.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，纳入不稳定型骨盆骨折患者60例，全部进入结果分析，无脱落。随访1-12个月。 2.2 治疗效果分析手术时间为伤后3-10 d，平均5 d；手术所需时间2-12 h，平均3.3 h；术中输血400-1 200 mL，平均800 mL。 60例患者中，疗效优30例(50%)，良24例(43%)，可3例(5%)，差3例(5%)，优良率为95%。所有患者经X射线或CT检查见骨折愈合，且未见畸形、固定物断裂或松动等。 2.3 影像学结果治疗前不同患者碎骨片、骨折细节结果如图1所示。骶骨棒固定见图2A、B，松质骨螺钉固定见图2C、D。C2双侧骨折患者给予前后路骨盆联合内固定，闭合复位。后方经皮拉力螺钉对骶髋关节脱位予以内固定，然后实施前方入路钛合金异型重建钢板螺钉内固定。术后3-5 d，给予患者常规抗生素治疗以预防感染。术后两三天拔除引流管。术后一两天给予患肢扶双拐活动，但暂不能负重，术后第3天开始依据患者骨折分型慢慢地增加患肢的负重，完全地负重于术后8-12周开始。C2型骨盆骨折患者根据骨盆后环损伤类型，在术后第8-12周开始扶拐行走练习。 2.4 典型病例男性患者，26岁，经诊断为C型不稳定型骨盆骨折。全麻后，行右耻骨及右骶髂经皮中空螺钉内固定。术后给予常规抗感染和康复治疗。经检查，患者右下肢肌力与感觉等均基本恢复，对修复效果表示满意。治疗前及治疗后X射线片检查结果如图3所示。 2.5 不良反应与并发症在术后并发症方面，3例患者出现尿路感染，4例患者出现切口感染，并发症发生率为12%。所有并发症患者均给予积极的针对治疗痊愈，未出现严重的并发症。无因手术引起感染、皮肤坏死者，无骨化性肌炎及静脉栓塞等并发症。有2例患者骨折复位欠佳，随访现有轻度跛行，1例术后出现神经损伤症状，3个月后症状消失。"

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