Objective: To investigate the effectiveness of modified internal fixator (INFIX) to fix the anterior pelvic ring for Tile C1.3 pelvic fracture by comparing with the traditional INFIX.
Methods: The patients with Tile C1.3 pelvic fractures admitted between April 2018 and June 2021 were taken as the study objects. Of them, 55 cases were included in the study according to the selection criteria. During operation, the anterior pelvic ring was fixed with the modified INFIX in 30 cases (modified group) and with the traditional INFIX in 25 cases (control group). The posterior pelvic ring in 55 cases was fixed with sacroiliac screws. There was no significant difference between the two groups in gender, age, cause of injury, time from injury to operation, and combined injury ( P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. The X-ray film was taken to evaluate the reduction of the anterior pelvic ring after operation, grade the reduction according to the Matta scoring standards, and observe the fracture healing and healing time. The function was evaluated according to Majeed scoring standards during follow-up.
Results: The operation time of the modified group was significantly longer than that of the control group ( Z=-3.837, P<0.001), but there was no significant difference in the intraoperative blood loss between the two groups ( t=-1.831, P=0.076). All patients were followed up 12-18 months (mean, 14 months). X-ray film reexamination showed that the excellent and good rate of Matta scoring for anterior pelvic ring reduction in the modified group was 88.00%, which was significantly better than that in the control group (63.33%) ( χ 2=4.373, P=0.037). All fractures healed, and the fracture healing time of the modified group and the control group was (12.04±3.59) and (14.83±4.83) weeks respectively, with a significant difference ( t=2.401, P=0.020). At last follow-up, the excellent and good rates of Majeed scoring were 80.00% in the modified group and 76.67% in the control group, with no significant difference ( χ 2=0.089, P=0.766). In the modified group, 2 cases (8%) had complications, all of which were incision infection above pubic symphysis. In the control group, 9 cases (30%) had complications, including 5 cases of lateral femoral cutaneous nerve injury, 2 cases of femoral nerve paralysis, and 2 cases of delayed fracture healing. The incidence of complications was significantly lower in the modified group than in the control group ( χ 2=4.125, P=0.042).
Conclusion: Compared with the traditional INFIX, the modified INFIX to fix the anterior pelvic ring for Tile C1.3 pelvic fracture has fewer complications, better stability, shorter fracture healing time, and lower risk of nerve injury.
目的: 通过与传统内置外固定架（internal fixator，INFIX）比较，探讨Tile C1.3型骨盆骨折治疗中采用改良INFIX固定骨盆前环的疗效。.
方法: 以2018年4月—2021年6月收治的Tile C1.3型骨盆骨折患者作为研究对象，其中55例符合选择标准纳入研究。术中骨盆前环采用传统INFIX固定30例（对照组）、改良INFIX固定25例（改良组），骨盆后环均采用骶髂螺钉固定。两组患者性别、年龄、致伤原因、受伤至手术时间以及合并伤等一般资料比较，差异均无统计学意义（ P>0.05）。记录并比较两组手术时间、术中出血量及并发症发生情况。术后复查X线片，评估骨盆前环复位情况，参照Matta 评分标准对复位程度分级；观察骨折愈合情况以及愈合时间。随访时参照Majeed 评分标准评价关节功能。.
结果: 改良组手术时间较对照组延长（ Z=–3.837， P<0.001），但两组术中出血量差异无统计学意义（ t=–1.831， P=0.076）。两组患者均获随访，随访时间12～18个月，平均14个月。X线片复查示根据Matta评分标准，改良组骨盆前环复位优良率为88.00%，优于对照组的63.33%（ χ 2=4.373， P=0.037）。改良组及对照组骨折均愈合，愈合时间分别为（12.04±3.59）、（14.83±4.83）周，差异有统计学意义（ t=2.401， P=0.020）。末次随访时，改良组Majeed评分优良率为80.00%，对照组为76.67%，差异无统计学意义（ χ 2=0.089， P=0.766）。改良组2例（8%）发生并发症，均为耻骨联合上方切口感染；对照组9例（30%）发生并发症，其中股外侧皮神经损伤5例、股神经麻痹2例、骨折延迟愈合2例。改良组并发症发生率低于对照组，差异有统计学意义（ χ 2=4.125， P=0.042）。.
结论: 与传统INFIX相比，Tile C1.3型骨盆骨折治疗中采用改良INFIX固定骨盆前环并发症更少，前环稳定性更好，骨折愈合时间更短，神经损伤风险更低。.
Keywords: Pelvic fracture; anterior pelvic ring; internal fixation; internal fixator.