Objective: To evaluate the feasibility and effectiveness of percutaneous cannulated screw fixation for the treatment of Day type Ⅱ pelvic crescent fracture.
Methods: The clinical data of 14 patients with Day type Ⅱ pelvic crescent fractures underwent closed reduction and percutaneous cannulated screw fixation between January 2009 and July 2016 were retrospectively analysed. There were 9 males and 5 females, aged 17-65 years (mean, 38 years). The causes of injury included traffic accident in 8 cases, falling from height in 3 cases, bruise injury in 3 cases; all were closed fractures. According to Tile classification, there were 8 cases of type B, 6 cases of type C. There were 13 cases combined with fracture of the anterior pelvic ring, including 8 cases of superior and inferior ramus of pubis fracture, 1 case of superior ramus of pubis fracture with symphysis separation, and 4 cases of symphysis separation. The interval of injury and admission was 1- 72 hours (mean, 16 hours), and the interval of injury and operation was 3-8 days (mean, 5 days). After operation, the reduction of fracture was evaluated by the Matta evaluation criteria, the clinical function was assessed by Majeed function assessment.
Results: The operation time was 35-95 minutes (mean, 55 minutes), cumulative C-arm fluoroscopy time was 3-8 minutes (mean, 5 minutes), no iatrogenic vascular injury and pelvic organ damage occurred. Postoperative X-ray films at 2 days indicated that 2 cases of vertical shift and 2 cases of mild rotation were not completely corrected. Postoperative CT examination at 3 days indicated that 2 pubic joint screws broke through the obturator bone cortex. None of the pubic ramus screws entered into the acetabulum, but a screw of superior pubic branch broke through the posterior cortical of superior pubic branch, a screw of posterior ilium column broke through the medial bone cortex of the ilium, and no clinical symptom was observed. One patient suffered from wound infection in the pubic symphysis, then healed after 2 weeks of wound drainage, the other wounds healed by first intention. According to Matta criterion for fracture reduction, the results were excellent in 9 cases, good in 4 cases, and fair in 1 case with an excellent and good rate of 92.9%. All patients were followed up 8-24 months (mean, 14 months). All fractures healed at 4 months and restored to the normal walking at 6 months after operation, 3 patients suffered from slight pain in the sacroiliac joints and slight claudication when they were tired or walked for a long time and unnecessary for special treatment. One patient felt pain in the back of the iliac spine when he was lying down. During the follow-up, no screw loosening or other internal fixation failure occurred. At last follow-up, according to Majeed functional evaluation criteria, the results were excellent in 7 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 85.7%.
Conclusion: The percutaneous cannulated screw fixation is a safe treatment for Day type Ⅱ pelvic crescent fracture, which has a reliable fixation and good effectiveness.
目的: 探讨经皮空心螺钉内固定术治疗 Day Ⅱ 型骨盆新月型骨折的可行性及疗效。.
方法: 回顾分析 2009 年 1 月—2016 年 7 月采用经皮空心螺钉内固定术治疗的 14 例 Day Ⅱ 型骨盆新月型骨折患者临床资料。其中男 9 例，女 5 例；年龄 17～65 岁，平均 38 岁。致伤原因：交通事故伤 8 例，高处坠落伤 3 例，重物砸伤 3 例；均为闭合性骨折。骨盆骨折 Tile 分型：B 型 8 例，C 型 6 例。13 例伴骨盆前环骨折，其中耻骨上下支均骨折 8 例，耻骨上支骨折伴耻骨联合分离 1 例，耻骨联合分离 4 例。受伤至入院时间 1～72 h，平均 16 h；伤后至手术时间 3～8 d，平均 5 d。术后根据 Matta 评价标准评价骨折复位情况，采用 Majeed 功能评分进行临床功能评价。.
结果: 总手术时间 35～95 min，平均 55 min；术中累计 C 臂 X 线机透视时间 3～8 min，平均 5 min；术中均无神经损伤及盆腔脏器损伤等发生。术后 2 d 行 X 线片检查显示各有 2 例垂直移位及轻度旋转移位未完全纠正。术后 3 d 行 CT 检查，发现 2 枚耻骨联合螺钉突破闭孔骨皮质；所有耻骨支螺钉均未进入髋臼，1 枚耻骨上支螺钉突破耻骨上支后侧骨皮质；1 枚髂骨后柱螺钉突破髂骨内侧骨皮质；但均未引起临床症状。1 例出现耻骨联合处伤口感染，经更换敷料 2 周后伤口愈合；其余伤口均Ⅰ期愈合。骨折复位按 Matta 评价标准评价，获优 9 例，良 4 例，可 1 例，优良率 92.9%。术后 14 例均获随访，随访时间 8～24 个月，平均 14 个月。骨折均在术后 4 个月内愈合，术后 6 个月患者均恢复正常行走功能。3 例患者劳累或行走时骶髂部轻微疼痛，轻度跛行；1 例平卧时有髂后部疼痛不适感。随访期间无螺钉松动、断裂等内固定失效发生。末次随访时按 Majeed 功能评分评价临床功能，获优 7 例，良 5 例，可 2 例，优良率 85.7%。.
结论: 经皮空心螺钉内固定术治疗 Day Ⅱ 型骨盆新月型骨折，复位满意，固定可靠，疗效较好。.
Keywords: Percutaneous; cannulated screw; internal fixation; pelvic crescent fracture.