经皮骶髂关节空心螺钉内固定联合支架外固定与切开复位重建钢板内固定治疗Tile B、C型骨盆骨折的比较研究

摘要 目的：对比经皮骶髂关节空心螺钉内固定联合支架外固定与切开复位重建钢板内固定治疗Tile B、C型骨盆骨折的临床效果。方法：选取本院2018年3月至2021年10月收治的Tile B、C型骨盆骨折患者共68例进行前瞻性研究。将纳入患者按随机数字表法分为经皮骶髂关节空心螺钉内固定联合支架外固定治疗（观察组）与切开复位重建钢板内固定治疗（对照组），每组各34例。比较两组患者手术时间、术中出血量、术后早期疼痛视觉模拟评分（VAS）、住院时间及术后早期并发症发生率；此外随访6个月，观察患者术后Matta影像学评分标准优良率（Matta优良率）、Majeed骨盆骨折功能评分（Majeed评分）和术后骨折愈合时间，另记录术后6个月时两组术后并发症发生情况。结果：两组手术时间、术后3天VAS评分、术后7天VAS评分、住院时间及术后骨折愈合时间比较均未见明显差异（P>0.05）；观察组术中出血量明显少于对照组，差异具有统计学意义（P<0.05）。观察组术后3个月时Matta优良率和Majeed评分均优于对照组，差异具有统计学意义（P<0.05），但两组术后6个月比较差异无统计学意义（P>0.05）；观察组的术后早期并发症发生率低于对照组，差异具有统计学意义（P<0.05）；术后6个月时两组并发症情况无统计学意义（P>0.05）。结论：两种方法治疗Tile B、C型骨盆骨折均可取得良好疗效，但切开复位重建钢板内固定方法仍保功能恢复良好的优点，而经皮骶髂关节空心螺钉内固定联合支架外固定具有低并发症发生率，更利于提升术后早期恢复效果。

Comparative Study of Percutaneous Sacroiliac Joint Cannulated Screw Internal Fixation Combined with External Stent Fixation and Open Reduction and Reconstruction Plate Internal Fixation in the Treatment of Tile B and C Pelvic Fractures

ABSTRACT Objective: To compare the clinical effects of percutaneous sacroiliac joint cannulated screw internal fixation combined with external stent fixation and open reduction and reconstruction plate internal fixation in the treatment of Tile B and C pelvic fractures. Methods: A total of 68 patients with Tile B and C pelvic fractures admitted to our hospital from March 2018 to October 2021 were selected for a prospective study. According to the random number table, The included patients were divided into two groups of percutaneous sacroiliac joint cannulated screw internal fixation combined with external stent fixation (observation group) and open reduction and reconstruction plate internal fixation (control group), with 34 patients in each group. The operation time, intraoperative blood loss, early postoperative visual analogue scale (VAS) score, length of hospital stay and incidence of early postoperative complications were compared between the two groups. In addition, The patients were followed up for 6 months to observe the Matta excellent rate, Majeed''s pelvic fracture function score and postoperative fracture healing time. The postoperative complications of the two groups were recorded at 6 months postoperatively. Results: There were no significant differences in operation time, VAS score at 3 days postoperatively and VAS score at 7 days postoperatively, length of hospital stay and postoperative fracture healing time between the two groups (P>0.05), The amount of intraoperative blood loss in the observation group was significantly less than that in the control group, and the difference was statistically significant(P<0.05). The Matta excellent rate and Majeed score of the observation group were better than those of the control group at 3 months postoperatively, and the difference was statistically significant(P<0.05), but there was no statistically significant difference between the two groups 6 months postoperatively(P>0.05), The early postoperative complications rate in the observation group were more lower than those in the control group, and the difference was statistically significant(P<0.05), There was no statistically significant difference in the complications of the two groups 6 months postoperatively(P>0.05). Conclusion: Both methods can achieve good efficacy in the treatment of Tile B and C pelvic fractures, but open reduction and reconstruction plate internal fixation still has the advantages of retain good functional recovery, and percutaneous sacroiliac joint cannulated screw internal fixation combined with external stent fixation has a low complication rate, which is more beneficial to improve the early postoperative recovery effect.