拉力螺钉固定技术在骨盆后环损伤中的临床应用

目的探讨应用拉力螺钉固定技术治疗骨盆后环部损伤的适应证、手术方法及疗效。方法1998年8月至2005年12月，对47例骨盆骶髂结构复合损伤患者分别采用后侧经骶髂关节的拉力螺钉固定方法，后侧跨骶骨的髂-髂拉力螺钉固定方法及骶-髂拉力螺钉加髂：髂拉力螺钉固定方法治疗骨盆后环损伤，男31例，女16例；年龄18～53岁，平均32岁。通过影像学检查明确47例患者有60侧骨盆骶髂结构复合损伤。按照AO骨盆环损伤方法分型：B型损伤20例，其中B2型9例，B3型11例；C型损伤27例，其中C1型8例，C2型12例，C3型7例。患者麻醉后取俯卧位，行闭合或开放复位后用拉力螺钉固定。所有操作均在C型臂X线机透视下进行。结果47例患者均获随访，随访时间6个月至6年6个月，平均27．7个月。平均手术时间为80min。47例共置入骶髂拉力螺钉104枚。患者在术后2～3个月双下肢可完全负重行走，并逐渐恢复体力劳动。仅发生3枚螺钉松动，未发生神经损伤及螺钉断裂等并发症，腰骶及下肢活动接近正常。结论拉力螺钉固定技术可使不稳定性骨盆后环获得良好的即刻复位和固定，恢复骨盆环的稳定性，适用于骶髂关节脱位及骶骨骨折患者。

The Clinical Exploration of the Lag Screws Fixation for the Injuries in the Posterior Ring of Pelvis

Objective To explore the indication,operative procedure and the result for the technique of lag screws fixation for the injuries in the posterior ring of pelvis. Methods From August 1998 to November 2005,47 patients with the injuries in the posterior ring of pelvis were treated with lag screws fixation,which involved 31 males and 16 females,their average was 32 years （range, 18-53 years）. 47 patients were diagnosed as 60 unilateral or bilateral in-juries of the sacroiliac complex by the radiography. According to the AO class system there were 9 of B2,11 of B3,8 of C1,12 of C2 and 7 of C3. The patients were laid on prone position after anesthesia,and the injuries were fixed with lag screws after open or closed reduction,The whole procedure was performed under monitoring of ＂C＂-arm for safety and accuracy. Results All the patients were available at follow-up with a mean of 27.7 months （tangs from 6 months to 6 years and a half）. The operations lasted 80 minutes averagely. A total of 104 screws were fixed in 47 patients. The patients could ambulate walk with full weight-bearing at the 2-3 months after operation. The function of the sacroiliac joint and low extremities recovered nearly to normal. There were no nerve injuries and breakage but loosening of 3 screws. Conclusion The technique of lag screw fixation is able to reduce and fix the unstable injuries in the posterior ring of pelvis perfectly and immediately after operation. It not only can rebuild the stability of pelvis,but also can be applied to the fractures of the sacrum and the fractured-dislocation of the sacroiliac joint.