李 亮, 黄 仲, 谭 振, 等.USS联合骶髂螺钉与CMAS骶髂固定系统治疗不稳定型骶骨骨折疗效比较.四川大学学报(医学版),2017,48(5):681-686
USS联合骶髂螺钉与CMAS骶髂固定系统治疗不稳定型骶骨骨折疗效比较
Comparison of USS Combined with Sacroiliac Screw and CMAS Iliosacral Fixation in the Treatment of Unstable
  
中文关键词:  骶骨骨折 骨盆骨折 CMAS 腰椎-骨盆固定 三角固定
英文关键词:Sacral fracture Pelvic fracture Closed Multi-Axial Screws Lumbo-pelvic fixation
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中文摘要:
      目的 对比通用脊柱内固定系统(USS)联合骶髂螺钉与闭口万向螺钉(closed multiaxial screws,CMAS)骶髂固定系统联合后路部分脊柱内固定系统的腰椎骨盆内固定方法治疗不稳定型骶骨骨折的疗效。方法 回顾性分析2010年1月至2014年12月四川大学华西医院收治的47例不稳定型骶骨骨折患者的临床资料,其中22例(28侧)采用USS联合骶髂螺钉(A组),25例(39侧)采用CMAS骶髂固定系统联合后路部分脊柱内固定系统(B组)。对比两组患者的手术时间、术中出血量、骨折的复位MATTA评分、术后1年的MAJEED功能评分和术后并发症发生情况,以及合并有骶神经症状的患者术前术后GIBBONS骶神经损伤分级情况。结果 A、B两组患者平均手术时间分别为(121.4±5.1) min、(110.6±4.5) min,差异有统计学意义( P<0.05),术中平均出血量分别为(618±45) mL、(570±40) mL,差异有统计学意义( P<0.05);A、B两组分别有2例患者术后出现了伤口感染,通过清创术及抗生素治疗后治愈。根据MATTA评分标准评价骨折复位质量:A组优良率92.9%,B组优良率为97.5%,B组优于A组,差异有统计学意义( P<0.05)。术后1年时根据MAJJEED功能评分标准评定疗效:A组优良率为86.4%,B组优良率为92.0%,差异有统计学意义( P<0.05)。术后1年时,术前伴有神经损伤的患者按GIBBONS骶神经损伤分级示A、B两组神经功能较术前均获得显著改善( P<0.05),但A、B两组之间比较差异无统计学意义( P>0.05)。结论 CMAS骶髂固定系统治疗不稳定型骶骨骨折的疗效优于USS联合骶髂螺钉。
英文摘要:
      【Abstract】 Objective To compare the effectiveness of two lumbopelvic fixation procedures for treating unstable sacral fractures. Methods The clinical data of 47 patients were treated for unstable sacral fractures in the West China Hospital of Sichuan University from January 2010 to December 2014 were reviewed. Twentytwo patients (28 sides) were treated with USS combined with iliosacral screw (group A), while 25 patients (39 sides) were treated with closed multiaxial screws (CMAS) iliosacral fixation system combined with Posterior Segmental Spinal Fixation system (group B). The outcomes of the two procedures were compared using the following indicators: length of operations, amount of intraoperative blood loss, MATTA score of fracture reduction, MAJEED function score one year postoperation, postoperative complications, and GIBBONS Classification of sacral nerve injury in patients with sacral nerve symptoms. Results Group A had longer operations 〔(121.4±5.1) min〕 than group B 〔(110.6±4.5) min, P<0.05〕. Group A had larger intraoperative blood loss 〔(618±45) mL〕 than group B 〔(570±40) mL, P<0.05〕. Both groups had two cases of wound infection after operations that were cured by debridement and antibiotic therapy. According to the MATTA scoring criteria, group A had 92.9% excellent and good fracture reduction, compared with 97.5% in group B ( P<0.05). According to the MAJEED functional scoring criteria, group A had 86.4% excellent and good clinical functions, compared with 92.0% in group A ( P<0.05). The GIBBONS criteria indicated that neurological functions of both groups improved significantly after operations ( P<0.05), but no significant difference appeared between the two groups ( P>0.05). Conclusion CMAS iliosacral fixation system is better for treating unstable sacral fractures compared with USS combined with iliosacral screws.
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