骶骨闭合复位质量对Tile C1.3型骨盆骨折术后临床结果的影响
Effect of sacral reduction quality on postoperative clinical outcomes in Tile C1.3 pelvic fractures
刘春贵 1李东阳 1李大双 1樊志强 2张堃 2庄岩 2王虎2
作者信息
- 1. 西安医学院,西安 710068
- 2. 西安交通大学附属红会医院骨创伤医院,西安 710054
- 折叠
摘要
目的:探讨骶骨闭合复位质量对Tile C1.3型骨盆骨折术后临床结果的影响.方法:回顾性分析2016年6月至2021年6月西安交通大学附属红会医院收治的97例Tile C1.3型骨盆骨折患者的临床资料.根据患者术后CT评估复位结果,将骶骨残余移位最大距离≤1 cm的42例患者纳入骶骨闭合复位优良组,将骶骨残余移位最大距离＞1 cm的55例患者纳入骶骨闭合复位不佳组.采用Gibbons分型系统评估术后骶神经损伤情况,采用Majeed评分评估术后骨盆功能,采用疼痛视觉模拟评分(VAS)评估术后疼痛程度.末次随访时行X线检查评估内固定物失效情况;术后1年行CT检查评估骶骨骨不连的情况.结果:所有患者随访24～47个月,平均随访(35.7±5.3)个月.手术前后两组患者骶神经损伤Gibbons分型差异均无统计学意义(P均＞0.05).术后骶骨闭合复位优良组Majeed评分优良率为83.3%(35/42),高于骶骨闭合复位不佳组的58.2%(32/55),且差异有统计学意义(χ2=16.668,P=0.001).两组患者术后疼痛程度差异有统计学意义(Z=-2.787,P=0.003).末次随访时,骶骨闭合复位优良组内固定物失效率为7.1%(3/42),低于骶骨闭合复位不佳组的27.3%(15/55),且差异有统计学意义(χ2=6.385,P＜0.05);术后1年,骶骨闭合复位不佳组骶骨骨不连发生率为14.5%(8/55),高于骶骨闭合复位优良组的0,且差异有统计学意义(P＜0.05).结论:骶骨残余移位最大距离＞1 cm的Tile C1.3型骨盆骨折患者术后骨盆功能明显差于最大距离≤1 cm的患者,主要表现为腰骶部疼痛,且骶骨残余移位最大距离＞1 cm的患者内固定物失效的风险及骶骨骨不连的发生率更高.
Abstract
Objective:To evaluate the effect of sacral reduction quality on postoperative clinical outcomes in Tile C1.3 pelvic fractures.Methods:A retrospective analysis was conducted on the clinical data of 97 patients with Tile C1.3 pelvic fractures treated at Honghui Hospital Affiliated to Xi'an Jiaotong University from June 2016 to June 2021.Patients were divided into two groups based on postoperative CT for assessing the reduction quality:a good sacral reduction group with a postoperative sacral displacement≤1 cm(42 cases)and a poor sacral reduction group with sacral displacement>1 cm(55 cases).The Gibbons classification system was used to assess postoperative sacral nerve injury,the Majeed score was used to evaluate pelvic functional post-surgery,and the Visual Analog Scale(VAS)was utilized to assess postoperative pain levels.At the last follow-up,X-rays were used to evaluate the failure of internal fixation devices,and CT scans were performed one year postoperatively to assess the degree of sacral nonunion.Results:All patients were followed up for 24 to 47 months,with an average follow-up of(35.7±5.3)months.There was no statistically significant difference in the Gibbons classification scores for sacral nerve injury between the two groups before and after surgery(all P>0.05).The good sacral reduction group had a better Majeed score,with a rate of 83.3%(35/42),which was significantly greater than the 58.2%(32/55)in the poor sacral reduction group(χ2=16.668,P=0.001).There was a significant difference in the postoperative pain between the two groups(Z=-2.787,P=0.003).At the last follow-up,the failure rate of internal fixation was 7.1%(3/42)in the good sacral reduction group,which was significantly lower than the 27.3%(15/55)in the poor sacral reduction group(χ2=6.385,P<0.05).One year postoperatively,sacral nonunion occurred in 14.5%(8/55)of the poor sacral reduction group,compared to 0%in the good sacral reduction group(P<0.05).Conclusions:In patients with Tile C1.3 pelvic fractures,sacral displacement>1 cm is associated with significantly worse postoperative pelvic function,as evidenced by increased lumbosacral pain,a greater risk for internal fixation failure and sacral nonunion compared to those with sacral displacement≤1 cm.
关键词
骶骨/复位/骨盆骨折/临床结果Key words
Sacrum/Reduction/Pelvic Fracture/Clinical Outcomes引用本文复制引用
基金项目
西安市科技计划项目(20YXYJ00047)
陕西省创新能力支撑计划项目(2021KJXX-57)
出版年
2024
NETL
NSTL
万方数据