手术治疗老年骨盆骨折的效果分析
Operative treatment of geriatric pelvic fractures
曹奇勇 1赵春鹏 1肖鸿鹄 1卑明健 1吴新宝1
作者信息
- 1. 首都医科大学附属北京积水潭医院创伤骨科,北京 100035
- 折叠
摘要
目的 探讨手术治疗老年骨盆骨折的临床效果.方法 回顾性分析2020年1月至2023年10月期间首都医科大学附属北京积水潭医院创伤骨科采用手术治疗的55例老年骨盆骨折患者资料.男13例,女42例;年龄72.0(68.0,83.3)岁.骨折AO/OTA分型:B型47例,C型8例;脆性骨盆骨折(FFP)分型:Ⅱ型5例,Ⅲ型44例,Ⅳ型6例.所有患者伤后4.0(3.0,6.3)d行手术治疗.10例患者采用切开复位内固定:后环钢板固定7例,螺钉固定3例;前环除2例未做固定外,其余采用钢板、外固定支架或微创经皮骨盆前环内支架固定技术等固定.45例患者采用闭合复位内固定:后环2例未做固定,其余均采用螺钉固定;前环10例未做固定,其余采用螺钉、外固定支架或微创经皮骨盆前环内支架固定技术等固定.记录患者围手术期主要并发症、术后骨折复位质量、病死率及末次随访时骨盆功能等.结果 所有患者围手术期未发生严重并发症.术后骨折复位质量根据Matta评分标准评定:优31例,良14例,可8例,差2例,优良率为81.8％(45/55).54例患者术后获(15.4±9.1)个月随访,另1例患者失访.4例患者术后1年内死亡,病死率为7.4％(4/54).随访时间超过4个月的46例患者末次随访时改良骨盆Majeed评分为69(54,76)分;根据笔者单位制定的功能评定标准评定:优27例,良8例,可11例,优良率为76.1％(35/46).随访期间3例患者发生内固定完全失效.结论 对于老年骨盆骨折,手术治疗可以获得满意的临床效果.
Abstract
Objective To explore the clinical efficacy of operative treatment of geriatric pelvic frac-tures.Methods A retrospective study was conducted to analyze the clinical data of 55 geriatric patients with pelvic fracture who had been operatively treated at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from January 2020 to October 2023.There were 13 males and 42 females with an age of 72.0(68.0,83.3)years.By the AO/OTA classification,there were 47 cases of type B and 8 cases of type C;by the clas-sification for fragility fractures of pelvis,there were 5 cases of type Ⅱ,44 cases of type Ⅲ,and 6 cases of typeⅣ.The patients received operative treatment 4.0(3.0,6.3)days after injury.Of the 10 patients treated by open reduction and closed reduction,the posterior ring was fixated by a plate in 7 and by screws in 3,and the anterior ring was fixated by either a plate,an external fixator or a minimally invasive anterior pelvic ring internal fixator except in the 2 cases receiving no fixation.Of the other 45 patients treated by closed reduction and fixa-tion,the posterior ring was all fixated by screws except in the 2 cases receiving no fixation,and the anterior ring was fixated by either screws,an external fixator or a minimally invasive anterior pelvic ring internal fixator ex-cept in the 10 cases receiving no fixation.The major peri-operative complications,quality of fracture reduction,mortality,and functional recovery of the pelvis at the last follow-up were recorded.Results There were no major peri-operative complications.According to the Matta criteria,the quality of fracture reduction was ex-cellent in 31,good in 14,fair in 8 and poor in 2 cases,giving a good to excellent rate of 81.8％(45/55).Fifty-four cases were followed up for(15.4±9.1)months and 1 case was lost to the follow-up.Four cases died within 1 year after operation,giving a mortality of 7.4％(4/54).The modified Majeed score at the last fol-low-up was 69(54,76)for the 46 cases who had been followed up for longer than 4 months;the functional re-covery of the pelvis at the last follow-up was rated as excellent in 27 cases,as good in 8 cases and as fair in 11 cases,giving a good to excellent rate of 76.1％(35/46)according to the criteria proposed by the faculty of the writers.The internal fixation failed in 3 cases during the follow-up.Conclusion For the geriatric pelvic fractures,operative treatment can lead to satisfactory clinical outcomes.
关键词
骨盆/骨折/骨折固定术/老年人/脆性骨盆骨折分型Key words
Pelvis/Fractures,bone/Fracture fixation/Aged/Fragility fracture of pelvis引用本文复制引用
基金项目
首都卫生发展科研专项(2022-2-2253)
北京积水潭医院院级科研基金(2023OSR-GCZX 202205)
出版年
2024
NETL
NSTL
万方数据