• 解放軍總醫(yī)院第一附屬醫(yī)院骨科（北京，100048）;

【摘 要】 目的 探討全螺紋加壓無(wú)頭空心螺釘經(jīng)皮固定治療骨盆骨折的療效。 方法 2008年3月－2010年4月對(duì)31例骨盆骨折患者行全螺紋加壓無(wú)頭空心螺釘經(jīng)皮內(nèi)固定（手術(shù)組），并與同期行保守治療的14例骨盆骨折患者（對(duì)照組）臨床療效進(jìn)行比較。兩組患者年齡、性別構(gòu)成比比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），骨折Tile分型對(duì)照組輕于手術(shù)組。傷后近期恢復(fù)以床上可主動(dòng)翻身和至下床助行器輔助下行走達(dá)到5步為標(biāo)準(zhǔn)。遠(yuǎn)期療效隨訪根據(jù)疼痛、步態(tài)、骨折愈合和功能恢復(fù)四方面評(píng)價(jià)。 結(jié)果 手術(shù)組除1例術(shù)前伴骶叢神經(jīng)損傷患者外，其余患者于傷后1～4 d達(dá)近期恢復(fù)標(biāo)準(zhǔn)；對(duì)照組A2型、B2型骨折，翻身時(shí)間分別為傷后9～13 d與17～25 d，行走達(dá)5步時(shí)間分別為傷后17～21 d與45～57 d。兩組患者均獲隨訪，隨訪時(shí)間6～19個(gè)月。骨折均在2～6個(gè)月內(nèi)愈合。術(shù)后6個(gè)月手術(shù)組患者療效獲優(yōu)29例，良2例；對(duì)照組獲優(yōu)8例，良6例，與手術(shù)組比較差異有統(tǒng)計(jì)學(xué)意義（χ2=6.636，P=0.017）。 結(jié)論 正確的經(jīng)皮內(nèi)固定技術(shù)結(jié)合全螺紋加壓無(wú)頭空心螺釘，能夠快速減輕患者痛苦、提高生活質(zhì)量，并有較好的治療效果。

引用本文： 張建 ,吳克儉,張偉佳,吳聞文,侯樹勛. 全螺紋加壓無(wú)頭空心螺釘經(jīng)皮固定骨盆骨折. 中國(guó)修復(fù)重建外科雜志, 2012, 26(1): 91-96. doi: 復(fù)制

1. Traumatol Cech, 2010, 77(6): 501-506.
2. screws. Clin Orthop Relat Res, 1998, (350): 237-245.
3. Trauma, 2008, 22(2): 81-87．.
4. pereutaneous fixation of unstable pelvic ring fractures. Injury, 2008, 39(8): 869-874．.
5. fractures: applicability of hip arthroscopy. Arthroscopy, 2010, 26(11): 1556-1561.
6. of acetabular fractures with 2D fluoroscopy-based computerized navigation. Arch Orthop Trauma Surg, 2010, 130(9): 1177-1183.
7. Cech, 2010, 77(2): 99-104.
8. Lewis AJ, Sod GA, Burba DJ, et al. Compressive forces achieved in simulated equine third metacarpal bone lateral condylar fractures of varying fragment thickness with Acutrak Plus screw and 4.5 mm AO cortical screws. Vet Surg, 2010, 39(1): 78-82.
9. 王慶賢, 張英澤, 潘進(jìn)社, 等. 髖臼前柱拉力螺釘內(nèi)固定的定量解剖學(xué)研究. 中國(guó)臨床解剖學(xué)雜志, 2004, 22(2): 133-135.
10. 王慶賢, 張英澤, 潘進(jìn)社, 等. 髖臼后柱拉力螺釘內(nèi)固定的定量解剖學(xué)研究. 中國(guó)臨床解剖學(xué)雜志, 2004, 22(6): 596-598.
11. Sen RK, Veerappa LA. Long-term outcome of conservatively managed displaced acetabular fractures. Trauma, 2009, 67(1): 155-159.
12. Zeman J, Pavelka T, Matějka. Suicidal jumper’s fracture. Acta Chir Orthop.
13. 項(xiàng)大業(yè), 池永龍, 鄭安祥, 等. 經(jīng)皮空心螺釘固定治療垂直不穩(wěn)定型骨盆骨折的臨床應(yīng)用. 中華醫(yī)學(xué)雜志, 2007, 87(9): 585-589.
14. 郭曉山, 池永龍. 經(jīng)皮閉合內(nèi)固定治療骨盆環(huán)損傷. 中華外科雜志, 2006, 44(4): 260-363.
15. 周海波, 郭曉山. 經(jīng)皮固定骨盆環(huán)和髖臼損傷技術(shù)的研究進(jìn)展. 中國(guó)骨傷, 2010, 23(9): 719-722.
16. Wheeler DL, McLoughlin SW. Biomechanical assessment of compression.
17. Routt ML Jr, Nork SE, Mills WJ. Percutaneous fixation of pelvic ring disruptions. Clin Orthop Relat Res, 2000, (375): 15-29．.
18. Start AJ, Nakatani T, Reinert CM, et al. Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure? J Orthop.
19. 張前法, 付有偉, 趙衛(wèi)東, 等. 骨盆后環(huán)骨折脫位不同內(nèi)固定的生物力學(xué)研究. 中國(guó)修復(fù)重建外科雜志, 2009, 23(12): 1466-1468.
20. Osterhoff G, Ossendorf C, Wanner GA, et al. Posterior screw fixation in rotationally unstable pelvic ring injuries. Injury, 2011, 42(10): 992-996.
21. Schweitzer D, Zylberberg A, Córdova M, et al. Closed reduction and iliosacral.
22. Yang JH, Chouhan DK, Oh KJ. Percutaneous screw fixation of acetabular.
23. Mouhsine E, Garofalo R, Borens O, et al. Percutaneous retrograde screwing for stabilisation of acetabular fractures. Injury, 2005, 36(11): 1330-1336．.
24. Rosenberger RE, Dolati B, Larndorfer R, et al. Accuracy of minimally invasive navigated acetabular and iliosacral fracture stabilization using a targeting and noninvasive registration device. Arch Orthop Trauma Surg, 2010, 130(2): 223-230.
25. Hong G, Cong-Feng L, Cheng-Fang H, et al. Percutaneous screw fixation.
26. Frank M, Dedek T, Trlica J, et al. Percutaneous fixation of anterior column acetabular fractures—first experience. Acta Chir Orthop Traumatol.
  1. 1. Traumatol Cech, 2010, 77(6): 501-506.
  2. 2. screws. Clin Orthop Relat Res, 1998, (350): 237-245.
  3. 3. Trauma, 2008, 22(2): 81-87．.
  4. 4. pereutaneous fixation of unstable pelvic ring fractures. Injury, 2008, 39(8): 869-874．.
  5. 5. fractures: applicability of hip arthroscopy. Arthroscopy, 2010, 26(11): 1556-1561.
  6. 6. of acetabular fractures with 2D fluoroscopy-based computerized navigation. Arch Orthop Trauma Surg, 2010, 130(9): 1177-1183.
  7. 7. Cech, 2010, 77(2): 99-104.
  8. 8. Lewis AJ, Sod GA, Burba DJ, et al. Compressive forces achieved in simulated equine third metacarpal bone lateral condylar fractures of varying fragment thickness with Acutrak Plus screw and 4.5 mm AO cortical screws. Vet Surg, 2010, 39(1): 78-82.
  9. 9. 王慶賢, 張英澤, 潘進(jìn)社, 等. 髖臼前柱拉力螺釘內(nèi)固定的定量解剖學(xué)研究. 中國(guó)臨床解剖學(xué)雜志, 2004, 22(2): 133-135.
  10. 10. 王慶賢, 張英澤, 潘進(jìn)社, 等. 髖臼后柱拉力螺釘內(nèi)固定的定量解剖學(xué)研究. 中國(guó)臨床解剖學(xué)雜志, 2004, 22(6): 596-598.
  11. 11. Sen RK, Veerappa LA. Long-term outcome of conservatively managed displaced acetabular fractures. Trauma, 2009, 67(1): 155-159.
  12. 12. Zeman J, Pavelka T, Matějka. Suicidal jumper’s fracture. Acta Chir Orthop.
  13. 13. 項(xiàng)大業(yè), 池永龍, 鄭安祥, 等. 經(jīng)皮空心螺釘固定治療垂直不穩(wěn)定型骨盆骨折的臨床應(yīng)用. 中華醫(yī)學(xué)雜志, 2007, 87(9): 585-589.
  14. 14. 郭曉山, 池永龍. 經(jīng)皮閉合內(nèi)固定治療骨盆環(huán)損傷. 中華外科雜志, 2006, 44(4): 260-363.
  15. 15. 周海波, 郭曉山. 經(jīng)皮固定骨盆環(huán)和髖臼損傷技術(shù)的研究進(jìn)展. 中國(guó)骨傷, 2010, 23(9): 719-722.
  16. 16. Wheeler DL, McLoughlin SW. Biomechanical assessment of compression.
  17. 17. Routt ML Jr, Nork SE, Mills WJ. Percutaneous fixation of pelvic ring disruptions. Clin Orthop Relat Res, 2000, (375): 15-29．.
  18. 18. Start AJ, Nakatani T, Reinert CM, et al. Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure? J Orthop.
  19. 19. 張前法, 付有偉, 趙衛(wèi)東, 等. 骨盆后環(huán)骨折脫位不同內(nèi)固定的生物力學(xué)研究. 中國(guó)修復(fù)重建外科雜志, 2009, 23(12): 1466-1468.
  20. 20. Osterhoff G, Ossendorf C, Wanner GA, et al. Posterior screw fixation in rotationally unstable pelvic ring injuries. Injury, 2011, 42(10): 992-996.
  21. 21. Schweitzer D, Zylberberg A, Córdova M, et al. Closed reduction and iliosacral.
  22. 22. Yang JH, Chouhan DK, Oh KJ. Percutaneous screw fixation of acetabular.
  23. 23. Mouhsine E, Garofalo R, Borens O, et al. Percutaneous retrograde screwing for stabilisation of acetabular fractures. Injury, 2005, 36(11): 1330-1336．.
  24. 24. Rosenberger RE, Dolati B, Larndorfer R, et al. Accuracy of minimally invasive navigated acetabular and iliosacral fracture stabilization using a targeting and noninvasive registration device. Arch Orthop Trauma Surg, 2010, 130(2): 223-230.
  25. 25. Hong G, Cong-Feng L, Cheng-Fang H, et al. Percutaneous screw fixation.
  26. 26. Frank M, Dedek T, Trlica J, et al. Percutaneous fixation of anterior column acetabular fractures—first experience. Acta Chir Orthop Traumatol.