目的 探讨骨盆复位架在闭合复位和微创固定骨盆骨折的手术方法 和临床疗效.方法 回顾性分析2017年7月—2019年6月华中科技大学同济医学院附属同济医院创伤外科采用陈华和唐佩福改进的石家庄亿成科技有限公司生产的微创骨盆复位架系统治疗不稳定骨盆骨折患者41例,男性14例,女性27例;年龄14～70岁,平均41.4岁.Tile分型:B型15例,C型26例;Young-Burgess分型:侧方挤压2型(LC2)损伤15例,垂直剪切(VS)损伤22例,混合型(CM)损伤4例;道路交通伤29例,坠落伤11例,重物砸伤1例.受伤至手术时间3～45d,平均10.1d.手术使用骨盆复位架复位,各通道螺钉技术、INFIX、外固定支架或钢板固定骨盆前后环.记录手术时间和术中出血量,观察并发症情况.根据Matta标准评价骨折复位情况,根据末次随访Majeed评分系统和Gibbons骶神经损伤分级分别对临床功能和神经功能进行评价.结果 除1例闭合复位失败改为开放手术,余40例闭合复位成功.手术时间45～316min,平均169.4mim;术中出血量10～300mL,平均49.3mL;至2020年1月,患者获7～24个月随访,平均14.1个月;所有患者3～6个月骨折愈合,未出现伤口脂肪液化、感染、伤口不愈合、内固定物松动、骨折再次移位等并发症.后环采用骶髂螺钉固定29例,LC2髂骨螺钉固定6例,骶髂螺钉和LC2螺钉联合固定5例.前环采用耻骨支螺钉固定11例,INFIX固定17例,外固定支架固定2例和钢板固定3例;耻骨支螺钉联合钢板固定1例;前环未固定6例.术后骨折复位按Matta评分:优21例,良16例,可3例.末次随访时Majeed评分:优36例,良4例.2020年1月末次随访时Gibbons骶神经损伤分级:术前合并神经损伤患者6例,完全恢复5例,未恢复1例.结论 与常规切开复位手术比较,骨盆复位架治疗骨盆骨折创伤小、出血少、切口相关并发症发生率低,临床疗效满意.

骨盆骨折多为高能量损伤，常合并其他损伤，如血管、神经、尿道损伤，容易漏诊。对于血流动力学不稳定的骨盆骨折患者，急救过程中大量液体复苏往往会引起腹腔内压增高，甚至引发腹腔高压(IAH)/腹腔间隙综合征(ACS)，容易漏诊、误诊，故常规监测腹腔内压显得尤为重要。笔者介绍1例骨盆骨折合并髂外动脉损伤和ACS患者，探讨该类损伤的诊治要点，供临床医师鉴别并避免误诊漏诊。

目的 探讨腹直肌旁入路治疗骨盆新月型骨折合并同侧耻骨支骨折的临床疗效.方法 回顾性分析2017年4月至2019年3月华中科技大学同济医学院附属同济医院采用腹直肌旁入路治疗骨盆新月型骨折合并同侧耻骨支骨折的22例患者的资料.其中,男12例,女10例;年龄19～70岁,平均年龄(43.1±12.3)岁.手术采用腹直肌旁入路切开复位并用钢板固定骨折断端.记录手术时间和术中出血量,观察并发症情况;根据Matta标准和末次随访时的Majeed评分分别对术后复位情况和临床功能进行评价.结果 22例患者手术获得解剖复位,手术时间75～158 min,平均(101.6±19.7) min;术中出血量230～890 mL,平均(395.5±170.3) mL;所有患者均获得9～24个月随访,平均(13.4±5.3)个月;所有患者骨折愈合顺利,未出现伤口脂肪液化、感染、伤口不愈、内固定物松动、骨折再次移位等并发症.末次随访时Majeed评分:优22例.结论 腹直肌旁入路治疗骨盆新月型骨折合并同侧耻骨支骨折创伤小、出血少,切口相关并发症发生率低,临床疗效满意.

Extra-articular screw placement in the true pelvis for fixing quadrilateral plate fractures remains challenging. We aimed to define the "safe zone" on the quadrilateral surface to facilitate safe plate-screw placement. Twenty cadaveric hemipelves were sectioned and assembled to define the projection of the acetabular boundary on the quadrilateral surface. Three lines (X, Y, and Z) were drawn tangent to the projection, with X parallel to the iliopectineal line, Y perpendicular to the iliopectineal line, and Z parallel to the posterior border of the ischial body. Then, the distances between X and the iliopectineal line (D1), Y and the sacroiliac joint (D2), and Z and the posterior border of the ischium (D3) could be used to determine a "safe zone" on the quadrilateral surface for screw insertion. We included 15 patients whose conditions satisfied the definition of a comminuted quadrilateral plate fracture and applied two-ended buttress plates for treatment in accordance with this "safe zone." The average D1 was 50.0mm, the average D2 was 30.6mm, and the average D3 was 12.4mm. For all 15 patients with comminuted quadrilateral fracture who were treated, no intraoperative or postoperative screw penetration of the acetabulum was identified, and no loss of reduction was observed during an average follow up of 17.7 months. The "safe zone" established in this study simplifies extraarticular screw placement for managing quadrilateral plate fractures in the true pelvis. As a result, two-ended buttress plate fixation in the true pelvis becomes safe, therefore, treatment with two-ended buttress plates may represent a viable alternative to single-ended elastic fixation in the management of comminuted quadrilateral fractures.