关键词: C型骨盆骨折； 固定方式； 步态生物力学； 生活质量； 功能恢复

Abstract: Objective To compare the effects of external fixator fixation, anterior plate fixation, and posterior pedicle screw-rod system fixation on postoperative gait biomechanics, quality of life, and functional recovery in patients with Tile C pelvic fractures.Methods Clinical data of 136 patients with Tile C pelvic fractures admitted to the Department of Orthopedics, Nanjing Jiangbei Hospital from August 2022 to December 2024 were retrospectively analyzed.Patients were divided into external fixator group (45 cases), anterior plate group (42 cases), and posterior pedicle screw-rod system group (49 cases) according to the fixation method.Gait biomechanical indicators (spatiotemporal, kinematic, and kinetic parameters) at 3, 6, and 12 months after surgery, quality of life (SF-36 score), functional recovery (excellent and good rate of Majeed score), and complication rate were compared among the three groups.The correlation between gait indicators and quality of life/functional recovery was analyzed.Results At 3, 6, and 12 months postoperatively, gait parameters including walking speed, step length, maximum hip flexion angle, and peak ground reaction force were significantly better in the posterior pedicle screw-rod fixation group than in the external fixator group and anterior plate fixation group (P<0.05).Specifically, at 12 months postoperatively, the posterior pedicle screw-rod group showed walking speed of (0.97±0.09) m/s, maximum hip flexion angle of (92.3±5.1)°, and peak ground reaction force of (925.7±62.9) N, all significantly higher than those in the external fixator group [(0.73±0.10) m/s, (78.5±5.9)°, (815.3±68.9) N] and the anterior plate group [(0.82±0.08) m/s, (84.2±5.5)°, (868.2±65.8) N] (P<0.05).Moreover, the improvement in walking speed from 3 to 12 months postoperatively was significantly greater in the posterior pedicle screw-rod group [(0.32±0.08) m/s] than in the external fixator group [(0.21±0.07) m/s] (P<0.001).At 12 months postoperatively, the SF-36 scores for physical functioning (82.3±7.5), bodily pain (78.6±8.2), and social functioning (80.5±7.8) in the posterior pedicle screw-rod group were significantly higher than those in the external fixator group [(68.5±8.1), (65.2±7.9) and (67.8±8.3)] and the anterior plate group [(75.6±7.3), (72.3±7.6) and (74.2±7.5)] (P<0.01).The excellent-to-good rate of Majeed score was 87.76% (43/49) in the posterior pedicle screw-rod group, which was significantly higher than that of the external fixator group [64.44% (29/45)] and the anterior plate group [76.19% (32/42)] (P<0.05).The complication rates were 15.56% (7/45) in the external fixator group, 11.90% (5/42) in the anterior plate group, and 8.16% (4/49) in the posterior pedicle screw-rod group, with no statistically significant difference among the three groups (P=0.340).Correlation analysis revealed that walking speed was positively correlated with SF-36 physical functioning score (r=0.723, P<0.001) and Majeed score (r=0.685, P<0.001).Maximum hip flexion angle was negatively correlated with SF-36 bodily pain score (r=-0.592, P<0.001), and peak ground reaction force was positively correlated with the walking subdomain score of Majeed scale (r=0.547, P<0.001).Conclusion Posterior pedicle screw-rod fixation for complex unstable Tile C pelvic fractures demonstrates superior outcomes in gait biomechanical recovery, quality of life improvement, and functional prognosis compared with external fixation and anterior plate fixation, with a favorable safety profile.

Key words: tile C pelvic fractures; fixation methods; gait biomechanics; quality of life; functional recovery