前后挤压型骶骨Ⅱ区骨折与骶丛神经损伤的关系  

Sacral plexus injury and anteroposterior compression zone-Ⅱsacral fractures:a cadaveric study

作　　者：赵立力[1] 张英泽[2] 

机构地区：[1]邢台市人民医院骨1科,054000 [2]河北医科大学第三医院创伤急救中心,050051

出　　处：《中华创伤杂志》2006年第12期930-933,共4页Chinese Journal of Trauma

摘　　要：目的探讨前后挤压致骶骨Ⅱ区骨折造成骶丛神经损伤的机制。方法经甲醛短期(1年内)浸泡固定的国人尸体6具,12侧。解剖保护骶丛神经,制成前后挤压型暴力致骶Ⅱ区骨折模型,定量测量不同骨折移位时骶丛神经被拉长的距离。另外,利用X线片观察骶丛神经受压情况。结果随耻骨联合分离逐渐增大,骶丛神经张应变呈直线相关逐渐加大,以S_1,S_4为最显著,且可造成神经的刺伤,多见于L_5和S_1,X线未发现骶丛神经受压表现。结论前后挤压型暴力致骶骨Ⅱ区骨折神经损伤以牵拉伤为主,以S_1,S_4为主,且与骨折移位程度成正相关关系。神经的刺伤,多见于骨折移位较大的L_5和S_1。Objective To study the mechanism of sacral plexus injury resuhing from anteroposteri or compression zone-Ⅱsacral fractures. Methods Six short-term （ within one year） embalmed pelves were obtained from Anatomic Department of Hebel Medical University. The preserved sacral plexus and resected pubic symphysis were used to make the models of anteroposterior compression zone-Ⅱ sacral fractures. Quantitative analysis for fracture displacement was carried out to observe the characteristics and mechanism of sacral plexus injury. The removed sacral plexus was replaced by proportional diameter silica gel pips filled with contrast medium. The experimental procedure was repeated under X-ray. The experimental data were analyzed by SPSS 10.0 statistic software to obtain result. Results In anteroposterior compression sacral fracture, sacral nerve canal was gradually opened and its volume raised. No sacral nerve was opressed in nerve canal. However ilium external rotation prolonged sacral nerves, especially S1,S4 and the more the pubic symphsis was separated the more the sacral plexus nerves were prolonged. At the same time, the sharp border of fracture segment stabbed the nerves, especially L5 （6 cases）, S1 （5 cases） and S2 （3 eases）. Conclusions Sacral plexus is tightly connected with the wall of pelvic cavity and fixed. When zone-Ⅱ sacral fractures happen sacral plexus is easily damaged. In anteroposterior compression sacral fracture, nerves S1 and S4 are likely to be damaged by dragment, and nerve compression injury is attributed to stabbing by fracture segment border, with L5 and S1. more hackneyed.

关 键 词：骶骨骨折 解剖模型 创伤机制 

分 类 号：R683[医药卫生—骨科学] R651.3[医药卫生—外科学]