微创可调式接骨板治疗骶骨DenisⅡ型骨折  

Denis type Ⅱ sacral fractures treated with minimally invasive adjustable plate

作　　者：陈伟[1] 张奇[1] 鲁谊[2] 马利杰[1] 吴新宝[2] 王满宜[2] 张英泽[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心,石家庄050051 [2]北京积水潭医院创伤骨科

出　　处：《中华创伤骨科杂志》2012年第5期385-390,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（30440014）中国专利号：ZL200810079334.7;ZL201010130308.X;ZL201010130312.6

摘　　要：目的探讨骶骨DenisⅡ型骨折的影像学特征及应用微创可调式接骨板治疗的效果。方法2007年6月至2008年7月应用微创可调式接骨板治疗15例（17例）骶骨DenisⅡ型骨折患者，男9例，女6例；平均年龄为47岁（28～63岁）；左侧7例，右侧6例，双侧2例。致伤原因：交通伤11例，砸伤3例，高处坠落伤1例。术前X线片和CT图像显示骶骨骨折在冠状面上压缩移位4侧，分离移位13侧；其中5例患者（5侧）存在垂直移位，3例患者（3侧）有前后方向移位。受伤至手术时间为2～10d，平均5d。应用微创可调式接骨板复位骶骨分离或压缩移位并固定骨折。术后行放射学检查，评估骨折复位及愈合情况。术后随访评估患者功能恢复情况。结果15例患者术后获平均40个月（30～52个月）随访。骶骨骨折均获愈合，愈合时间平均为3．4个月（3～5个月）。根据Lindahl等提出的标准评估骨折复位质量：优11侧，良5侧，可1侧。按照Lindahl等提出的评分系统评价患者功能恢复情况：优8例，良5例，可2例。本组无医源性神经损伤、内固定失败、内固定物导致的刺激症状或压疮等并发症发生。结论骶骨DenisⅡ型骨折在冠状面上存在分离或压缩移位，应用微创可调式接骨板可有效复位骨折并坚强固定，临床疗效良好。Objective To analyze the imageological features of Denis type Ⅱ sacral fracture and observe the clinical outcome of treatment of such injuries with minimally invasive adjustable plate （MIAP）. Methods From June 2007 to July 2008, 15 patients with Denis type Ⅱ sacral fracture were treated with MIAP in our institute, including 9 men and 6 women with an average age of 47 years （from 28 to 63 years）. There were 7 left, 6 right and 2 bilateral fractures. The injury mechanisms included traffic accident in 11 cases, crush injury, in 3 cases and fall from a height in one case. There were 4 compressed fractures and 13 separated fractures （including 5 vertical and 3 anteroposterior displacements） in the coronal plane according to preoperative X-ray films and CT scan images. The time from injury to surgery ranged from 2 to 10 days（average, 5 days） . The compressed and separated fractures were reduced and fixed with MIAP. Radiographs were taken postoperatively to evaluate the reduction and union of sacral fractures. The patients were followed up to assess the elinical outcomes. Results The patients were followed up for 40 months on average （range, 30 to 52 months） . All sacral fractures united well at 3.4 months postoperatively on average （range, 3 to 5 months）. Aecording to the criteria proposed by Lindahl Jet al, the reduction of sacral fracture was assessed as excellent in 11 fractures, good in 5 fractures and fair in one fracture; the clinical outcomes were assessed as excellent in 8 cases, good in 5 cases and fair in 2 cases. The iatrogenie neurovascular injury, implant failure or soft tissue complications related to implants were not observed in this series. Conclusion MIAP can be used to effectively reduce and fixate compressed or separated displacements in the coronal plane that exist in Denis type Ⅱ sacral fractures, yielding satisfactory clinical outcomes.

关 键 词：骶骨 骨折 骨板 骨折固定术 移位 

分 类 号：R687.3[医药卫生—骨科学]