骨盆后环不稳定伴骶丛损伤的诊断和治疗  

Diagnosis and treatment of unstable posterior pelvic ring fracture combined with sacral plexus injury

作　　者：陈爱民[1] 李永川[1] 赵良瑜[1] 叶添文[1] 郭永飞[1] 鹿楠[1] 朱磊[1] 张志凌[1] 李菁[1] 杨迪[1] 朱清华[1] 欧阳跃平[1] 刘岩[1] 侯春林[1] 

机构地区：[1]第二军医大学附属长征医院创伤骨科,上海200003

出　　处：《中华创伤杂志》2012年第6期516-519,共4页Chinese Journal of Trauma

摘　　要：目的分析骨盆后环不稳定伴骶神经损伤的治疗效果，探讨其诊治方法与疗效的关系。方法2000年1月-2010年1月收治的骨盆骨折并骶神经损伤患者38例，其中男20例，女18例；年龄10-59岁，平均35岁。致伤原因：交通伤20例，坠落伤12例，重物砸伤5例，戳伤1例。骨盆后环骨折分类：骶髂关节骨折脱位8例，髂翼骨折2例，骶骨骨折28例。骶骨骨折按Denis分型：Ⅰ型1例，Ⅱ型14例，Ⅲ型13例。38例患者均有下肢或会阴部及肛周皮肤感觉减弱或丧失。其中30例存在下肢运动功能障碍，20例存在膀胱括约肌和肛门括约肌或性功能障碍。13例怀疑骶丛撕脱损伤行椎管照影或MRI检查，其中4例确诊为撕脱损伤。所有患者均有1处以上伴发伤。ISS评分平均21．9分（9-47分）。治疗方法：8例行单纯骨折复位固定术＋非减压分解术；30例行神经减压术，其中26例骨折复位固定，4例未行固定术。手术时间为伤后6d-6个月。根据英国医学研究会（BMRC）提出的感觉和运动功能评价标准评价术后疗效。结果34例患者获得平均4．9年（1-10年）随访，所有患者骨盆均获稳定。神经恢复情况：非减压组优2例，良4例，无变化2例；减压组优16例，良9例，无变化1例。减压组疗效优于非减压组（P〈0．05）。结论对骨盆骨折伴骶神经损伤行减压松解＋内固定术能更好地改善骶神经功能并获得良好的骨盆环稳定性，值得推荐临床应用。Objective To analyze the methods and effects for treating unstable posterior pelvic ring fracture combined with sacral nerve injury and further identify the relationships among the diagnostic methods, surgical approaches and clinical outcomes. Methods A total of 38 patients with posterior pelvic ring fracture combined with sacral plexus injury treated from January 2000 to January 2010 were en- rolled in the study. There were 20 males and 18 females at an average age of 35 years （range, 10 to 59 years）. The causes of fractures included traffic injury in 20 patients, fall injury in 12, weighty object impingement injury in five, and stabbing injury in one. Classification of posterior pelvic ring fractures in- cluded fracture and dislocation of sacroiliac joints in eight patients, fracture of ilium wing in two and sa- crum fracture in 28. According to the Denis typing of sacrum fractures, there was one patient with type Ⅰ fracture,14 with typeⅡfracture and 13 with type Ⅲ fracture. All 38 patients presented the decrease or loss of skin sensation around the lower extremities, perineal region and crissum. Simultaneously, 30 pa- tients suffered motor dysfunction of the lower extremities, while 20 patients had bladder and anus sphinc- ter dysfunction or sexual disorder. Thirteen patients were suspected of sacral plexus avulsion and four of them were confirmed by myelography or MRI examination. All patients had at least one associated injury. The average ISS was 21.9 points （range, 9 to 47 points）. Therapeutic methods were fracture reduction and fixation in the absence of nerve decompression for eight patients and nerve decompression for 30 patients including 26 patients being also managed by fracture reduction and fixation. Operation time ranged from 6 days to 6 months. The clinical outcomes were evaluated according to the British Medical Research Council（BMRC） evaluation criteria of sensation and movement function. Results Thirty-four patients were fol- lowed up for average 4.9 years （ range, 1 to 10

关 键 词：腰骶丛 骨盆 骨折固定术 神经损伤 

分 类 号：R687.3[医药卫生—骨科学]