腰椎-骨盆固定治疗U型骶骨骨折  

Lumbopelvic fixation for U-Shaped sacral fractures

作　　者：易成腊[1] 刘振辉[1] 白祥军[1] 宋先舟[1] 胡耑[1] 李占飞[1] 田利华[1] 陈安民[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,武汉430030 [2]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《中华创伤骨科杂志》2012年第9期767-771,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨腰椎-骨瓮固定治疗u型骶骨骨折的手术方法和疗效。方法对2005年12月至2011年2月年收治的8例u型骶骨骨折患者进行回顾性分析，其中男6例，女2例；年龄21～53岁，平均36．9岁；骨折类型按照骨折形态学分类：H型损伤5例，U、T和“人”字型损伤各l例；骶骨横形骨折按Rov—Camille和Strange—Vognsen分型：Ⅱ型2例，Ⅲ型6例；神经损伤按Gibbons等的评分标准：3级2例，4级6例；7例合并多发伤。待生命体征平稳后所有患者行后路骶骨椎板减压和骶神经根减压、骨折复位和腰椎-骨盆固定术，3例行骨盆前环固定术。结果所有患者术后获6～24个月（平均14．5个月）随访。所有患者术后6个门CT扫描示骨折均愈合；2例患者切口皮缘部分坏死，1例患者伤口深部感染经清创负压封例闭引流后愈合；5例患者诉髂后上棘螺钉突出不适；6例直肠、膀胱功能障碍患者3例完全康复，3例有不同程度地改善；Gibbons评分平均提高2．45分。1例髂骨螺钉位置不佳，无发生内网定断裂和复位丢失等并发症。结论u型骶骨骨折常引起脊柱-骨衙不稳定和神经拟伤，早期神经减压可促进神经功能恢复，腰椎-骨盆同定可提供多平面的稳定性，是治疗此类骨折的有效方法。Objective To analyze the clinical characteristics, treatments and outcomes of U-shaped sacral fractures. Methods From December 2005 to February 2011, 8 cases of U-shaped sacral fractures were operatively treated in our department. They were 6 males and 2 females, aging from 21 to 53 years （mean, 36.9 years）. There were 5 cases of H pattern, one ease of U pattern, one ease of lambda pattern and one case of T pattern, according to fractm＇e shape. The transverse part of sacra] fracture was diagnosed as type I] in 2 cases and as type m in 6 cases, according to Roy-Camille and Strange-Vognsen sub-classification. The combined neurological impairments were judged as grade 3 in 2 eases anti grade 4 in 6 eases, according to Gibbons＇ criteria. Seven patients were complicated with multiple injuries. After stabilization of vital signs, all were treated with open reduction, posterior sacral decompression and lumbopelvic or [umbosacral fixation using the segment pedicel system, whereby the transverse fixation was obtained using a 6 mm rod as cross-connector between the 2 main rods. Results All the patients were followed up for an average of 14.5 months （from 6 to 24 months） . All demonstrated fracture healing on CT scan at 6 months. Two cases of partial incision necrosis and one case of superficial infection were managed successfully with surgical debridement and aggressive wound care. Five patients complained of symptoms related to the prominence of the iliac screws. Of the 6 patients with bowel and bladder deficits, 3 obtained full recovery and 3 partial recovery.. The average C, ihbons scoft improved by 2.45 points. One case had mal-placement of iliac screws. No rupture of implants or loss of fracture reduction was seen at the final radiological follow-up. Conclusions U-shaped sacral fraetul~ can result in spino-pelvic instability associated with neurological deficits. Good neurological recovery can be expected after early sacral decompression. Lumbopelvic fixation, providing multi-planer fixation, is effective

关 键 词：骶骨 骨折 骨盆 创伤和损伤 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]