腰骶椎融合术后继发骶骨骨折的手术治疗一例  

Surgical treatment of sacral fractures following lumbosacral vertebral fusion: 1 case report

作　　者：胡永凯[1] 刘宪义[1] 李淳德[1] 王宇[1] 于峥嵘[1] 

机构地区：[1]北京大学第一医院骨科,100034

出　　处：《中国骨与关节杂志》2016年第1期77-79,共3页Chinese Journal of Bone and Joint

摘　　要：临床上诊断为继发于腰骶椎体后路融合术的骶骨骨折不常见,相关文献报道为数不多。尽管该类骶骨骨折报道较少,但其发生率可能很高。该类骨折在X线片中很难被发现,确诊一般依赖于CT或MRI,因此易致漏诊。漏诊的另一个原因是大多数该类骨折未予手术干预也能在数月内痊愈,一般很难引起骨科医生的重视。根据文献报道的经验,大多数该类骨折发生在腰骶椎融合术后3个月内,绝大多数患者经保守治疗效果较好。Objective To present a case of totally displaced sacral fracture following posterior L4- S1 fusion. Methods This article presented a case of totally displaced sacral fracture following posterior L4- S1 fusion in a 65-year-old female patient with a 15-year history use of corticosteroid. She underwent open reduction and internal fixation by iliac screws. Results Immediately after the revision surgery, the patient＇s pain in buttock and left leg was relieved significantly. The weakness of the left lower extremity was also improved from 3 / 5 to 5 / 5. Conclusions The incidence of postoperative sacral fractures has been rather underestimated, because most of these fractures are not visible on plain radiographs. CT has been proved to be able to detect most of such fractures and should be performed routinely when patients complain of renewed buttock pain within 3 months after the lumbosacral fusion. The majority of the patients respond well to the conservative treatment. The fusion construction to the iliac wings by iliac screws will be needed when concurrent fracture displacement, sagittal imbalance, neurologic symptoms, or painful nonunion exist.

关 键 词：脊柱融合术 腰骶部 脊柱骨折 骶骨 骨钉 

分 类 号：R687.3[医药卫生—骨科学]