闭口万向螺钉骶髂固定系统联合后路部分脊柱内固定系统治疗不稳定型骶骨骨折  

Evaluation of closed multi-axial screws iliosacral fixation system combined with posterior segmental spinal fixation for treatment of unstable sacral fractures

作　　者：黄仲[1] 孟维锟 李亮[1] 谭振[1] 郭强[1] 刘雷[1] 黄富国[1] 王光林[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2017年第3期313-318,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省科技支撑计划资助项目(2013FZ0066);广安市2016年创新基金项目~~

摘　　要：目的评价应用闭口万向螺钉(closed multi-axial screws,CMAS)骶髂固定系统联合后路部分脊柱内固定系统行腰椎-骨盆内固定治疗不稳定型骶骨骨折的临床效果。方法回顾分析2013年1月—2014年11月采用CMAS骶髂固定系统联合后路部分脊柱内固定系统行腰椎-骨盆内固定治疗的25例(39侧)不稳定型骶骨骨折患者临床资料。其中男17例,女8例;年龄19~55岁,平均33.9岁。致伤原因:交通事故伤15例,高处坠落伤8例,挤压伤2例。受伤至入院时间1~13 d,平均3.5 d。骨折按Denis分型:Ⅰ型2侧,Ⅱ型20侧,Ⅲ型17侧。术前20例伴神经损伤,根据Gibbons评分Ⅰ级2例,Ⅱ级2例,Ⅲ级7例,Ⅳ级9例。术后2 d根据Matta标准对骨折复位质量进行评价,根据Majeed功能评分标准及Gibbons评分标准分别对临床功能和神经功能进行评价。结果手术时间80~150 min,平均110 min;术中出血量250~1 400 mL,平均570 mL。2例术后出现切口感染,经清创术及抗生素治疗后愈合。25例患者均获随访,随访时间15~22个月,平均18个月。X线片及CT复查示骶骨骨折均达临床愈合,愈合时间8~12周,平均10周。根据Matta评分标准评估骨折复位质量,获优32侧、良好6侧、一般1侧,优良率97.5%。术后12~20个月,平均13个月取出内固定物,无螺钉松动、断裂,内固定物与周围组织无粘连,未见明显电解离现象发生。末次随访时,根据Majeed标准评价临床功能,为64~98分,平均84.7分;获优18例、良好5例、一般2例,优良率92.0%。20例神经损伤者其神经功能较术前明显恢复,Gibbons评分获Ⅰ级8例,Ⅱ级8例,Ⅲ级3例,Ⅳ级1例。结论应用CMAS骶髂固定系统联合后路部分脊柱内固定系统行腰椎-骨盆内固定治疗不稳定型骶骨骨折,不仅为骶骨骨折提供了坚强固定,实现早期完全负重,而且可进行术中骶神经探查及减压以促进神经功能恢复。Objective To evaluate the effectiveness of lumbopelvic fixation using the combination of closed multi-axial screws （CMAS） iliosacral fixation system and the posterior segmental spinal fixation for unstable sacral fractures. Methods Between January 2013 and November 2014, 25 patients （39 sides） with unstable sacral fractures were treated with lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation. There were 17 males and 8 females, aged 19-55 years （mean, 33.9 years）. The causes were traffic accident injury in 15 cases, falling injury from height in 8 cases, and crushing injury in 2 cases. The interval of injury and operation was 1-13 days （mean, 3.5 days）. Fracture was classified as Denis type I in 2 sides, type II in 20 sides, and type III in 17 sides; nerve injury was rated as Gibbons grade I in 2 cases, grade II in 2 cases, grade III in 7 cases, and grade IV in 9 cases. The reduction quality was evaluated by Matta criterion, the clinical function outcome by Majeed, and nerve function by Gibbons criterion. Results The average operation time was 110 minutes （range, 80-150 minutes）. The average blood loss was 570 mL （range, 250-1400 mL）. Superficial wound infection occurred in 2 patients, and was cured after debridement and antibiotic therapy. All patients were followed up for an average of 18 months （range, 15-22 months）. Postoperative X- ray and CT examination showed clinical healing of sacral fractures at 8-12 weeks after operation （mean, 10 weeks）. The mean removal time of internal fixation was 13 months （range, 12-20 months）. No screw loosening and fracture, adhesion of internal fixation to surrounding tissue, and obvious electrolysis phenomenon occurred. According to Matta criterion, reduction was rated as excellent in 32 sides, good in 6 sides, fair in 1 side, and the excellent and good rate was 97.5%. According to Majeed functional scoring at last follow-up, the mean score was 84.7 （range, 64-98）

关 键 词：骶骨骨折 骨盆骨折 闭口万向螺钉 腰椎-骨盆内固定 

分 类 号：R687.3[医药卫生—骨科学]