腰髂固定系统治疗脊柱—骨盆分离损伤  

Lumboiliac fixation system for treatment of spinopelvic dissociation injuries

作　　者：王衍武 王伯珉[2] WANG Yan-wu;WANG Bo-min(Department of Orthopaedics, People＇s Hospital of Sishui County, Sishui 273200, China;Departm.ent of Orthopaedic Traumatology, Provincial Hospital of Shandong, Jinan 250021, China)

机构地区：[1]山东省泗水县人民医院骨科,济宁市泗水县273200 [2]山东省立医院创伤骨科,济南市槐荫区250021

出　　处：《中国矫形外科杂志》2018年第8期682-686,共5页Orthopedic Journal of China

摘　　要：[目的]回顾性分析采用腰髂固定系统治疗脊柱-骨盆分离损伤的疗效。[方法]回顾性分析2010年1月~2015年12月,19例脊柱-骨盆分离损伤患者采用腰髂固定系统治疗的资料,男14例,女5例;年龄20~51岁,平均35.7岁;车祸伤2例,坠落伤13例,砸伤4例。创伤严重度评分(injury severity score,ISS)为27~66分,平均40.5分。所有患者均有骶骨骨折,且Dennis分型均为Ⅲ型,其中3例为开放性损伤,3例伴颅脑损伤,10例伴胸部脏器损伤,3例伴腹部脏器损伤。骶骨骨折中19例均为累及骶管的马尾损伤,包括Gibbons评价Ⅰ级0例、Ⅱ级3例、Ⅲ级7例、Ⅳ级9例。Majeed评分、Gibbons评分、医源性损伤、并发症等指标用于结果评估。[结果]患者手术时间130~510 min,平均(157.79±83.89)min;术中出血量600~2 100 ml,平均(770.91±398.77)ml。无血管、神经等医源性损伤发生。19例患者均获得随访,随访时间12~36个月,平均(14.38±5.33)个月。末次随访Majeed评分76~91分,平均(83.3±4.92)分,其中优良率为63.2%。Gibbons评分由术前(3.65±0.41)分降至末次随访(1.43±0.36)分,两者比较差异有统计学意义(P<0.001)。末次随访均无1例发生感染、内固定物失效、骨不愈合等并发症。[结论]腰髂固定系统是治疗脊柱-骨盆分离损伤的有效方法,可以达到满意的治疗效果。[Objective] To evaluate retrospectively the outcomes of spinopelvic dissociation injuries treated by the lumboiliac fixation system. [Methods] A retrospective study was conducted on the clinical data of 19 patients with spinopelvic dissociation injuries received surgical treatment with the lumboiliac fixation system from January 2010 to December 2015. Of them, 14 males and 5 females aged from 20 to 51 years with an average of 35.7 years, including 2 of traffic accident, 13 of falling injury and 4 of crashing injury. The patients were graded as 27 to 66 in Injury Severity Score（ISS） with an average of 40.5. All the patients had Dennis type III of sacral fractures, including 3 of open injuries, 3 accompanied with craniocerebral injuries, 10 with thoracic injuries and 3 with abdominal injuries. Of the sacral fractures, 19 patients involved the sacral canal or accompanied with cauda equina injury, with Gibbons Grade I in 0, Gradewith cauda equina injury, with Gibbons Grade I in 0, Grade II in 3 Grade III in 7 and Grade IV in 9. The Majeed score and Gibbons grade, iatrogenic injuries and complications were recorded for evaluation. [Results] All the patients un-derwent operation successfully, with operation time ranged from 130 to 510 min（157.79±83.89） min, intraoperative blood loss from 600 to 2100 ml（770.91±398.77） ml. No iatrogenic injuries, such as neurovascular injuries, happened in any patient. All of them were followed up from 12 to 36 months with an average of 14.38±5.33 months. At the latest follow up, the Majeed score ranged from 76 to 91（83.3±4.92）, with the excellent and good rate of 63.2%. The Gibbons grade statistically decreased from（3.65±0.41） preoperatively to（1.43±0.36） at the latest follow up（P〈0.001）. No severe complications, such as infection, failure of internal fixation and bone nonunion occurred in any patient at the final follow up. [Conclusion] This lumboiliac fixation system is an effective approach for treatment of spinopelvic dissociation, the rare and se

关 键 词：脊柱-骨盆分离损伤 腰骼固定系统 骨盆 骶骨骨折 

分 类 号：R687[医药卫生—骨科学]