骨盆骨折合并腰骶丛损伤的诊治  

Diagnosis and treatment of the lumbosacral plexus injury associated with pelvic fractures

作　　者：顾立强[1] 张景僚[1] 王钢[1] 裴国献[1] 

机构地区：[1]第一军医大学南方医院全军创伤骨科中心,广州市510515

出　　处：《中华创伤骨科杂志》2002年第3期174-177,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：腰骶丛损伤临床较为少见,但骨盆后环骨折移位、骶髂关节脱位、骶骨骨折时可牵拉、压迫致伤腰骶丛神经,TileC型骨盆骨折时腰骶丛神经损伤的发病率高达50%。腰骶丛损伤多数为神经失用、轴突断裂,严重者神经断裂,个别神经根撕脱。多发伤及不稳定性骨盆骨折时,腰骶丛损伤的早期临床诊断较为困难,要求在早期复苏时及病情稳定后进行仔细的神经学检查谨防漏诊,电生理学、影像学检查有助于确诊及损伤机制分析。骨盆骨折早期手术切开复位、牢固内固定,恢复骨盆后环的解剖学结构与稳定性特别重要,多数患者能自行恢复神经功能;少数患者可酌情行神经探查、减压手术或神经修复术。但对腰骶丛神经根撕脱目前尚无有效的治疗方法,灼性神经痛也是一个棘手的问题。The lumbosacral plexus injury(LPI )is not common in clinic.It can be caused by being dragged and compressed during the di splacement of posterior ring of fractured pelves,the dislocation of the sacroiliac joint,and sacrum fractu re.The incidence of LPI can amount even up to 50%in the pelvic fracture of Tile type C.Phenotypes of LPI varies from neurapraxia and axonotmesis in most cases,neurotmesis in severe cases and even nerve root avulsion in a few c ases.Because of the difficulty of ea rly clinical diagnosis of LPI in mult iple injury and unstable fracture,the attentive neurological examination i s necessary both after the early resu scitation and during the stationary phase.At t he same time electrophysiologic and image examination is helpful for the final diagnosis and the analysis of trauma togenic mechanism.Early open reduction of pelvic fracture,rigid internal fixation and recovery of the anatomi c structure and stability of posterior pelvic ring are vital.The nerve fu nction can recover by itself in the majority of p atients and exploration,decompression or repair of nerve are needed in t he minority.At present there is no valid therapeutic method for avulsion of lumbosacral plexus,and for causalg ia.[

关 键 词：腰骶丛 神经损伤 骨盆骨折 诊断 治疗 

分 类 号：R683.3[医药卫生—骨科学] R651.3[医药卫生—外科学]