三角固定术治疗单侧IslerⅡ型腰骶结合部损伤  

Surgical treatment of unilateral Isler type Ⅱ lumbosacral junction injuries with triangular osteosynthesis

作　　者：刘兆杰[1] 贾健[1] 金鑫[1] 田维[1] 孙玉玺 戚浩天 王宏川[1] 肖湘[1] 李刚[1] 胡永成[1] Liu Zhaojie;Jia Jian;Jin Xin;Tian Wei;Sun Yuxi;Qi Haotian;Wang Hongchuan;Xiao Xiang;Li Gang;Hu Yongcheng(Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin 300211, China)

机构地区：[1]天津市天津医院创伤骨科,300211

出　　处：《中华骨科杂志》2019年第13期833-840,共8页Chinese Journal of Orthopaedics

基　　金：天津市卫生局科技基金(2015KZ065).

摘　　要：目的探讨三角固定术治疗单侧IslerⅡ型腰骶结合部损伤的临床疗效。方法回顾性分析2015年3月至2017年2月采用三角固定术治疗16例单侧IslerⅡ型腰骶结合部损伤患者资料,男13例,女3例;年龄24~61岁,平均35.5岁;其中7例为多发伤患者,合并头部、胸部、肌肉骨骼系统以及神经系统损伤。腰骶结合部损伤根据Isler分型,Ⅱa型5例,Ⅱb型9例,Ⅱc型2例。所有腰骶结合部损伤均合并同侧骶骨骨折,骶骨骨折根据Denis分区,Ⅰ区1例,Ⅱ区13例,Ⅲ区2例。骨盆骨折根据Tile分型,B2型3例,C1型11例,C3型2例。其中合并骶神经损伤3例,根据Gibbons神经损伤分级,Ⅱ级2例,Ⅲ级1例。所有IslerⅡ型腰骶结合部损伤均采用三角固定术治疗,其中14例联合应用同侧S1椎体骶髂螺钉固定,2例联合应用后方锁定钢板固定。结果16例患者术后均获随访,随访时间16~30个月,平均20.6个月。术后12~24个月CT检查示所有骶骨骨折均达骨性愈合;2例腰骶结合部L5S1关节突关节骨性融合,14例未融合。术后Majeed评分66~100分,平均81.7分,其中优12例,良2例,可2例,优良率87.5%(14/16)。根据Mears和Velyvis影像学标准,解剖复位14例,复位满意2例。术前3例合并骶神经损伤患者中,2例Gibbons分级由术前Ⅱ级恢复至Ⅰ级;1例术后仍残留足外侧部分感觉减退,但Gibbons分级从Ⅲ级恢复至Ⅱ级。所有患者术中均未出现神经血管损伤,术后无一例发生伤口感染、脂肪液化等切口相关并发症。术后1例患者腰骶部内置物压迫皮肤出现疼痛,待内固定取出后疼痛消失;1例患者出现腰部僵硬感,取出内固定后逐渐好转。结论三角固定术能够稳定单侧IslerⅡ型腰骶结合部损伤,治疗效果满意。Objective To explore the treatment outcome of triangular osteosynthesis (TOS) for the treatment of unilateral Isler type Ⅱ lumbosacral junction injuries (LSJIs). Methods Data of sixteen patients with unilateral Isler type Ⅱ LSJIs surgically who were treated in our Hospital from March 2015 to February 2017 were retrospectively analyzed. There were 13 males and 3 females with an average age of 35.5 years (range, 24-61 years). Seven patients were multiple injuries including head, thoracic, musculoskeletal and nerve injuries. According to Isler classification of LSJIs, there were 5 cases of type Ⅱa, 9 of type Ⅱb and 2 of type Ⅱc. All the LSJIs combined with ipsilateral sacral fractures. The sacral fractures were classified by Denis classification with 1 case of zone Ⅰ, 13 cases of zone Ⅱ and 2 cases of zone Ⅲ. According to Tile classification of pelvic fractures, there were 3 cases of type B2, 11 of type C1 and 2 of type C3. There were 3 cases combined with sacral nerve injury among which there were 2 cases of grade Ⅱ and 1 case of grade Ⅲ according to Gibbons classification of neurologic deficits. All cases were surgically treated with triangular osteosynthesis. There were 14 cases combined with iliosacral screws fixation in S1 and 2 cases combined with posterior locking plates. Results All patients were followed up for 20.6 months (range, 16-30 months). CT scan was conducted 12 to 24 months after surgery which showed all the sacral fractures were union, and 2 cases achieved bony fusion in L5S1 facets while the other 14 didn’t. According to Majeed’s pelvic injury evaluation, clinical outcomes were rated with excellent in 12 cases, good in 2 cases, fair in 2 cases. The excellent and good rate was 87.5%(14/16). According to Mears-Velyvis evaluation criterion, there were 14 cases with anatomical reduction and 2 cases with satisfactory reduction. Among the 3 cases with sacral nerve injury, 2 cases were improved from Gibbons grade Ⅱ to grade Ⅰ and the other 1 case was improved from Gibbons gra

关 键 词：骶骨 骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]