经腹直肌旁入路与骶骨后正中入路行腰骶丛减压术在不稳定型骶骨骨折治疗中的比较研究  

Lateral rectus abdominis approach versus posteromedian sacrum approach for unstable sacral fracture complicated with lumbosacral plexus injury

作　　者：吴旻昊[1] 谢远龙[1] 金伟[1] 田大为[1] 邓洲铭[1] 雷军[1] 蔡林[1] Wu Minhao;Xie Yuanlong;Jin Wei;Tian Dawei;Deng Zhouming;Lei Jun;Cai Lin(Department of Orthopaedics, Spinal and Pelvic Surgery Center, Zhongnan Hospital, Wuhan University, Wuhan 430071, China)

机构地区：[1]武汉大学中南医院骨科,武汉大学中南医院脊柱骨盆外科中心,430071

出　　处：《中华创伤骨科杂志》2019年第7期628-632,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较经腹直肌旁入路与骶骨后正中入路行腰骶丛减压术在治疗不稳定型骶骨骨折中的临床疗效。方法回顾性分析2010年6月至2014年12月武汉大学中南医院骨科行腰骶丛减压术治疗并获随访的33例不稳定型骶骨骨折患者的临床资料,其中新鲜骨折24例,陈旧性骨折9例;按手术入路将其分为:经腹直肌旁入路组(17例)和骶骨后正中入路组(16例)。所有患者均于伤后2~12周(平均4.5周)接受手术治疗。比较两组患者手术时间、出血量、术后负重时间、并发症、疼痛视觉模拟评分(VAS)、欧洲五维健康量表(EQ-5D)及腰骶丛损伤评分(LSICS)等方面的差异。结果两组患者临床基线情况比较差异无统计学意义(P>0.05),具有可比性。所有患者术后获17~37个月(平均26.8个月)随访。围手术期间2例患者出现腰骶部切口感染、坏死,3例患者出现医源性腰骶丛神经损伤,其余患者切口均愈合良好,无伤口感染、压疮、内固定物松动或断裂等并发症发生。两组患者手术时间[(235.8±72.0)min和(318.0±64.7)min]、术中出血量[(558.8±125.7)mL和(734.0±98.0)mL]、术后负重时间[(9.4±2.4)周和(11.3±2.3)周]、术后并发症发生情况、VAS评分[(1.1±0.6)分和(1.0±0.6)分]、EQ-5D评分[(0.82±0.09)分和(0.78±0.06)分]比较差异均无统计学意义(P>0.05)。末次随访时两组患者的VAS评分、EQ-5D评分及LSICS较术前均有不同程度恢复,差异有统计学意义(P<0.05)。结论经腹直肌旁入路与骶骨后正中入路行神经减压术均可充分松解卡压的腰骶丛神经根,疗效满意。Objective To compare the lateral rectus abdominis approach versus posteromedian sacrum approach in the surgical treatment of unstable sacral fracture complicated with lumbosacral plexus injury. Methods From June 2010 to December 2014, 33 unstable sacral fractures complicated with lumbosacral plexus injury were treated at Department of Orthopaedics, Spinal and Pelvic Surgery Center, Zhongnan Hospital. Of them, 24 were fresh and 9 obsolete. The lateral rectus abdominis approach was adopted in 17 patients and the posteromedian sacrum approach in 16. All the patients received surgical treatment within 2 to 12 weeks (average, 4.5 weeks) after injury. The 2 groups were compared in terms of operation time, bleeding volume, complications, weight-bearing time, visual analogue scale (VAS), European QOL Five Dimensional health scale (EQ-5D) and lumbosacral injury classification and severity scale (LSICS). Results The 2 groups were compatible due to their insignificant differences in baseline data (P>0.05). Their follow-up time ranged from 17 to 37 months (average, 26.8 months). Perioperatively, infection and necrosis of the lumbosacral incision appeared in 2 patients and iatrogenic injury to the lumbosacral plexus in 3 patients. All the other incisions healed well without major complications like infection, pressure ulcer or implant failure. There were no significant differences between the 2 groups in operation time (235.8±72.0 minutes versus 318.0±64.7 minutes), intraoperative bleeding volume (558.8±125.7 mL versus 734.0±98.0 mL), weight-bearing time (9.4±2.4 weeks versus 11.3±2.3 weeks), postoperative complications, VAS(1.1±0.6 points versus 1.0±0.6 points), EQ-5D (0.82±0.09 points versus 0.78±0.06 points) or LSICS (P>0.05). The final follow-ups revealed significant improvements in VAS, EQ-5D and LSICS in all the patients (P<0.05). Conclusion The lumbosacral plexus can be well decompressed via both the lateral rectus abdominis approach and the posteromedian sacrum approach, leading to satisfactory clinical outc

关 键 词：骶骨 腰骶丛 骨折 神经损伤 手术治疗 

分 类 号：R687.3[医药卫生—骨科学]