Denis Ⅱ、Ⅲ型骶骨骨折伴神经损伤的治疗研究  

Treatment of the Denis Ⅱ and Ⅲ Sacral Fracture with Nerve Injury

作　　者：刘威 杨朝晖[2] Liu Wei;Yang Zhaohui(Department of Orthopaedics,the Second Clinical Medical College,Shanxi Medical University,Taiyuan 030001,China;Department of Orthopaedics,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二临床医学院骨科,山西太原030001 [2]山西医科大学第二医院骨科,山西太原030001

出　　处：《实用骨科杂志》2020年第2期103-107,共5页Journal of Practical Orthopaedics

摘　　要：目的比较单纯骨折固定与固定骨折同时行神经探查减压治疗DenisⅡ、Ⅲ型骶骨骨折伴神经损伤的治疗效果。方法选取2016年8月至2018年8月于我院明确诊断住院的DenisⅡ、Ⅲ型骶骨骨折伴神经损伤患者32例,男20例,女12例;年龄18~60岁,平均41.7岁,随机分为固定组16例和减压组16例,分别接受骶骨骨折内固定及内固定+神经减压治疗。通过比较两组患者术后第1、3、6个月Lindahl影像学评分、美国脊髓损伤协会(American spinal injury association,ASIA)残损分级、脊髓损伤神经学分类国际标准(international standards for neurological classification of spinal cord injury,ISNCSCI)评分等指标,对比两种治疗方案的疗效。结果减压组患者术中出血量较固定组多(P<0.05),但两组术后引流量及住院天数差异无统计学意义(P>0.05)。两组患者术后随访6个月,Lindahl影像学评价比较差异无统计学意义(P>0.05),术后骨折均可获得骨性融合,且愈合良好。而对比神经恢复情况,两组之间存在差异。虽然两种治疗方案术后神经损伤均获得一定程度的恢复,但ASIA残损分级及ISNCSCI评分均显示减压组疗效好于固定组(P<0.05)。结论对于DenisⅡ、Ⅲ型骶骨骨折伴神经损伤的患者,坚强固定是骨折愈合的基础,在此基础上,及时行神经探查减压的治疗方案对患者神经损伤的恢复更加有利。Objective To compare the effect of nerve exploration and decompression with fixation withsimple fracturefixation in DenisⅡandⅢsacral fractures with nerve injury patients.Methods Thirty-two patients(20 males and 12 females),aged 18~60 years,with an average age of 41.7 years,who were hospitalized in our hospital from August 2016 to August 2018,were randomly divided into fixed group(n=16 cases)and decompression group(n=16 cases).They were treated with internal fixation and internal fixation plus nerve decompression respectively.Lindahl imaging score,ASIA disability grade and ISNCSCI score were compared between the two groups at 1,3 and 6 months after operation.Results The amount of bleeding in decompression group was more than that in fixed group(P<0.05),but there was no significant difference in the number of days in hospital between the two groups(P>0.05).After 6 months of follow-up,there was no significant difference in Lindahl imaging score between the two groups(P>0.05).Bone fusion and good healing were achieved in all cases.Compared with the recovery of nerve injury,there were differences between the two groups.Although the nerve injuries recovered to some extent after the two treatments,ASIA disability grade and ISNCSCI score both showed that the effect of decompression group was better than that of fixed group(P<0.05).Conclusion For the patients with DenisⅡandⅢsacral fractures and nerve injury,strong fixation is the basis of fracture healing.On this basis,timely treatment of nerve exploration and decompression is more beneficial to the recovery of nerve injury.

关 键 词：骶骨骨折 神经损伤 内固定 神经减压 评分标准 

分 类 号：R683.41[医药卫生—骨科学]