腹直肌旁入路结合骶前减压术治疗陈旧性Denis Ⅱ型骶骨骨折合并上骶丛损伤的疗效分析  

Lateral rectus abdominis approach combined with presacral decompression for old Denis type Ⅱ sacral fractures complicated with upper sacral plexus injury

作　　者：吴旻昊[1] 许可可 陈子孟 刘火文 谢远龙[1] 闫飞飞[1] 平安松[1] 邓洲铭[1] 朱晓彬[1] 齐勇建[1] 雷军[1] 蔡林[1] Wu Minhao;Xu Keke;Chen Zimeng;Liu Huowen;Xie Yuanlong;Yan Feifei;Ping Ansong;Deng Zhouming;Zhu Xiaobin;Qi Yongjian;Lei Jun;Cai Lin(Department of Spine Surgery and Musculoskeletal Tumor,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院脊柱与骨肿瘤科,430071

出　　处：《中华创伤杂志》2020年第5期421-427,共7页Chinese Journal of Trauma

摘　　要：目的探讨腹直肌旁入路结合骶前减压术治疗陈旧性DenisⅡ型骶骨骨折合并上骶丛损伤的临床疗效。方法采用回顾性病例系列研究分析2010年6月—2016年12月武汉大学中南医院收治的9例陈旧性DenisⅡ型骶骨骨折合并上骶丛(L4~S1)损伤患者的临床资料,其中男6例,女3例;年龄15~58岁[(33.1±7.5)岁]。患者均于术前2 h在数字减影血管造影(DSA)下行髂内动脉栓塞并预置腹主动脉球囊。均采用腹直肌旁入路行骶前减压治疗。记录手术时间、术中出血量及术后完全负重时间;摄X线片及CT观察内固定及骨折愈合情况;比较患者术前、末次随访时视觉模拟评分(VAS)及欧洲五维健康量表(EQ-5D)评分;采用Gibbons骶神经损伤分级评价神经功能;观察术中、术后并发症情况。结果患者均获随访24~52个月[(35.2±5.2)个月]。手术时间(2.9±0.6)h;术中出血量(573±138)ml;完全负重时间为术后(11.6±1.2)周。VAS和EQ-5D评分由术前(7.8±0.6)分和(0.34±0.07)分改善为末次随访时(0.8±0.3)分和(0.81±0.05)分(P<0.05)。术后1年随访Gibbons骶神经损伤分级:Ⅰ级8例,Ⅱ级1例(P<0.01),下肢放射性疼痛较术前明显改善,其中8例患者疼痛消失,完全恢复正常;1例仍残留患侧肢体的麻木及感觉减退。术中无医源性腰骶丛神经、重要血管及盆腔脏器损伤。术后随访中仅1例出现创伤性髋关节炎,于术后6个月接受全髋关节置换术。其余患者无伤口感染、压疮、内固定物松动或断裂等并发症发生。结论采用腹直肌旁入路行骶前减压治疗陈旧性DenisⅡ型骶骨骨折合并上骶丛损伤,可充分松解卡压的上骶丛神经,缓解疼痛及促进功能康复,且并发症发生率低,是一种可供选择的手术方式。Objective To investigate the clinical effect of lateral rectus abdominis approach combined with presacral decompression for surgical treatment of old Denis type Ⅱ sacral fractures complicated with upper sacral plexus injury.Methods A retrospective case series study was performed on the clinical data of 9 patients with old Denis type Ⅱ sacral fractures complicated with upper sacral plexus injury(L4-S1)admitted to Zhongnan Hospital of Wuhan University from June 2010 to December 2016.There were 6 males and 3 females,aged(33.1±7.5)years(range,15-58 years).Embolization of internal iliac artery and preimplantation of abdominal aortic balloon were performed 2 hours before operation under the guidance of digital subtraction angiography(DSA).Surgery was performed using a single lateral rectus abdominis approach combined with presacral decompression.The operation time,intraoperative blood loss and full weight-bearing time were recorded.The visual analogue scale(VAS)and European QOL Five Dimensional health scale(EQ-5D)were compared before and after operation.The Gibbons'impairment scale was used to assess neurological function.X-ray and CT scan were used to observe internal fixation and fracture healing.The complications during and after operation were recorded.Results The patients were followed up for 24-52 months[(35.2±5.2)months].The operation time was(2.9±0.6)hours.The intraoperative bleeding was(573±138)ml,and the full weight-bearing time was(11.6±1.2)weeks.X-ray and CT scan showed bone healing in all patients at the latest follow-up.The VAS and EQ-5D scale improved from preoperative(7.8±0.6)points and(0.34±0.07)points to the final follow-up of(0.8±0.3)points and(0.81±0.05)points(P<0.05).According to Gibbons classification,8 patients were grade I and 1 patient was grade Ⅱ one year after operation(P<0.01).Namely,the radiation pain of lower extremities was significantly improved in all patients,among which 8 patients showed pain disappeared and completely returned to normal and 1 patient showed residual nu

关 键 词：骶骨 骨折固定术 内 腰骶丛 减压术 外科 神经损伤 

分 类 号：R687.3[医药卫生—骨科学]