不稳定骶骨骨折手术治疗体会  

Experience in surgical treatment of unstable sacral fractures

作　　者：顾海伦[1] 王湛[1] 牟珈萱 向世洋 GU Hai-lun;WANG Zhan;MU Jia-xuan;XIANG Si-yang(Department of Trauma Orthopaedics,Shengjing Hospital of China Medical University,Shenyang,Liaoning 110004,China)

机构地区：[1]中国医科大学附属盛京医院创伤骨科,辽宁沈阳110004

出　　处：《中国骨与关节损伤杂志》2021年第8期785-788,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨不稳定骶骨骨折的手术治疗方法及临床体会。方法回顾性分析自2012-01—2018-12采用腰髂椎弓根钉内固定治疗的35例不稳定骶骨骨折(DenisⅡ型24例,DenisⅢ型11例),23例合并神经损伤症状(其中14例存在神经根管压迫需进行骶神经根管减压)。结果35例均获得随访,随访时间平均24.1(10~36)个月。2例切口延迟愈合。1例切口深层感染,经二次清创并灌洗引流2周后愈合。骶骨骨折均愈合,未出现内固定松动、断裂。术后平均13.1(10~18)个月取出内固定物,内固定物与周围组织无粘连。末次随访时Majeed评分平均85.1(62~94)分,其中优24例,良8例,可3例。23例神经损伤者末次随访时神经功能较术前明显改善,Gibbons评分:Ⅰ级17例,Ⅱ级4例,Ⅲ级1例,Ⅳ级1例。结论不稳定骶骨骨折需积极手术治疗,腰髂椎弓根钉内固定可以早期稳定骨折端,同时需对合并骶神经损伤者进行综合评价,存在神经压迫者要早期减压,如此才能获得满意疗效。ObjectiveTo explore the surgical treatment and clinical experience of unstable sacral fractures.MethodsThirty-five patients with unstable sacral fractures treated with lumbar iliac pedicle screw fixation from January 2012 to December2018(Denis type Ⅱ in 24 cases, Denis type Ⅲ in 11 cases)were retrospectively analyzed, and 23 cases were complicated with nerve injury symptoms(of which 14 cases had nerve root canal compression and needed sacral nerve root canal decompression).ResultsAll 35 cases were followed up for an average of 24.1(10-36)months. Delayed healing of incision was found in 2 cases. One case of deep incision infection healed after secondary debridement and lavage and drainage for 2 weeks. All sacral fractures healed and there was no internal fixation loosening or fracture. The internal fixation was removed at an average of 13.1(10-18)months after operation, and there was no adhesion between the internal fixation and the surrounding tissue. At the last follow-up, the average Majeed score was 85.1(62-94), of which 24 cases were excellent, 8 good and 3 fair. At the last follow-up,the neurological function of 23 patients with nerve injury was significantly improved as compared with that before operation. According to Gibbons score, there were 17 cases of grade Ⅰ, 4 cases of grade Ⅱ, 1 case of grade Ⅲ and 1 case of grade Ⅳ.ConclusionUnstable sacral fractures need active surgical treatment, lumbar iliac pedicle screw internal fixation can stabilize the fracture site early, and patients with sacral nerve injury need to be comprehensively evaluated. Patients with nerve compression should be decompressed early in order to obtain satisfactory results.

关 键 词：不稳定骶骨骨折 骶神经损伤 髂腰固定 神经减压 

分 类 号：R687.3[医药卫生—骨科学]