经骶骨翼髂骨螺钉腰椎-骨盆固定术治疗骶骨骨折  

Lumbopelvic fixation using sacral ala-iliac screw for sacral fractures

作　　者：李悦 罗杨兴 尹恩志 解杰 张谦 何立 杨阳 谷美琪 龚嵩 易成腊[1] Li Yue;Luo Yangxing;Yin Enzhi;Xie Jie;Zhang Qian;He Li;Yang Yang;Gu Meiqi;Gong Song;Yi Chengla(Department of Traumatic Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,武汉430030

出　　处：《中华骨科杂志》2021年第19期1404-1411,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨经骶骨翼髂骨(sacral ala-iliac,SAI)螺钉腰椎-骨盆固定或三角固定术治疗骶骨骨折的临床疗效。方法回顾性分析2019年12月至2020年6月期间采用SAI螺钉腰椎-骨盆固定或三角固定术治疗骶骨骨折12例患者的病历资料,男3例,女9例;年龄(32.6±15.0)岁(范围13~52岁)。致伤原因:坠落伤11例,交通伤1例。骶骨骨折Denis分型:Ⅱ型4例,Ⅲ型8例。AO分型(Tile-Muller):C1.3型4例,C3.3型8例;其中C3.3型8例的改良Roy-Camille和Strange-Vognsen分型:Ⅱ型2例,Ⅲ型6例。8例C3.3型患者按Gibbons骶神经损伤评分:3分6例,4分2例;4例C1.3型无神经损伤。6例患者合并骨盆前环损伤。受伤至手术时间为(19.3±9.2)d(范围6~32 d)。待生命体征平稳后行椎板切除减压和骶神经根减压、骨折复位、SAI螺钉腰椎-骨盆固定或三角固定术,骨盆前环根据损伤情况决定固定方式。根据Matta标准评价术后骨折复位情况,末次随访时采用Majeed评分系统和Gibbons骶神经损伤评分系统对临床功能和神经功能进行评价。结果12例患者顺利完成手术。8例C3.3型骨折采用腰椎-骨盆固定,其中6例因为有纵向分离移位加用横联杆固定;4例C1.3型骨折采用三角固定术,横向固定采用骶髂螺钉3例、骶骨局部钢板1例。6例合并前环损伤者采用钢板固定4例,INFIX固定1例,耻骨支螺钉固定1例。所有患者随访时间为(7.3±1.7)个月(范围6~12个月)。按Matta标准评价骨折复位:优7例,良4例,可1例。末次随访时Majeed评分:优6例,良5例,可1例。2例直肠、膀胱功能障碍者1例完全恢复,另1例术中发现S1,S2神经根部分断裂,末次随访时直肠、膀胱功能恢复,但小腿以下仍残存肌力减退;6例术前小腿以下肌力减退者均有明显改善,4例完全恢复,2例残存下肢感觉障碍。Gibbons骶神经损伤评分术前平均为3.2分,术后平均为1.4分,改善(1.8±0.7)分。术后3~6个月X线片示骨折均愈合。随访期间1例S2AI�Objective To investigate clinical effects of lumbopelvic fixation and triangular osteosynthesis using sacral ala-iliac screws for the treatment of sacral fractures.Methods The data of 12 patients with sacral fractures treated with lumbopelvic fixation and triangular osteosynthesis using sacral ala-iliac screws from December 2019 to June 2020 were retrospectively analyzed.There were 3 males and 9 females with an average age of 32.6±15.0 years(range,13-52 years);causes of injury:11 fall injuries and 1 traffic injury.The Denis classification of sacrum fracture:4 cases of type II and 8 cases of type III.AO(Tile-Muller)classification:4 cases of type C1.3,8 cases of type C3.3;of the 8 cases of C3.3 fractures,Roy-Camille and Strange-Vognsen classification:2 cases of type II,6 cases of type III.According to the scoring system of Gibbons sacral nerve injury,there were 6 cases of scored 3 and 2 cases of scored 4;4 cases of C1.3 fractures had no nerve injury.The time from injury to operation was 6 to 32 days,with an average of 19.3±9.2 days.After the vital signs were stabilized,laminectomy and decompression of sacral nerve roots,fracture reduction,lumbopelvic fixation and triangular osteosynthesis using sacral ala-ilac screws were performed.The fixation method of the anterior ring was determined according to the injury.The postoperative fracture reduction quality was evaluated according to Matta criteria.The clinical function and neurological function were evaluated according to the Majeed scoring system and Gibbons sacral nerve injury scoring system at the last follow-up.Results Twelve patients were operated smoothly.8 cases of C3.3 fractures were fixed by lumbopelvic fixation,of which 6 cases of U-shaped fractures were fixed by transverse rods due tolongitudinal separation displacement;Four cases of C1.3 used triangular osteosynthesis and transverse fixation in 3 cases with sacroiliac screws,and 1 case with sacral local plate.Six patients with anterior ring injury were fixed with steel plate in 4 cases,INFIX in 1 case a

关 键 词：骶骨 骨折 骨螺丝 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]