骶髂关节脱位合并同侧骶骨翼骨折的手术方法及临床疗效评价  

To evaluate clinical efficacy and surgical methods of sacroiliac joint dislocation with ipsilateral sacrosacral wing fracture

作　　者：唐毓金[1] 杨成亮 刘佳[1] 王华 李涛 麦奇光 樊仕才 Tang Yujin;Yang Chengliang;Liu Jia;Wang Hua;Mai Qiguang;Li Tao;Fan Shicai(Department of Orthopedics,Affiliated Hospital of Youjiang Medical University for Nationalities,Guangxi Key Laboratory of basic and translational research of Bone and Joint Degenerative Diseases,Guangxi Biomedical Materials Engineering Research Center for Bone and Joint Degenerative Diseases,Baise 533000,China;Department of Traumatic Surgery,Center for Orthopaedic Surgery,The Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China)

机构地区：[1]右江民族医学院附属医院骨科,广西骨与关节退行性疾病基础研究与转化重点实验室,广西骨与关节退行性疾病生物医用材料工程研究中心,百色533000 [2]南方医科大学第三附属医院骨科医学中心创伤骨科,广州510630

出　　处：《中华骨科杂志》2021年第23期1692-1700,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82072411,81772428);广西科技计划项目(2018GXNSFAA294116,2018GXNSFAA138074,2018GXNSAA294091);广西重点研发项目(桂科AB18050008)。

摘　　要：目的探讨骶髂关节脱位合并同侧骶骨翼骨折经腹直肌外侧入路(lateral-rectus approach,LRA)显露、骨折复位固定、神经探查减压的手术方法,并评价其临床疗效。方法回顾性分析2016年1月至2019年7月采用LRA显露,骶骨翼骨折及骶髂关节脱位复位、固定,腰骶干神经探查、减压松解(合并腰骶干神经损伤者)治疗12例骶髂关节脱位合并同侧骶骨翼骨折患者资料,其中男3例,女9例;年龄(34.35±16.32)岁(范围13~58岁);伤后至手术时间(29.25±25.49)d(范围7~96 d)。骨盆骨折Tile分型:C1.3型7例,C2型1例,C3型4例;8例合并同侧或双侧腰骶干神经损伤;神经损伤分级:完全损伤6例,部分损伤2例;伤后至手术时间:<1周1例,1~2周2例,2~3周4例,>3周5例。手术经LRA腹膜外显露骶髂关节周围,复位骶骨骨折、骶髂关节脱位,对于合并腰骶干神经损伤患者同时行腰骶干神经减压松解,骶髂螺钉固定或紧贴骨面放置钢板跨骶髂关节固定后环。结果12例患者均顺利完成手术,手术时间(172.08±36.83)min(范围105~230 min);术中出血量为(981.67±369.44)ml(范围400~1700 ml);术后复查X线、CT示骨折复位固定好。12例均获得随访,随访时间(43.54±13.36)个月(范围12~72个月),骶骨骨折均愈合,愈合时间(7.71±3.38)周(范围6~12周),无骨折复位丢失、内固定失效等并发症出现;术后1年复查时,8例出现腰骶干神经损害表现者中症状完全恢复6例,1例部分恢复,另1例术中未行神经探查,术后1年复查无恢复。1例合并膀胱造瘘患者术后出现切口脂肪液化,无其他手术相关并发症。结论LRA能较好地显露一侧骶骨翼、骶髂关节至耻骨联合半骨盆环内侧面,能直视下前方松解牵拉及受卡压的腰骶干神经,结合下肢牵引可达到骨折的满意复位,骶髂螺钉固定或跨骶髂关节钢板固定能达到较好的后环固定效果,是治疗骶髂关节脱位合并同侧骶骨翼骨折、腰骶干神经损伤的一种理Objective To investigate the surgical methods of sacroiliac joint dislocation with ipsilateral sacrosacral wing fracture through the lateral-rectus approach(LRA)for exposure,fracture reduction and fixation,and nerve exploration and decompression,and to evaluate its clinical efficacy.Methods Data of 12 patients with sacroiliac joint dislocation and ipsilateral sacral wing fracture treated with LRA for exposure,reduction and fixation of sacroiliac wing fracture and sacroiliac joint dislocation,lumbosacral trunk nerve exploration and decompression(combined with lumbosacral trunk nerve injury)were retrospectively analyzed from January 2016 to July 2019.They were 3 males and 9 females,aged 34.35±16.32 years(13-58 years).The time from injury to operation was 29.25±25.49 d(7-96 d).By the Tile classification,there were 7 cases of type C1.3,1 case of type C2,4 cases of type C3.Among them,8 cases were combined with ipsilateral or bilateral lumbosacral nerve injury.The grade of nerve injury:6 cases of complete injury and 2 cases of partial injury.Interval time from injury to surgery:less than 1 week:1 case,1-2 weeks:2 cases,2-3 weeks:4 cases,>3 weeks:5 cases.Surgery was performed through LRA,the sacroiliac joint was exposed outside the peritoneum,and the sacral fracture and sacroiliac joint dislocation were reduced.At the same time,the lumbosacral nerve was decompressed and loosened for patients with lumbosacral nerve injury.Then the posterior ring was fixed with a sacroiliac screw or a transsacroiliac joint plate attached to the bony surface.Results All the 12 cases underwent the operation successfully.The average surgical time was 172.08±36.8 min(range,105-230 min)and the mean blood loss was 981.67±369.44 ml(range,400-1700 ml).Postoperative X-ray and CT indicated an excellent reduction of fracture.One patient with bladder dysplasia had wound fat liquefaction after operation,and no other surgery-related complications.During the follow-up period of 12-72 months,all sacral fractures healed,and the healing time was 7.7±3

关 键 词：骶髂关节 骶骨 骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]