微创可调式接骨板联合前环撑开复位治疗新鲜骶骨DenisⅡB型骨折合并骶神经损伤的疗效分析  

Minimally invasive adjustable plate and anterior ring distraction reduction for fresh Denis typeⅡB sacral fracture with sacral nerve injury

作　　者：樊仕才 侯志勇[2] 陈伟[2] 麦奇光 李涛 朱振华 张英泽[2] Fan Shicai;Hou Zhiyong;Chen Wei;Mai Qiguang;Li Tao;Zhu Zhenhua;Zhang Yingze(Department of Traumatic Surgery,Center for Orthopaedic Surgery,The Third Hospital Affiliated to Southern Medical University,Guangzhou 510630,China;Trauma Emergency Center,The Third Hospital of Hebei Medical University,Orthopaedic Research Institution of Hebei Province,Shijiazhuang 050051,China)

机构地区：[1]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 [2]河北医科大学第三医院创伤急救中心,石家庄050051

出　　处：《中华创伤骨科杂志》2022年第3期213-218,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(82072411,81772428)。

摘　　要：目的探讨微创可调式接骨板联合微创经皮骨盆前环内固定术(INFIX)撑开复位治疗新鲜骶骨DenisⅡB型骨折合并骶神经损伤的手术方法,并评价其临床疗效。方法回顾性分析2017年6月至2020年6月期间南方医科大学第三附属医院骨科医学中心创伤骨科和河北医科大学第三医院创伤急救中心收治的12例新鲜骶骨DenisⅡB型骨折患者资料。男8例,女4例;平均年龄为30岁(16~44岁)。术前影像学表现为骶骨DenisⅡB型骨折,腰骶丛磁共振神经成像检查均有骶孔处骶神经根损伤。12例患者伤后均有患侧S1神经根损伤症状:M0级9例,M1级3例。受伤至手术时间平均为11 d(5~19 d)。行INFIX联合微创可调式接骨板撑开压缩的骶骨骨折并固定。术后评估患者的骨折复位质量及骶神经功能恢复情况。结果根据Lindahl等提出的标准评估骨折复位质量:优8例,良2例,可2例。12例患者术后获平均20个月(12~36个月)随访,骶骨骨折均获愈合,愈合时间平均为6周(5~8周)。术后1年随访时根据英国医学研究会神经损伤委员会提出的肌力评价标准评定术后肌力恢复情况:10例完全恢复,2例部分恢复。结论新鲜骶骨DenisⅡB型骨折应用微创可调式接骨板联合INFIX撑开,可有效撑开骶骨压缩骨折,扩大骶神经前孔并间接减压骶神经,临床疗效良好。Objective To explore the surgical techniques and clinical effects of minimally invasive adjustable plate(MIAP)together with distraction reduction by minimally invasive anterior pelvic ring internal fixator(INFIX)in the treatment of fresh Denis typeⅡB sacral fracture with sacral nerve injury.Methods From June 2017 to June 2020,12 fresh Denis typeⅡB sacral fractures were treated by anterior-posterior distraction reduction and fixation with MIAP and INFIX.There were 8 males and 4 females,with an average age of 30 years(from 16 to 44 years).Preoperatively,imaging found DenisⅡB fracture of the sacrum and magnetic resonance neurography of the lumbosacral plexus showed injury to the sacral nerve root at the sacral foramen.All patients had symptoms of S1 nerve root injury on the affected side after injury,with 9 cases of grade M0 and 3 cases of grade M1.The time from injury to operation averaged 11 days(from 5 to 19 days).INFIX combined with MIAP was used to distract and fixate the compressed sacral fracture.The quality of fracture reduction and recovery of sacral nerve function were evaluated postoperatively.Results According to the criteria proposed by Lindahl et al.,the quality of fracture reduction was excellent in 8 cases,good in 2 and fair in 2.The 12 cases were followed up for an average of 20 months(from 12 to 36 months).All sacral fractures got united after an average of 6 weeks(from 5 to 8 months).At one-year follow-up,according to the criteria proposed by the Nerve Injuries Committee of the British Medical Research Council,the postoperative muscle strength recovery was evaluated as complete recovery in 10 cases and as partial recovery in 2 cases.Conclusion In the treatment of fresh Denis typeⅡB sacral fracture,MIAP combined with INFIX can obtain satisfactory clinical effects because the compressed sacrum can be effectively distracted,the sacral foramen be expanded and the sacral nerve be decompressed indirectly.

关 键 词：骶骨 骨折 骶神经 创伤和损伤 骨板 内固定器 外科手术 微创性 撑开复位 

分 类 号：R687.3[医药卫生—骨科学]