创伤性脊柱骨盆分离的治疗进展  

Research progress in the treatment of traumatic spinopelvic dissociation

作　　者：戚浩天 贾健[1] Qi Haotian;Jia Jian(Department of Plevic Trauma,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院骨盆科,天津300211

出　　处：《中华骨科杂志》2022年第18期1242-1248,共7页Chinese Journal of Orthopaedics

基　　金：天津市卫生健康委科技人才培育项目 (RC20203)。

摘　　要：创伤性脊柱骨盆分离是创伤所致骨盆和脊柱解剖学上的完全分离,特点为骶骨两侧纵行骨折线伴横形骨折,为多平面不稳定骨折,多见于高能暴力损伤,合并伤多,骶神经损伤发生率高,处理不当易导致骨折再移位、疼痛性畸形愈合、继发性神经损伤、功能障碍等不良后果。创伤性脊柱骨盆分离手术治疗的难点在于骨折复位与固定方式,其中骨折复位方式是采用切开复位还是闭合微创复位、内固定采用单纯骶髂螺钉或钢板或髂腰固定或三角固定,以及骶神经损伤是否需直接减压处理仍存在争议。随着对脊柱骨盆分离损伤认识的提高及闭合微创复位技术的临床应用,微创骶髂螺钉、髂腰固定、三角固定越来越多地应用于临床治疗中,术后伤口并发症明显降低,患者功能预后良好,骨折复位后损伤的骶神经间接减压有助于神经功能恢复,但对骨折移位大伴骶管狭窄、骨折断端或游离骨块卡压神经时需行椎板切除直接减压手术。Traumatic spinopelvic dissociation is trauma-induced complete separation of the pelvis and spine anatomy.It is characterized by longitudinal fracture lines on both sides of the sacral bone with transverse fractures,multiplane unstable fractures,more common in high-energy violent injury,more combined injuries,high incidence of sacral nerve injury,improper treatment can easily lead to fracture re-displacement,painful deformity healing,secondary nerve injury,dysfunction and other adverse consequences.The difficulty in the surgical treatment of traumatic spinopelvic dissociation lies in the reduction and fixation of fractures.Among them,it is still controversial whether the reduction method of fracture should be open reduction or closed minimally invasive reduction,the internal fixation should be simple sacroiliac screw or plate,iliolumbar fixation or triangular fixation,and whether the sacral nerve injury needs direct decompression.With the improvement of the understanding of spinopelvic dissociation injuries and clinical application of closed minimally invasive reduction technology,minimally invasive sacroiliac screws,iliolumbar fixation,and triangular fixation are increasingly used in clinical treatment,postoperative wound complications are significantly reduced,patient function prognosis is good,indirect decompression of the injured sacral nerve after fracture reduction helps to restore nerve function,but when the fracture displacement is large with a narrow sacral canal and the nerve is compressed by the fracture or free bone mass,direct decompression by laminectomy is recommended.

关 键 词：骨折复位 骨折断端 减压手术 畸形愈合 不稳定骨折 横形骨折 纵行骨折 疼痛性 

分 类 号：R687.3[医药卫生—骨科学]