骶管减压联合腰椎-骨盆固定术治疗创伤性骶骨骨折合并脊柱-骨盆分离疗效分析

    Effect of the sacral canal decompression combined with lumbar-pelvic fixation in the treatment of traumatic sacral fractures complicated with spine-pelvic separation

    • 摘要:
      目的探讨骶管减压联合腰椎-骨盆固定术治疗创伤性骶骨骨折合并脊柱-骨盆分离的临床疗效。
      方法收集创伤性骶骨骨折合并脊柱-骨盆分离病人16例,骨折分型Denis Ⅲ型,采用骶管减压联合腰椎-骨盆固定术治疗,并随访2年以上,记录病人手术前后相关指标,比较术前、末次随访神经功能Gibbons评分,参照Majeed功能评分评价综合疗效,并记录并发症发生情况。
      结果所有病人均顺利完成手术,手术耗时(172.34±43.23)min,出血量(670.98±98.34)mL,住院时间(25.76±6.45)d,骨折愈合时间(4.21±0.43)个月。病人末次随访时Gibbons评分较术前明显降低(P < 0.01),Majeed评分明显升高(P < 0.01);末次随访Majeed评分综合疗效优7例,良4例,可4例,差1例,优良率68.75%(11/16);术后切口感染2例,压疮1例,均无钢板、连接杆断裂、骨折再移位等严重并发症出现。
      结论骶管减压联合腰椎-骨盆固定术能重建创伤性骶骨骨折合并脊柱-骨盆分离病人骨盆环及脊柱稳定性,改善术后神经功能及活动功能。

       

      Abstract:
      ObjectiveTo investigate the effects of the sacral canal decompression combined with lumbar-pelvic fixation in the treatment of traumatic sacral fractures complicated with spine-pelvic separation.
      MethodsSixteen patients with traumatic sacral fractures(Denis type Ⅲ) complicated with spine-pelvic separation were treated with sacral canal decompression combined with lumbar-pelvic fixation, and followed up for more than 2 years.The relative indexes of patients before and after the operation were recorded.The neurological Gibbons scores of patients were compared between before operation and last follow-up.The comprehensive efficacy was evaluated according to the Majeed functional score, and the complication was recorded.
      ResultsThe operations of all patients were successfully completed.The time of operation, blood loss, hospital stay and time of fracture healing of patients were (172.34±43.23)min, (670.98±98.34)mL, (25.76±6.45)d and (4.21±0.43) months, respectively.Compared with before operation, the last follow-up Gibbons score and Majeed score of patients significantly decreased and increased, respectively(P < 0.01).The results of the last follow-up showed the excellent in 7 cases, good in 4cases, fair in 4 cases and poor in 1 case, and the good rate of which was 68.75%.The postoperative incision infection in 2 cases, hemorrhoids in 1 case, and no serious complications, such as steel plate, connecting rod fracture, fracture and displacement, were found.
      ConclusionsThe sacral canal decompression combined with lumbar-pelvic fixation can reconstruct the pelvic ring and spinal stability, and improve the postoperative neurological function and activity in patients with traumatic sacral fractures complicated with spine-pelvic separation.

       

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