骶管减压腰髂固定后外侧植骨融合治疗Denis Ⅲ型骶骨骨折伴腰盆分离

The clinical outcome of sacral decompression lumbopelvic fixation and posterior lateral bone fusion for Denis type-Ⅲ sacral fracture with spinopelvic dissociation

中文关键词:  Denis Ⅲ型骶骨骨折  腰盆分离  减压  腰髂固定  疗效

英文关键词:Department of Spine Surgery, Xi′an Red Cross Hospital, Xi′an, 710054, China

中文摘要:

  【摘要】 目的：探讨Denis Ⅲ型骶骨骨折伴腰盆分离的外科治疗方法。方法：2009年1月～2011年1月，我院共收治骶骨骨折患者87例，其中Denis Ⅲ型骶骨骨折伴腰盆分离患者15例，男9例，女6例，年龄18～51岁，平均32．7岁。致伤原因：坠落伤8例，车祸伤5例，挤压伤2例。患者均有明显的骶神经根损伤症状，依据Gibbons标准：3型6例，4型9例。均行后路手术复位、骶管减压、探查松解神经、腰髂固定、后外侧植骨融合术。记录围手术期并发症，观察骨折复位情况和植骨愈合情况，应用Gibbons标准评分评定患者神经功能改善情况。结果：手术时间120～190min，平均160min；术中出血量780～1200ml，平均840ml。术中无相关并发症。术后1例患者出现创面浅表感染，给予及时清创及敏感抗生素治疗后治愈。所有患者均获得随访，随访时间8～24个月，平均16个月，术后6个月骨折均获得骨性愈合，无残留骨盆畸形及假关节形成。无骨折再移位、深部感染等并发症。11例神经功能完全恢复；3例明显改善，但遗留足下垂及下肢感觉减退；1例略有改善，除遗留下肢功能障碍外，尚有膀胱、直肠功能障碍。Gibbons评分由术前的平均3.80±0.78分恢复至末次随访时的1.49±0.81分。1例术后9个月内固定断裂，患者无明显临床症状，复查X线片和三维CT提示植骨融合，取出内固定；1例术后1年复查X线片提示S1椎体螺钉松动，患者无临床症状，未予处理。结论：后路手术复位、骶管减压、腰髂固定、后外侧植骨融合可以恢复腰骶复合体的解剖关系，重建腰骶段稳定性，有利于神经损伤的恢复，是治疗Denis Ⅲ型骶骨骨折伴腰盆分离的有效方法。

英文摘要:

  【Abstract】 Objectives: To evaluate the outcomes of surgical treatment for Denis type-Ⅲ sacral fracture with spinopslvic dissociation. Methods: From Juanuary 2009 to Juanuary 2011, 87 cases suffered from sacral fracture were therapied in our hospital, 15 cases in which were diagnosed as Denis type-Ⅲ sacral fracture with spinopslvic dissociation. There were 9 males and 6 females, with an average age of 32.7 years old, ranged from 18 to 51 years old. The causes of injury included fall injury in 8 cases, traffic accident injury in 5 cases, and crush injury in 2 cases. All of them combined with neurologically impairment. According to the Gibbons′ criteria, there were type 3 in 6 cases, and type 4 in 9 cases. All cases underwent open reduction, sacral decompression, lumbopelvic fixation and posterior lateral bone fusion. Neurological outcome was measured by Gibbons′ criteria． The perioperative complications were recorded. The reduction of dislocation and bone fusion were assessed. Results: The mean operation time was 160min(range 120-190min), and the mean blood loss was 840ml(range 780-1200ml). There was no major intraoperative complication. One case diagnosed as superficial infection of incision healed with prompt surgical debridement and sensitive antibiotics. All cases were followed up on an average of 16 months(ranged from 8 to 24m)． All cases got reduction and bone fusion without pelvic malformation or pseudarthrosis 6 months after operation． There were no deep infections and re-displacement of fractures. Neurological functions were fully recovered in 11 cases, sgnificant improvement in 3 cases with foot-drop and hypesthesia of lower extremity, poor recovered in 1 case with bladder and bowel dysfunction expect for dysfunction of lower extremity. The average Gibbons′ score recovered from 3.80±0.78 to 1.49±0.81 at the last follow-up. One case without clinical symptom was found internal fixation failure 9 months after operation, and found with bone fusion by the examination of X-ray and 3-D CT. One case without clinical symptom was found with S1 screw loosening by the examination of X-ray 1 year after operation. Conclusions: Open reduction，sacral decompression, lumbopelvic fixation and posterior lateral bone fusion can get reduction of the lumbosacral complex, which can promote the recovery of nerve injury． It is an effective method for Denis type-Ⅲ sacral farcture with spinopelvic dissociation．