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

English Keywords:Department of Spine Surgery, Xi′an Red Cross Hospital, Xi′an, 710054, China

English Abstract:

  【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．