骶骨骨折的外科治疗

Surgical treatment of sacral fractures

目的：探讨骶骨骨折的外科治疗方法和疗效。方法：对36例骶骨骨折病例作回顾分析，根据Denis骶骨骨折分类法，Ⅰ型15例，Ⅱ型16例，Ⅲ型5例。Ⅰ型骨折中2例伴有L4或L5神经根损伤，1例L4、L5神经根损伤。Ⅱ型12例伴有S1、S2神经根损伤。Ⅲ型3例单侧S1、S2神经根损伤，2例双侧S1、S2神经根及马尾神经损伤。Ⅰ型骨折15例予保守治疗，Ⅱ、Ⅲ型骨折21例均予手术治疗，其中8例无神经损伤或损伤轻微者单纯行骶骨骨折切开复位内固定术，13例伴有严重神经损伤者，予骨折切开复位内固定加神经探查松解术。结果：随访6～36个月，36例骶骨骨折均愈合，神经损伤均有不同程度恢复。3例Ⅰ型，10例Ⅱ型，3例Ⅲ型神经症状完全恢复，2例Ⅱ型残留骶神经损伤症状，2例Ⅲ型残留鞍区感觉减退、排尿乏力及性功能减退等症状。结论：骶骨骨折的治疗方案应取决于骨折类型及骶神经损伤程度。Ⅰ型骶骨骨折保守治疗效果满意，Ⅱ、Ⅲ型骶骨骨折需切复内固定手术，有严重骶神经损伤者需神经探查松解术。

Objective： To study the methods and therapeutic effects of surgical treatment for sacral fracture. Methods： Thirty-six patients with sacral fracture were reviewed in the study. According to Denis＇ classification of sacral fracture,there were 15 patients of Type Ⅰ , 16 of Type Ⅱ and 5 of Type Ⅲ. Among 15 patients of Type Ⅰ ,2 patients were accompanied with nerve root injuries at L4 or L5 ,and 1 patient with nerve root injuries at L4.5. Among 16 patients of Type Ⅱ, 12 patients were accompanied with nerve root injuries at S1.2. Within 5 patines of Type Ⅲ ,3 patients were accompanied with nerve root injuries at S1.2 of single side, and 2 patients with S1.2 of double sides as well as cauda equina nerve injuries. Fifteen patients of Type Ⅰ were treated with conservative methods. Among 21 patients of Type Ⅱ andⅢ who were treated with operation,8 patients without nerve injuries or with slight injuries were treated with internal fixation, and other 13 patients with severe nerve injuries were treated with internal fixation combined with endoneurolysis. Results： During the following-up time ranging from 6 to 36 months, all the patients attained bone healing and recovery of nerve function to different degrees. Nerve functions recovered completely in 3 cases of Type Ⅰ , 10 cases of Type Ⅱ and 3 cases of Type Ⅲ. The symptoms such as hypoesthesia, acraturesis and sexual disorder were found in 2 patients of Type Ⅱ. Conclusion： Treatment project of the sacral fracture should be selected based on the Type of fracture and the injury degrees of nerve. Conservative treatment usually achieves satisfactory results in Type Ⅰ. Internal fixation should be done in Type Ⅱ and Ⅲ actively. The endoneurolysis is necessary for those patients with severe sacral nerve injuries.