Denis Ⅲ型骶骨骨折合并神经损伤的外科治疗

Surgical Treatment of Dennis Ⅲ Type Sacral Fracture Complicated with Neurological Deficit

目的探讨髂骨螺钉联合椎弓根螺钉重建骨盆环的稳定性治疗Denis Ⅲ型骶骨骨折合并神经损伤。方法回顾性分析自2002年2月至2006年3月期间来我院治疗的14例Denis Ⅲ型骶骨骨折合并神经损伤的患者,所有患者均为外伤所致,其中车祸伤6例,坠落伤4例,重物压伤4例。在该组患者中,9例仅伴有坐骨神经损伤,而不伴有马尾神经损伤的症状,另外5例既有坐骨神经损伤,也有马尾神经损伤的临床表现。所有患者均采用后路减压,髂骨螺钉联合椎弓根螺钉重建骨盆环稳定性,术前术后以及随访时按照Majeed骨盆骨折评价标准进行评分。结果14例患者中,男9例,女5例,年龄23～48岁,平均37岁。随访时间12～52个月,平均35个月。所有14例患者均重新获得了骨性愈合,在合并有马尾神经损伤的5例患者中,有3例完全恢复正常,Majeed评分大于85分;另外2例获得部分恢复,Majeed评分分别为71分和78分;在9例仅伴有坐骨神经损伤的患者中,有7例完全恢复正常,Majeed评分大于85分;另外2例仅获得部分恢复,Majeed评分分别为67分和64分。结论对于骨盆稳定性受到破坏,合并有神经受损的De-nis型骶骨骨折,应在神经探查的同时采用髂骨螺钉联合椎弓根螺钉重建骨盆的稳定性,能保留骶髂关节的功能,获得优良的预后。

Objective To discuss the surgical treatment of DennisⅢ type sacrum fracture complicated with neu rological deficit by iliac＇pedicle instrumentation. Methods A total of 14 cases （9 males and 5 females,with the average age of 37 years old） with Dennis Ⅲ type sacrum fracture complicated with neurological deficit duo to injury from Feb 2002 to March 2006 were reviewed retrospectively. Of these patients, 6 cases were subjected from traffic accident, 4 cases from downfall injury and 4 cases from crush injury. 9 cases had the clinical symptom of only sciatic nerve deficit while the other 5 cases demonstrated both sciatic nerve and saddle parenthesia after injury. All cases were followed by surgical treatment of posterior decompression and pelvic ring reconstruction by iliac pedicle combined with lumbar pedicle screw instrument. Majeed pelvic scoring system was used to evaluate the pre and postsurgical status of each patients. Results All cases were followed for an average of 35 months （range,12-52 months）,bony fusion was evidenced rediographically at final follow-up. Of 5 cases with saddle parenthesia, 3 cases recovered completely with the final Majeed〉85,while the other 2 cases only got partial recovery with Majeed of 71 and 78 respectively;of 9 cases with only sciatic nerve deficit, 7 cases got completely recovery with Majeed〉 85,while the other 2 cases got partial recovery with Majeed of 67 and 64 respectively. Conclusion For those with Dennis Ⅲ type sacrum fracture complicated with neurological deficit,posterior decompression and pelvic ring reconstruction by iliac pedicle combined with lumbar pedicle screw instrument can maintain the sacroiliac joint as well as a good outcome.