应用椎弓根系统经腰-髂间固定治疗骶骨骨折

TREATMENT OF SACRAL FRACTURES WITH PEDICAL SCREW SYSTEMS FIXED BETWEEN LUMBAR AND ILIUM

目的评价应用椎弓根系统经腰-髂间固定治疗骶骨骨折的临床效果。方法2003年6月-2009年6月,对21例29侧骶骨骨折患者采用椎弓根系统经腰-髂间行骨折复位和固定治疗。男12例,女9例;年龄23～59岁,平均38.2岁。致伤原因:交通事故伤12例,高处坠落伤7例,挤压伤2例。其中单侧13例,双侧8例。术前伤侧骨盆较对侧上移(16.29±6.47)mm。术中对1例合并S1神经根及3例合并双侧S2、3神经根损伤的患者同时行骶管减压,12例合并骨盆前环损伤或髋臼骨折的患者同时行前环或髋臼骨折复位固定。结果术后患者切口均Ⅰ期愈合,无感染等并发症发生。患者均获随访,随访时间6个月～6年,平均3年6个月。骨折于术后6～9周达临床愈合。术前1例合并S1神经根损伤者,术后9周伸肌肌力恢复正常;3例合并双侧S2、3损伤者,术后4～6周二便和勃起功能恢复;余17例术后下肢均无神经功能损害。患者均于术后6～12周恢复正常行走,均能下蹲。无内固定断裂或移位发生。术后伤侧骨盆较对侧上移(3.51±0.68)mm,与术前比较差异有统计学意义(P<0.01)。结论应用椎弓根系统经腰-髂间固定治疗骶骨骨折,是一种可供选择的方法,但应严格把握手术适应证和掌握手术技巧,避免并发症发生。

Objective To evaluate the clinical effect of pedical screw systems fixed between lumbar and ilium for treatment of sacral fractures. Methods From June 2003 to June 2009,21 cases of sacral fracture （29 sides including monolateral 13 cases and bilateral 8 cases） were treated with pedical screw systems to have reduction and fixation. There were 12 males and 9 females,aging 23-59 years （38.2 years on average）. Fractue was caused by traffic accident in 12 cases,by falling from height in 7 cases,and by crash in 2 cases. Screws were inserted into lumbar pedicles and iliac crests. Decompression was used in 4 cases complicated by sacral nerves injury,and reductions and fi xations were used in 12 cases complicated anterior pelvic or acetabulum injury. The preoperative proximal displacement at the injured side of the pelvis was （16.29 ± 6.47） mm compared with contralateral pelvis. Results All incisions healed primarily with no complication of infection. Twenty-one patients were followed up 6 months to 6 years. Clinical healing time of fracture was 6-9 weeks. In 4 cases complicated by S1 or S2,3 nerves injury,the function recovered completely after 4-9 weeks. In other 17 patients,no complication of intra-operative nerve injury occurred. All patients could walk and squat after 6-12 weeks of operation. No breakage or displacement of implant occurred. The postoperative proximal displacement at the injured side of the pelvis was （3.51 ± 0.68） mm compared with contralateral pelvis,showing significant difference （P 〈0.01） when compared with preoperative one. Conclusion It is a novel choice to have reduction and internal fixation for sacral fracture with pedical screw systems fixed between lumbar and ilium. The strict regulation of indication and skill is the key to prevent complication.