骶骨骨折合并骶神经损伤的手术治疗

Surgical treatment of sacral fractures combined with sacral nerve injury

目的:探讨手术治疗骶骨骨折合并骶神经损伤的临床疗效。方法:2002年3月至2009年2月,对21例骶骨骨折合并骶神经损伤患者进行回顾性分析,男15例,女6例;年龄16～60岁,平均36.3岁。致伤原因:车祸伤13例,高处坠落伤5例,挤压伤3例。按Denis分型标准:Ⅰ型5例,Ⅱ型14例,Ⅲ型2例。12例单纯行骶骨骨折经皮重建钢板内固定,9例在内固定后同时行后路骶神经减压术。结果:21例全部获得随访,时间12～48个月,平均19个月。无切口感染、内固定松动及断裂、骨不愈合、明显双下肢不等长发生。9例行骶神经探查减压患者,神经损伤完全恢复4例,部分恢复3例,未恢复2例。12例单纯行骶骨骨折经皮重建钢板内固定患者,神经损伤完全恢复9例,部分恢复2例,未恢复1例。根据Majeed功能评价:优7例,良9例,可4例,差1例。结论:骶骨骨折切开复位内固定可以恢复骶骨的解剖关系,有利于神经损伤的恢复。对伴有明显骨块压迫者适宜行神经探查松解术。

Objective：To explore the clinical effects of surgica1 treatment of sacral fractures combined with sacral nerve injury. Methods：From March 2002 to February 2009,21 patients with sacral fractures combined with sacral nerve injury were retrospectively analyzed. There were 15 males and 6 females,ranging in age from 16 to 60 years with an average of 36.3 years. 13 cases caused by road accident,5 by fall from high and 3 by crush injury. According to classification of Denis,typeⅠwas in 5 cases,typeⅡin 14 and type Ⅲin 2. Among them,12 cases were treated with internal fixation of percutaneous reconstructive plate and 9 cases were treated with above same internal fixation combined with sacral nerve decompression. Results：All patients were followed up from 12 to 48 months with the mean of 19 months. There was no case with infection,loosening or breakage of the screws. All cases obtained bone union and lower limbs length were equal. Nine cases treated by internal fixation combined with sacral nerve decompression,the nerve completely recovered in 4 cases,partially recovered in 3 cases and no recovered in 2 cases. Other 12 cases treated by simple internal fixation,the nerve completely recovered in 9 cases,partially recovered in 2 cases and no recovered in 1 case. According to the Majeed standards,7 cases got excellent result,9 good,4 fair,1 poor. Conclusion：Open reduction and internal fixation can make accurate reduction of the sacral fractures,which can promote the recovery of nerve injury. Nerve decompression is suitable for sacral fractures combined with compression by fragment obviously.