腰骶髂联合固定治疗骶髂关节骨折脱位的疗效分析

Clinical outcomes of the combined lumb-sacro-iliac fixation in treatment of sacroiliac joint fractures and dislocation

目的探讨应用腰骶髂联合固定治疗骶髂关节骨折脱位的临床效果。方法对2007年7月~2010年1月收治的11例骶髂关节骨折脱位的骨盆骨折患者进行手术治疗。男6例,女5例;年龄21~60岁,平均36岁。11例均为Tile C型骨盆骨折。采用后路腰骶髂切口,椎弓根钉棒系统固定L5∕S1椎体和髂骨螺钉固定髂骨,配合患肢牵引和器械的撑开、合拢纠正垂直及分离移位。结果 11例患者术后获得12~20个月随访,平均16.5个月。术后X线片均示骶髂关节骨折脱位复位固定满意,骨盆后环形态恢复良好;下肢等长,未出现医源性神经、血管损伤,患者未出现跛行,下蹲功能满意。术后12个月Majeed评分：优9例,良2例。结论腰骶髂联合固定治疗骶髂关节骨折脱位疗效满意,且具有操作简单、并发症少的优点。

Objective To evaluate the clinical outcomes of the combined lumb-sacro-iliac fixation in treatment of sacroiliac joint fractures and dislocation.Methods From Jul 2007 to Jan 2010,11 patients（6 males and 5 females） with sacroiliac joint fractures and dislocation were treated with operation combined lumb-sacro-iliac fixation.According to the classification of Tile,11 patients were classified as type C.This fixation combined a posterior pedicle screw system which fixed L5∕S1 with a ilium screw which fixed the posterior iliac spine after replacement by drafting affected leg and bracing or rejoining the screw.Results All 11 patients were followed up 12~20 months after surgery,with an average of 16.5 months.Postoperative X-ray showed satisfactory reduction of sacroiliac joint fractures and dislocation.No iatrogenic complications of neurovascular injury occurred.Patients now walk unassistedly without pain in the waist or legs,and with no shortening of lower limbs or claudication.By considering symptom and satisfactory scores,the Majeed functional assessment revealed that patients had 9 excellent and 2 good at 12 months after surgery.Conclusion The combined lumb-sacro-iliac fixation allowed early mobilization and ambulation,with general applicability and definite safety,is an effective surgical technique for the treatment of sacroiliac joint fractures and dislocation.