髂骨钉在腰骶骨盆重建中的临床应用

Clinical application of iliac nail for the treatment of lumbosacral and pelvis reconstruction

目的:观察髂骨钉在腰骶骨盆重建中的临床应用效果。方法:2004年1月至2010年2月,收治10例患者,其中L5S1椎体结核5例,骶骨骨巨细胞瘤2例,重度骨质疏松合并腰骶椎滑脱3例;男4例,女6例;年龄25～75岁,平均46.5岁。术前主要表现腰痛,腰部活动受限及排便困难等,应用髂骨钉及腰骶椎弓根钉技术进行腰骶骨盆重建,疗效评定采用Nakai评分标准,骨性融合情况采用Suk标准判断。结果:所有患者手术顺利,术中无大血管损伤,术后均按时拆线,手术切口Ⅰ期愈合。均获得随访,时间18～36个月,平均24个月。术后无双下肢感觉、运动减退,无脊髓损伤加重等并发症,均恢复正常负重及行走。按Nakai评定标准:优7例,良2例,中1例。植骨全部骨性融合,融合时间平均为3.5个月。结论:通过髂骨钉的应用使腰椎与骨盆间达到坚强的内固定,有效的解决了因腰骶部病变需要固定的难题。具有出血量及手术时间明显减少等优点,是较为理想的手术方法。

Objective：To observe the therapeutic effects of iliac nail in the treatment of lumbar sacral and pelvis reconstruction. Methods：Form January 2004 to February 2010,10 patients（4 males and 6 females,ranging age from 25 to 75 years,with an average of 46.5 years ） were treated. Among the patients,5 cases were L5S1 vertebral tuberculosis,2 cases were sacral giant-cell tumors and 3 cases were severe osteoporosis combined with lumbar sacral slipping. The main symptoms manifested low back pain,limited activity and dysphasia before treatment. Iliac nail and lumbar-sacral pedicle screw were used for reconstruction of lumbar-sacral spine and pelvis. Nakai scale was used to evaluate therapeutic effects,Suk scale for osseous fusion. Results：All operations were succeful,obtained primary healing. All the patients were followed up,and the mean time of follow-up was 24 months（ranged from 18 to 36 months）. The complications,such as weakness and decreased sensation of lower libs and activity,increased spinal cord injury,were not occurred after operation. According to Nakai scale,7 cases got excellent result,2 good and 1 fair. All bone graft were bony fusion with an average time of 3.5 months. Conclusion：Iliac nail can fixed well between lumbar vertebra and pelvis and solve the problem of fixation due to pathological changes of lumbosacral region. It is an ideal method of less blood loss and operating time.