前后联合入路微创治疗合并神经损伤的不稳定骶骨骨折

Less Invasive Surgical Treatment of Unstable Sacral Fracture Accompanied by Neurological Damage with LCP Through Anterior and Posterior Approach

目的:探讨前后联合入路锁定加压钢板(LCP)微创治疗合并神经损伤的骶骨不稳定骨折的效果。方法:前后联合入路按照杜明奎等方法[1]采用LCP固定治疗合并神经损伤的不稳定骶骨骨折患者5例:L5神经根损伤2例,骶丛神经损伤3例。前方入路暴露骨盆前环重建钢板固定,后方入路经皮下锁定加压钢板骨折复位固定术,椎管探查减压以MRI显示有无神经压迫为据。结果:5例均获随访,时间3～20(14.8±7.2)个月。2例L5神经根损伤和3例骶丛神经损伤者Frankel分级由C级恢复至E级,术后功能根据Matta评分标准评定:优3例,良2例。结论:前后联合入路LCP微创治疗合并神经损伤的骶骨不稳定骨折是一种简单微创有效的方法,值得临床推广。

Objective： To investigate the less invasive surgical treatment of unstable sacral fracture accompanied by neurological damage with LCP through anterior and posterior approach.Methods： 5 cases of unstable sacral fracture accompanied by neurological damage were treated with LCP through Du＇s approach（anterior and posterior approach.） and 2 cases were L5 nerve root damage and 3 cases were sacral plexus damage.Reconstruction plate fixation of anterior pelvic ring was performed through anterior approach,LCP internal fixation was performed through posterior approach and decompression of spinal canal was related to the nerve compression by MRI.Results： All the 5 cases were followed up from 3-20 months（average 14.8 ±7.2 months）.Frankel score method was used to evaluate the therapeutic effect and 2 cases with L5 nerve root damage and 3 cases with sacral plexus damage recovered from C grade to E grade and post operation function was evaluated by Matta score： 3 cases were excellent,2 cases were good.Conclusion： Treatment of unstable sacral fracture accompanied by neurological damage with LCP fixation through anterior and posterior approach was effective and was deserved to be explored.