骨盆指数在评价骶骨骨折矢状面成角畸形中的应用价值和临床意义

The application value and clinical significance of pelvic incidence in evaluating angulation deformity on sagital plane of sacral fractures

[目的]探讨骨盆指数在评价骶骨"U"形骨折和"H"形骨折矢状面成角畸形中的应用价值。[方法]回顾性分析自2007年5月～2009年5月收治的23例骶骨"U"形骨折或"H"形骨折患者的影像资料和治疗结果。本组骶骨"U"形骨折14例;"H"形骨折9例。其中屈曲型骨折15例;中立位骨折5例;伸展型骨折3例。全组患者均行髂腰内固定治疗。术后随访平均34.4个月。此间对患者术前和术后的放射影像行骨盆指数和骶骨成角畸形的计算机测量。[结果](1)屈曲型骶骨骨折的术后PI由术前76.3°±7.0°改善至58.1°±7.5°(P<0.05);术后成角畸形由术前33.5°±7.1°改善至12.7°±4.3°(P<0.05)。手术前后PI差值与成角畸形差值呈正相关(P<0.05);(2)术后JOA评分平均19.4分。其中术后PI>62°者,JOA评分平均16.7分;PI<62°者,JOA评分平均23.3分;(3)术后PI与JOA评分呈负相关(r=-0.880,P<0.05)。[结论]PI可用于测量骶骨骨折矢状面的成角畸形改变,并据此推测患者的功能预后。

[Objective]To explore the application value of pelvic incidence in evaluating angulation deformity on sagital plane of U-shaped and H-shaped sacral fractures. [Method]A group of 23 patients with U-shaped or H-shaped sacral fracture were studied retrospectively in our hospital between May 2007 and May 2009. The study content included radiographic measurements and clinical treatment outcomes. There were 14 cases with U-shaped sacral fracture and 9 with H-shaped. The sacral fracture type was flextion for 15 cases, neutral position fracture for 5 cases and extension for 3 cases. All patients were treated operatively with lumboiliac fixation. The average follow-up period was 34.4 months. The parameters of pelvic incidence and angulation deformity were measured by radiography at preoperation and at postoperation respectively using computed technique. The low- back clinical sysptoms were evaluated with JOA score. [Result] （1）In the cases for flextion, the postoperative PI was improved from preoperative 76.3°±7.0° to 58.1°±7.5°（P 〈0.05） and angulation deformity improved from 33.5°± 7.1° to 12.7°±4.3 ° （ P 〈 0.05 ） after operation. There was a positive correlation in difference value between PI and angulation deformity. （ 2 ） The average JOA score was 19.4 in the last follow-up. The average JOA score of the patients with a PI above 62 degrees was 16. 7. The average JOA score of the patients with a PI above 62 degrees was 16.7. The average JOA score of the patients with a PI below 62 degrees was 23.3. （ 3 ） There were negative correlations between PI and JOA postoperatively（r=- 0. 880. P 〈 0.05 ）.