骶骨Ⅱ区骨折侧方、前后、旋转移位特点及其与骶神经损伤关系

Influences of lateral, front-rear and rotational displacements on injury to sacral nerves in fractures of sacral zone Ⅱ

目的 回顾性分析骶骨Ⅱ区骨折各亚型骨折移位特点及其与骶神经损伤的关系. 方法 收集2005年1月至2008年12月收治的62例骶骨Ⅱ区骨折患者资料,压缩骨折44侧,其中伴神经损伤组15侧,无神经损伤组29侧;分离骨折24侧,其中伴神经损伤组8侧,无神经损伤组16侧.比较压缩骨折或分离骨折中伴神经损伤组和无神经损伤组患者的骨折压缩距离或分离距离、发生骨折前后移位和旋转移位的情况. 结果 压缩骨折的伴神经损伤组的压缩距离[（7.43±2.98） mm]大于无神经损伤组[（4.40±3.02）mm],差异有统计学意义（t=0.162.P=0.003）.伴神经损伤组前后移位和骨折断端旋转移位的发生情况较无神经损伤组更为严重,差异均有统计学意义（P＜0.05）.分离骨折的伴神经损伤组和无神经损伤组的分离距离和前后移位发生情况比较差异均无统计学意义（P＞0.05）.伴神经损伤组骨折断端旋转移位的发生情况较无神经损伤组更为严重,差异有统计学意义（P=0.021）.结论 骶骨Ⅱ区压缩骨折的压缩程度与神经损伤有关,伴有前后移位或骨折断端旋转移位更易伴发神经损伤.分离骨折的分离程度与骶神经损伤无明显关系,分离骨折同时伴有断端旋转移位时易造成骶神经损伤.

Objective To retrospectively analyze the associations of injury to the sacral nerves with lateral,front-rear and rotational displacements in fractures of sacral zone Ⅱ.Methods The data of 62 patients with fracture of sacral zone Ⅱ who had been treated in our hospital between January 2005 through December 2008 were collected using the PACS system and case reports checking system.There were 44 sides of compressed fracture,15 of which had combined nerve injury while 29 did not.There were 24 sides of separated fracture,8 of which had combined nerve injury while 16 did not.The groups with and without combined nerve injury in both compressed and separated fractures were compared in terms of the compression or separation distances as well as front-rear and rotational displacements.Results In compressed fractures,the average compression distance in the group with nerve injury （7.43 ± 2.98 mm） was significantly longer than that in the group without nerve injury （4.40± 3.02 mm） （t =0.162,P =0.003）.There were significantly more front-rear and rotational displacements in the nerve injury group than in the other group （P 〈 0.05）.In separated fractures,the average separation distance in the group with nerve injury （8.24 ±5.51 mm） was similar to that in the group without nerve injury （6.91 ±2.78 mm） （t =0.792,P =0.437）.No statistical difference was found between the 2 groups in the front-rear displacement （P =0.667） but there were significantly more rotational displacements in the nerve injury group than in the other group（P =0.021）.Conclusions The compression distance is associated with neurological deficit in fractures of sacral zone Ⅱ.The fractures combined with front-rear and rotational displacements are more likely associated with nerve injury.The separation distance in separated fractures is not associated with neural damage.The separated fractures combined with rotational dislocation are more likely combined with neural injury.