髂腰固定术治疗DenisⅡ型骶骨骨折的疗效分析

Analysis of clinical effects of iliolumbar fixation in treating sacrum fracture of Denis typeⅡ

目的 ：评价应用髂腰固定术治疗DenisⅡ型骶骨骨折的临床疗效。方法 ：2008年1月至2012年1月采用髂腰固定术治疗86例DenisⅡ型骶骨骨折,其中男55例,女31例;年龄17-55岁,平均39.1岁;伴骨盆骨折73例,髋臼骨折13例;有骶神经症状37例,无骶神经症状49例。术后对获得随访的患者分别进行骨折愈合、神经功能、临床功能评价及并发症分析。结果：86例患者中80例获得随访,失访6例,平均随访时间36个月（24-71个月）,骨折平均愈合时间为13周（10-38周）。根据Gibbons等的神经功能评分,神经康复、下肢感觉、下肢活动、膀胱直肠功能以及总分分别由术前的0.62±0.04、1.54±0.35、1.12±0.18、0.23±0.01、3.46±0.47恢复至术后0.82±0.12、0.36±0.04、0.05±0.01、0.03±0.01、1.25±0.22,两组比较差异有统计学意义（P〈0.05）。根据Majeed临床功能评价标准,术后疼痛（22.54±4.02）分,站立（27.93±5.46）分,坐（8.47±3.61）分,性生活（2.54±1.33）分,工作能力（16.46±4.34）分,总分81.32±8.73;疗效优60例,良17例,可3例。主要并发症：骨折不愈合5例,切口深部感染1例,内固定物过度突出不适8例。结论：髂腰固定术具有固定牢靠、功能恢复满意、并发症少等优点,是治疗DenisⅡ型骶骨骨折的好方法。

Objective：To evaluate the clinical effects of iliolumbar fixation for the sacrum fractures of Denis type Ⅱ.Methods：The clinical data of 86 patients with sacrum fracture of Denis typeⅡtreated by iliolumbar fixation from January 2008 to January 2012 were retrospectively analyzed. There were 55 males and 31 females,aged from 17 to 55 years old with an average of 39.1 years. Among them,73 cases complicated with pelvis fracture and 13 cases with acetabular fracture;37 cases with sacral neurological symptoms and 49 cases without sacral neurological symptoms. Fracture healing time,nerve function,clinical function and complications were observed in the patients. Results：In 86 cases,6 cases were out of followed up and 80 cases were followed up from 24 to 71 months with an average of 36 months. The mean fracture healing time was 13 weeks（ranged,10 to 38 weeks）. According to Gibbons scoring to evaluate the neurological function,preoperative nerve rehabilitation,lower limbs feeling,lower limbs activity,bladder and rectum function,total score respectively were 0.62±0.04,1.54±0.35,1.12±0.18,0.23±0.01,3.46±0.47 and postoperative respectively were 0.82±0.12,0.36±0.04,0.05±0.01,0.03±0.01,1.25±0.22,there were statistically significant differences between preoperative and postoperative（P〈0.05）. According to Majeed scoring to evaluate the clinical function,postoperative pain,standing,sitting,sexual life,work ability,total score respectively were 22.54±4.02,27.93±5.46,8.47 ±3.61,2.54 ±1.33,16.46 ±4.34,81.32 ±8.73,60 cases got excellent results,17 good,3 fair. The main complications including fracture nonunion of 5 cases,deep incision infection of 1 case,and screw prominence resulting uncomfortable of 8cases. Conclusion：Iliolumbar fixation has the advantages of stable fixation,satisfactory functional rehabilitation,less complications,and is a good method in treating sacrum fracture of Denis type Ⅱ.