摘要
目的探讨经腹直肌外侧切口治疗骨盆、骶骨骨折合并腰骶丛损伤的手术方法及临床疗效。方法回顾性分析2013年1月至2015年1月,采用经腹直肌外侧切口治疗9例骨盆、骶骨骨折合并腰骶丛损伤患者资料,男4例,女5例;年龄21-61岁,平均38岁;伤后至手术时间:6例为7-20d,3例为21-59d。骨盆骨折Tile分型:B2型2例,B3型1例,cl型2例,c2型1例,c3型3例;骶骨骨折Denis分型:I型3例,Ⅱ型6例;神经损伤分级:完全损伤1例,部分损伤8例;其中3例合并髋臼骨折,3例合并同侧股骨中段骨折,2例合并胫骨骨折,其他脏器损伤5例。术前通过3D打印制作1:1骨折模型,并在电脑上进行骨折模拟复位;5例患者术前1h在血管造影下行患侧髂内动脉栓塞术。手术经腹直肌外侧切口进入,于腰骶干外侧显露骶髂关节,在骶正中血管与腰骶干、髂内血管间分离显露s,椎体前方,复位骶骨骨折并松解腰骶丛,紧贴骨面放置钢板跨骶髂关节固定,而后再处理合并的耻骨支及髋臼骨折。结果9例患者均顺利完成手术,手术时间125-224min,平均183min;术中出血440-2760ml,平均1150ml。术后影像学检查示骨折复位固定良好,无一例发生手术相关并发症,骶骨骨折均愈合,愈合时间8-12周,陈旧骨折与新鲜骨折愈合时间无明显差异;术后3个月,6例新鲜骨折中5例腰骶丛损伤症状完全恢复,1例恢复良好;3例陈旧骨折患者,其中2例于术后6个月神经症状大部分恢复,1例无恢复。结论采用经腹直肌外侧切口入路能较好显露骶髂关节周围,松解骨折压迫的腰骶丛神经根,通过腰骶干下方跨骶髂关节钢板固定能达到较好的固定效果,是治疗骶骨骨折合并腰骶丛损伤的一种可行洼手术方法。
Objective To explore the lateral-rectus approach for surgical treatment of pelvic and sacral fracture with lum- bosacral plexus injury and its effect. Methods From January 2013 to January 2015, 9 patients had undergone internal fixation and decompression of the sacral nerve via the lateral-rectus approach. Classification of pelvic fracture included Tile B2 in 2 pa- tients, Tile B3 in 1 patient, Tile C1 in 2 patients, Tile C2 in 1 patient, Tile C3 in 3 patients. According to Denis classification, 3 cases were type I and 6 were type II. Among them, 3 cases involved acetabular fracture, 5 cases complicated with limbs fracture and 5 cases had organ injury. The durations before operations were 7-59 days after the trauma. The fracture model was manufac- tured by 3D printing and fracture reduction was simulated on computer preoperatively. 5 of 9 patients underwent DSA to block the internal iliac artery 1 hour before surgery. The patient was in supine position, after general anesthesia, the sacroiliac joint was ex- posed via the lateral-rectus approach. Then S was approached between median sacral artery and lumbosacral trunk and internal il- iac artery. After reduction of the sacral fracture and release of the sacral plexus nerve, the sacroiliac joint was fixed with a plate. Fi- nally, the fracture of acetabulum and anterior ring of pelvis was repaired. Postoperative treatment included prevention of infection and thrombosis. Results All the 9 cases underwent the operation successfully. The average surgical time was 183 min (range, 125-224 min) and the mean blood loss was 1 150 ml (range, 440-2 760 ml). Postoperative X-ray and CT indicated an excellent re- duction of fracture. No complication was observed. 5 of 6 patients with fresh fracture had recovery of neurologic function 3 months after operation and one was good. The neurological outcome of old fractures was good in two, unrecovered in one. Conclusion In surgical treatment of sacral fractures, the lateral-rectus approach provides adequate exposure of sacroiliac joint and the sacral plex- us nerve could be well decompressed. A stable fixation could be achieved with a plate crossing the sacroiliac joint.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2016年第9期521-527,共7页
Chinese Journal of Orthopaedics
基金
广东省科技计划项目前沿与关键技术创新重大专项资金(20158010125006)
天河区科技计划(201404KW006)
关键词
骨盆
骶骨
骨折
腰骶丛
Pelvis
Sacrum
Fractures, bone
Lumbosacral plexus