骶管减压及髂腰固定治疗Denis Ⅲ型骶骨骨折患者的临床疗效以及影响因素分析

Clinical efficacy and influencing factors of sacral canal decompression and lumboiliac fixation in treatment of patients with Denis Ⅲ sacral fracture

背景:骶骨骨折是骨盆骨折中的重要类型,DenisⅢ型骶骨骨折常合并神经损伤等并发症,采用骶管减压及髂腰固定术治疗的疗效及其影响因素目前尚未确定。目的:评估骶管减压及髂腰固定术治疗DenisⅢ型骶骨骨折的疗效并分析其影响因素。方法:分析2011年9月至2016年9月行骶管减压及髂腰固定术治疗的65例和接受保守治疗的9例DenisⅢ型骶骨骨折患者随访1年的病例资料,分别采用Gibbons、Majeed评分标准评估患者治疗前和治疗1年后的神经损伤和骨折情况。采用配对t检验比较手术组患者治疗前、治疗1年后的Gibbons评分及Majeed评分。采用成组t检验比较手术组与保守组治疗1年后Gibbons、Majeed评分改善程度。采用COX风险回归模型分析治疗疗效的影响因素。结果:手术组患者治疗前Gibbons评分高于治疗1年后,差异有统计学意义(t=35.553,P=0.000);治疗前Majeed评分低于治疗1年后,差异有统计学意义(t=37.114,P=0.000)。手术组患者Gibbons和Majeed评分改善程度均高于保守组,差异有统计学意义(t=-9.048,P=0.000;t=-10.256,P=0.000)。性别、年龄、受伤原因、减压方式对手术疗效的影响不明显,骨折类型(RR=2.190)、马尾损伤程度(RR=2.575)、Roy-Camille分型(RR=2.548)、手术时间(RR=1.359)、骨折后凸角(RR=2.739)、是否置入骶骨螺钉(RR=1.698)、L5-S1单侧小关节损伤程度(RR=1.223)是影响手术疗效的独立影响因素,且均为危险因素。结论:DenisⅢ型骶骨骨折患者实行骶管减压及髂腰固定术治疗的疗效肯定,骨折类型、马尾损伤程度、RoyCamille分型、手术时间、骨折后凸角、是否置入骶骨螺钉、L5-S1单侧小关节损伤程度是影响手术疗效的独立危险因素。

Background： Sacral fractures are an important class of pelvic fractures. Sacral fracture of Denis Ⅲ is often complicated with nerve injury. Sacral canal decompression and lumboiliac fixation is one choice for it. however the efficacy and influencing factors are not yet sure. Objective： To evaluate the efficacy of sacral canal decompression and lumboiliac fixation in the treatment of Denis Ⅲ sacral fractures and its influencing factors. Methods： The clinical data of 65 Denis Ⅲsacral fracture patients undergoing sacral decompression and lumboiliac fixation and 9 patients receiving conservative treatment in our hospital from September 2011 to September 2016 were analyzed. The patients were all followed up for one year. Gibbons and Majeed scores systems were respectively used to assess the degree of nerve injury and fracture preoperative and one year after operation. The paired t-test was used to compare the Gibbons and Majeed scores before and one year after operation in the operation group. Group t-test was used to compare the improvement of Gibbons and Majeed scores between the operation group and the conservative group one year after operation. COX risk regression model was used to analyze the influencing factors for efficacy. Results： In the operation group, the preoperative Gibbons score was significantly higher than that of one year after operation（t=35.553, P=0.000）, and the preoperative Majeed score was lower than that of one year after operation（t=37.114, P=0.000）. The improvement of Gibbons and Majeed scores in the operation group were significantly higher than those in the conservative group（t=-9.048, P=0.000; t=-10.256, P=0.000）. The influence played by sex, age, causes of injury and the approaches of decompression is not significant（P〈0.05）. The type of fracture（RR=2.190）, the degree of cauda equina injury（RR=2.575）, Roy-Camille classification（RR=2.548）, operative time（RR=1.359）, kyphotic angle（RR=2.739）, whether inserting the sacral screw（RR=1.698） and the degree of L5-S1 unilateral minor joint injury（RR=1.223） were independent factors for efficacy and also risk factors. Conclusions： The effect of sacral canal decompression and lumboiliac fixation in treatment of patients with Denis Ⅲ sacral fracture is confirmed, and the type of fracture, degree of cauda equina injury, Roy-Camille classification, operative time, kyphotic angle, whether inserting the sacral screw, the degree of L5-S1 unilateral minor joint injury are independent risk factors affecting the effect.