直接减压联合腰髂固定治疗伴骶孔骨块占位和骶神经损伤Denis Ⅱ型骶骨骨折的疗效

Curative effect of direct decompression plus lumbo-iliac fixation for Denis type Ⅱ sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury

目的探讨直接减压或间接减压联合腰髂固定治疗伴骶孔骨块占位和骶神经损伤DenisⅡ型骶骨骨折的临床效果。方法采用回顾性病例对照研究分析2012年3月—2017年3月西安交通大学医学院附属红会医院收治的47例伴骨块突入骶孔和骶神经损伤DenisⅡ型骶骨骨折患者临床资料。患者均行腰髂固定术。手术时间为伤后3~14 d,平均6 d。26例接受直接减压(直接减压组),其中男16例,女10例;年龄(36.2±8.4)岁。21例接受间接减压(间接减压组),其中男11例,女10例;年龄(38.7±9.8)岁。比较两组手术时间、术中出血量、骨折愈合、术后Mears影像学评估、末次随访Gibbons评分和Majeed功能评分,观察并发症情况。结果患者均获随访12~33个月,平均16.7个月。直接减压组手术时间和术中出血量分别为(112.3±26.3)min、(512.1±29.4)ml;间接减压组分别为(129.3±25.1)min、(529.7±22.1)ml(P均>0.05)。患者骨折均愈合。根据Mears影像学评估,直接减压组解剖复位17例,复位满意9例;间接减压组解剖复位15例,复位满意6例(P>0.05)。末次随访时,直接减压组Gibbons评分[(1.2±0.3)分]低于间接减压组[(2.2±0.5)分],Majeed功能评分[(87.3±11.4)分]高于间接减压组[(68.5±16.7)分](P均<0.01)。直接减压组1例出现伤口深部感染,间接减压组1例因髂骨螺钉钉尾突出压迫皮肤出现压疮。结论对于伴骶孔骨块占位和骶神经损伤DenisⅡ型骶骨骨折,相比于间接减压,直接减压联合腰髂固定能获得更好的神经功能恢复和生活功能恢复。

Objective To discuss the curative effect between direct decompression and indirect decompression plus lumbo-iliac fixation for treatment of Denis type Ⅱ sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury.Methods A retrospective case-control study was performed on clinical data of 47 patients with Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury admitted to Honghui Hospital Affiliated to Xi’an Jiaotong University School of Medicine from March 2012 to March 2017.All patients underwent lumbo-iliac internal fixation.The operation time ranged from 3 to 14 days after injury,with an average of 6 days.In direct decompression group(n=26),the sacral foramina mass was removed during the operation and direct decompression was performed.There were 16 males and 10 females,with age of(36.2±8.4)years.In indirect decompression group(n=21),indirect decompression through traction and distraction was performed.There were 11 males and 10 females,with the age of(38.7±9.8)years.Operation time,intraoperative blood loss,bone union,Mears imaging evaluation,Gibbons score,and Majeed function score were compared between the two groups.Postoperative complications were observed as well.Results All patients were followed up for 1233 months,with an average of 16.7 months.The operation time and intraoperative blood loss in direct decompression group were(112.3±26.3)minutes and(512.1±29.4)ml,which had no significant differences in comparison with that in indirect decompression group[(129.3±25.1)minutes and(529.7±22.1)ml](P>0.05).Bone union was observed in all patients.According to the Mears imaging evaluation,the direct decompression group had anatomical reduction in 17 patients,and satisfactory reduction in 9,and the indirect decompression group had anatomical reduction in 15 patients and satisfactory reduction in 6(P>0.05).At the last follow-up,Gibbons score in direct decompression group was lower than that in the indirect decompression group[(1.2±0.3)points vs.(2.2±0.5)points](P<0.01);Majeed function score in direct decompression group was higher than that in indirect decompression group[(87.3±11.4)points vs.(68.5±16.7)points](P<0.01).In direct decompression group,1 patient had deep wound infection,while in indirect decompression group,1 patient had pressure sore due to the protrusion of the tail of the iliac screws on the skin.Conclusion For Denis type Ⅱ sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury,direct decompression with lumbo-iliac fixation can obtain better neural functional recovery and functional recovery of life compared with the indirect decompression.