髂腰固定术治疗U型骶骨骨折的疗效分析

Analysis of clinical effects of iliolumbar fixation in treating U-shaped sacral fractures

目的:评价应用髂腰固定术治疗U型骶骨骨折的手术疗效。方法:回顾分析2014年1月至2019年12月采用髂腰固定术治疗14例U型骶骨骨折,其中男10例,女4例;年龄24~48(35.4±6.5)岁。术后对获得随访的患者分别进行骨愈合、神经功能、临床功能评价及并发症分析。结果:所有患者术后获随访,时间16~36(26.0±5.9)个月,骨愈合完全负重时间9~16 (12.4±2.0)周。术后发生1例手术切口感染,1例髂骨钉穿出至髂骨外,无压疮、内固定物松动或断裂等并发症发生。根据Gihbons神经功能评分,由术前的(2.9±0.9)分恢复至术后的(2.1±1.1)分,差异有统计学意义(t=6.9,P=0.00)。术后骶骨畸形角度由术前(41.4±11.2)°改善为末次随访时(28.3±7.5)°,差异有统计学意义(t=4.70,P=0.00)。根据Majeed临床功能评价标准,术后末次随访疼痛(23.21±3.17)分,站立(25.57±3.94)分,坐(7.71±1.54)分,性生活(2.64±0.92)分,工作能力(16.14±2.41)分,总分(75.30±8.10)分,疗效优2例,良10例,可2例。结论:髂腰固定术是治疗U型骶骨骨折的一种有效方法,具有内固定坚强、功能恢复满意等优点。

Objective:To evaluate the efficacy of iliolumbar fixation in the treatment of U-shaped sacral fractures.Methods:A retrospective study was conducted on the 14 complex U-shaped sacral fractures which had been treated from January 2014 to December 2019,involved 10 males and 4 females,aged 24 to 48(35.4±6.5)years.Fracture healing time,nerve function,clinical function and complications were observed in the patients.Results:All patients were followed up for 9 to 16(26.0±5.9)months.The complete weight-bearing time for bone healing was(12.4±2.0)weeks.One case of surgical incision infection occurred after operation,and one case of sacrum nails penetrated to the outer plate of sacrum.No complications such as pressure ulcers,loosening or rupture of internal fixation occurred.According to Gibbons scoring,the neurological function recovered from preoperative 2.9±0.9 to postoperative 2.1±1.1,there were statistically significant differences between preoperative and postoperative(t=6.9,P=0.00).There was significant difference between preoperative malformation angle(41.4±11.2)°and postoperative value(28.3±7.5)°(t=4.70,P=0.00).According to Majeed scoring to evaluate the clinical function,postoperative pain,standing,sitting,sexual life,work ability,total score respectively were 23.21±3.17,25.57±3.94,7.71±1.54,2.64±0.92,16.14±2.41,75.30±8.10,2 cases got excellent results,10 good,2 fair.Conclusion:Sacral lumbar fixation is an effective method for the treatment of U-shaped sacrum fractures.It has the advantages of strong internal fixation and satisfactory functional recovery.