-
骶骨骨折在脊柱骨折中占比较少,多源于交通事故、高处跌落等高能量损伤,严重的骨骼肌肉损伤多伴有骨盆骨折出现,同时并发神经损伤比例也较高[1],可引起较为严重的并发症,且对手术操作要求较高。髂腰固定是治疗骶骨骨折的主要方案,骶管减压术在解除神经压迫方面具有十分重要的意义[2],但也有学者[3]认为早期骶管减压对远期神经损伤的恢复并无明显作用,这可能与不同研究纳入病例数、骨折分型等有关。为探讨骶骨骨折合并脊柱-骨盆分离的合理治疗方案,本研究回顾性分析创伤性骶骨骨折合并脊柱-骨盆分离病人16例的临床资料,探讨骶管减压联合腰椎-骨盆固定术治疗创伤性骶骨骨折合并脊柱-骨盆分离的临床疗效。现作报道。
-
所有病人均顺利完成手术,手术耗时(172.34±43.23)min,出血量(670.98±98.34)mL,住院时间(25.76±6.45)d,骨折愈合时间(4.21±0.43)个月,随访时间(2.25±0.31)年。
-
病人末次随访时Gibbons评分明显低于术前(P < 0.01),Majeed评分明显高于术前(P < 0.01)(见表 1)。
时间 n Gibbons评分 Majeed评分 术前 16 3.15±0.32 36.45±7.02 末次随访 16 2.03±0.20 81.08±6.45 t — 11.87 18.73 P — <0.01 <0.01 表 1 病人手术前后Gibbons评分和Majeed评分比较(x±s;分)
-
末次随访时,病人根据Majeed评分综合疗效优7例,良4例,可4例,差1例,优良率为68.75%;术后切口感染2例,经清创及万古霉素静脉治疗后控制;褥疮1例,位于髂后上棘,进行清创、负压引流等处理后愈合;均无钢板、连接杆断裂、骨折再移位等严重并发症出现。典型病例见图 1。
骶管减压联合腰椎-骨盆固定术治疗创伤性骶骨骨折合并脊柱-骨盆分离疗效分析
Effect of the sacral canal decompression combined with lumbar-pelvic fixation in the treatment of traumatic sacral fractures complicated with spine-pelvic separation
-
摘要:
目的探讨骶管减压联合腰椎-骨盆固定术治疗创伤性骶骨骨折合并脊柱-骨盆分离的临床疗效。 方法收集创伤性骶骨骨折合并脊柱-骨盆分离病人16例,骨折分型Denis Ⅲ型,采用骶管减压联合腰椎-骨盆固定术治疗,并随访2年以上,记录病人手术前后相关指标,比较术前、末次随访神经功能Gibbons评分,参照Majeed功能评分评价综合疗效,并记录并发症发生情况。 结果所有病人均顺利完成手术,手术耗时(172.34±43.23)min,出血量(670.98±98.34)mL,住院时间(25.76±6.45)d,骨折愈合时间(4.21±0.43)个月。病人末次随访时Gibbons评分较术前明显降低(P < 0.01),Majeed评分明显升高(P < 0.01);末次随访Majeed评分综合疗效优7例,良4例,可4例,差1例,优良率68.75%(11/16);术后切口感染2例,压疮1例,均无钢板、连接杆断裂、骨折再移位等严重并发症出现。 结论骶管减压联合腰椎-骨盆固定术能重建创伤性骶骨骨折合并脊柱-骨盆分离病人骨盆环及脊柱稳定性,改善术后神经功能及活动功能。 Abstract:ObjectiveTo investigate the effects of the sacral canal decompression combined with lumbar-pelvic fixation in the treatment of traumatic sacral fractures complicated with spine-pelvic separation. MethodsSixteen patients with traumatic sacral fractures(Denis type Ⅲ) complicated with spine-pelvic separation were treated with sacral canal decompression combined with lumbar-pelvic fixation, and followed up for more than 2 years.The relative indexes of patients before and after the operation were recorded.The neurological Gibbons scores of patients were compared between before operation and last follow-up.The comprehensive efficacy was evaluated according to the Majeed functional score, and the complication was recorded. ResultsThe operations of all patients were successfully completed.The time of operation, blood loss, hospital stay and time of fracture healing of patients were (172.34±43.23)min, (670.98±98.34)mL, (25.76±6.45)d and (4.21±0.43) months, respectively.Compared with before operation, the last follow-up Gibbons score and Majeed score of patients significantly decreased and increased, respectively(P < 0.01).The results of the last follow-up showed the excellent in 7 cases, good in 4cases, fair in 4 cases and poor in 1 case, and the good rate of which was 68.75%.The postoperative incision infection in 2 cases, hemorrhoids in 1 case, and no serious complications, such as steel plate, connecting rod fracture, fracture and displacement, were found. ConclusionsThe sacral canal decompression combined with lumbar-pelvic fixation can reconstruct the pelvic ring and spinal stability, and improve the postoperative neurological function and activity in patients with traumatic sacral fractures complicated with spine-pelvic separation. -
表 1 病人手术前后Gibbons评分和Majeed评分比较(x±s;分)
时间 n Gibbons评分 Majeed评分 术前 16 3.15±0.32 36.45±7.02 末次随访 16 2.03±0.20 81.08±6.45 t — 11.87 18.73 P — <0.01 <0.01 -
[1] 黄保, 李生鋆, 赵凤东.从胸腰椎骨折到下腰骶椎骨折之TLICS到LSICS[J].中华骨科杂志, 2016, 36(22):1456. doi: 10.3760/cma.j.issn.0253-2352.2016.22.008 [2] 袁雷红, 郑博隆, 郝定均, 等.骶骨骨折的分型及治疗进展[J].中华创伤骨科杂志, 2017, 19(6):491. doi: 10.3760/cma.j.issn.1671-7600.2017.06.006 [3] 胡铮, 李钿, 何旭辉, 等.不稳定型骶骨骨折手术治疗方式选择[J].中国矫形外科杂志, 2017, 25(20):1853. [4] NAEEMA H, ALRUMSIHI G, BAILEYCP.136 Type Ⅲ odontoid fracture with C1 and C2 distraction injury manifesting as a variant of occipital-cervical dissociation[J].Can J Neurol Sci, 2016, 43(S2):S51. [5] PEETZA, SALIM A, ASKARIA R, et al.Association of model for end-stage liver disease score and mortality in trauma patients With chronic liver disease[J].JAMA Surg, 2016, 151(1):1. doi: 10.1001/jamasurg.2015.2892 [6] 汪金平, 李翱翔, 莫世赞, 等.经皮耻骨上支螺钉内固定治疗不稳定骨盆骨折的疗效评价[J].中国骨与关节损伤杂志, 2016, 31(10):1056. doi: 10.7531/j.issn.1672-9935.2016.10.015 [7] 吴新宝, 孙旭.骶骨骨折的治疗[J].中国医刊, 2016, 51(10):2. doi: 10.3969/j.issn.1008-1070.2016.10.002 [8] SCHICHO A, SCHMIDT A, SEEBER K, et al.Pelvic X-ray misses out on detecting sacral fractures in the elderly-importance of CT imaging in blunt pelvic trauma[J].Injury, 2016, 47(3):707. doi: 10.1016/j.injury.2016.01.027 [9] 王衍武, 王伯珉.腰髂固定系统治疗脊柱-骨盆分离损伤[J].中国矫形外科杂志, 2018, 26(8):682. [10] 巩腾, 苏学涛, 夏群, 等.后路经皮腰-髂钉棒固定在DenisⅡ型骶骨骨折中的应用[J].中华创伤骨科杂志, 2017, 19(6):484. doi: 10.3760/cma.j.issn.1671-7600.2017.06.005 [11] CHOI YH, KWON SW, MOONJ H, et al.Lateral lumbar interbody fusion and in situ screw fixation for rostral adjacent segment stenosis of the lumbar spine[J].J Korean Neurosurg Soc, 2017, 60(6):755. doi: 10.3340/jkns.2017.0606.003 [12] 陈文瑶, 李新志, 阙祥勇, 等.经椎旁肌间隙入路髂腰固定治疗不稳定性骶骨骨折[J].实用骨科杂志, 2017, 23(9):830. [13] BORIANI S, TEDESCO G, MING L, et al.Carbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors:a preliminary report[J].Eur Spine J, 2017, 27(7):1. [14] 曹浙标, 叶招明, 张永进, 等髂腰固定术治疗DenisⅡ型骶骨骨折的疗效分析[J].中国骨伤, 2016, 29(3):248. doi: 10.3969/j.issn.1003-0034.2016.03.010 [15] 黄南翔, 林宏, 李伟.骶管减压髂腰固定治疗复杂DenisⅢ型骶骨骨折[J].西部医学, 2017, 29(1):110. doi: 10.3969/j.issn.1672-3511.2017.01.024