摘要
目的探讨腰骶髂螺钉固定治疗复杂骶骨骨折的临床效果。方法回顾性分析2012年1月至2014年10月采用后路腰一骶一髂螺钉固定联合骶椎管减压的方式进行手术治疗的18例复杂骶骨骨折患者的资料，男11例，女7例，年龄17-46岁，平均32岁。18例均合并有不稳定的骨盆骨折以及不同程度的马尾神经功能障碍，Gibbons分型评分均为4分。术中受骨折影响可以将固定阶段延长至L4、S2水平，根据神经损害表现和骨折移位情况行骶管减压，纠正垂直移位和旋转移位，之后放置横连进一步固定。结果18例在受伤后2-21d接受手术治疗，平均10．2d；手术时间150-240min，平均180min；术中出血600-2000ml，平均1100ml；随访时间13-34个月，平均23．4个月。临床疗效评价：至末次随访Gibbons评分从术前4分降至2．78分，差异有统计学意义；术前骶骨畸形角平均为42．89°，术后为21．94°，为术前的51．2％，差异有统计学意义；术后Majeed评分64．5分，其中优3例、良3例、可7例、差5例，优良率为33．33％；末次随访视觉模拟疼痛（visual analogue scale，VAS）评分平均从术前8．78分降至2．22分，差异有统计学意义。骨折愈合情况：术后Tomettaand Matto方法测量结果5例优、3例良、7例可、5例差，优良率为：44．44％。结论对于复杂骶骨骨折患者行腰-骶-髂螺钉固定术治疗，骨折复位良好，神经加压充分，更有利于患者更快、更好的恢复。
Objective To investigate the clinical efficacy of lumbar-saeurm-illac screws fixation in the treatment of com- plicated sacral fi＇actures. Methods From January 2012 to October 2012, 18 complicated sacrum fracture patients with unstable pelvic fractures and eauda equina dysfunctionwere retrospectively studied, which Gibbons score were all 4 points. Surgical treatment was performed by posterior lumbar-sacurm-iliac screw fixation combined with sacral decompression. The fixation stage can be extended to L4, S2 level by fracture. According to the patient＇s nerve injury and fracture displacement surgery sacral decompres- sion and observation of nerve root injury. After full decompression, correct the vertical displacement and rotate the displacement, and then place the cross further fixed. The first 3 months after surgery, the patient reviewed once a month, 3 months after the pa- tient review once every six months. Results 18 patients underwent surgery for 2-21 d after injury, with an average of 10.2 d. The operation time is 150-240 rain, an average of 180 rain. Intraoperative blood loss of 600-2 000ml, an average of 1 100ml. The time of follow-up was 13-34 mouths, with an average of 23.4 months. Gibbons score averaged 4 points from preoperative to 2.78 points, the difference was statistically significant. Preoperative patients with an average angle of 42.89, postoperative 21.94, the difference was statistically significant. Postoperative Majeed scores averaged 64.5 points. Excellent in 3 cases, good in 3 cases, can be 7 cas- es, poor in 5 cases, excellent rate was 33.33%. Preoperative visual analogue scale （VAS） score averaged from 8.78 points before surgery to 2.22 points, this difference was statistically significant. The results of Tometta and Matto method were excellent in 5 cas- es, 3 cases were good, 7 cases were available, 5 cases were poor, excellent and good rate was 44.44%. Conclusion Lumbarsaeurm-iliae screw fixation in the treatment of complex sacral fractures can achieve a good reduction of fractu
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第10期577-586,共10页
Chinese Journal of Orthopaedics
关键词
骶骨
骨折固定术
内
治疗结果
Sacrum
Fracture fixation, internal
Treatment outcome
