CAJ | 학술논문

目的探讨腰椎-骨盆固定治疗U型骶骨骨折的手术方法和疗效.方法对2005年12月至2011年2月年收治的8例U型骶骨骨折患者进行回顾性分析,其中男6例,女2例;年龄21～53岁,平均36.9岁;骨折类型按照骨折形态学分类:H型损伤5例,U、T和“人”字型损伤各1例;骶骨横形骨折按Roy-Camille和Strange-Vognsen分型:Ⅱ型2例,Ⅲ型6例;神经损伤按Gibbons等的评分标准:3级2例,4级6例;7例合并多发伤.待生命体征平稳后所有患者行后路骶骨椎板减压和骶神经根减压、骨折复位和腰椎-骨盆固定术,3例行骨盆前环固定术.结果所有患者术后获6 ～ 24个月(平均14.5个月)随访.所有患者术后6个月CT扫描示骨折均愈合;2例患者切口皮缘部分坏死,l例患者伤口深部感染经清创负压封闭引流后愈合;5例患者诉髂后上棘螺钉突出不适;6例直肠、膀胱功能障碍患者3例完全康复,3例有不同程度地改善;Gibbons评分平均提高2.45分.1例髂骨螺钉位置不佳,无发生内固定断裂和复位丢失等并发症.结论 U型骶骨骨折常引起脊柱-骨盆不稳定和神经损伤,早期神经减压可促进神经功能恢复,腰椎-骨盆固定可提供多平面的稳定性,是治疗此类骨折的有效方法.
목적 탐토요추-골분고정치료U형저골골절적수술방법화료효.방법 대2005년12월지2011년2월년수치적8례U형저골골절환자진행회고성분석,기중남6례,녀2례;년령21～53세,평균36.9세;골절류형안조골절형태학분류:H형손상5례,U、T화“인”자형손상각1례;저골횡형골절안Roy-Camille화Strange-Vognsen분형:Ⅱ형2례,Ⅲ형6례;신경손상안Gibbons등적평분표준:3급2례,4급6례;7례합병다발상.대생명체정평은후소유환자행후로저골추판감압화저신경근감압、골절복위화요추-골분고정술,3례행골분전배고정술.결과 소유환자술후획6 ～ 24개월(평균14.5개월)수방.소유환자술후6개월CT소묘시골절균유합;2례환자절구피연부분배사,l례환자상구심부감염경청창부압봉폐인류후유합;5례환자소가후상극라정돌출불괄;6례직장、방광공능장애환자3례완전강복,3례유불동정도지개선;Gibbons평분평균제고2.45분.1례가골라정위치불가,무발생내고정단렬화복위주실등병발증.결론 U형저골골절상인기척주-골분불은정화신경손상,조기신경감압가촉진신경공능회복,요추-골분고정가제공다평면적은정성,시치료차류골절적유효방법.
Objective To analyze the clinical characteristics,treatments and outcomes of U-shaped sacral fractures. Methods From December 2005 to February 2011,8 cases of U-shaped sacral fractures were operatively treated in our department. They were 6 males and 2 females,aging from 21 to 53 years (mean,36.9 years).There were 5 cases of H pattern,one case of U pattern,one case of lambda pattern and one case of T pattern,according to fracture shape.The transverse part of sacral fracture was diagnosed as type Ⅱ in 2 cases and as type Ⅲ in 6 cases,according to Roy-Camille and Strange-Vognsen sub-classification.The combined neurological impairments were judged as grade 3 in 2 cases and grade 4 in 6 cases,according to Gibbons' criteria.Seven patients were complicated with multiple injuries.After stabilization of vital signs,all were treated with open reduction,posterior sacral decompression and lumbopelvic or lumbosacral fixation using the segment pedicel system,whereby the transverse fixation was obtained using a 6 mm rod as cross-connector between the 2 main rods. Results All the patients were followed up for an average of 14.5 months (from 6 to 24 months).All demonstrated fracture healing on CT scan at 6 months.Two cases of partial incision necrosis and one case of superficial infection were managed successfully with surgical debridement and aggressive wound care.Five patients complained of symptoms related to the prominence of the iliac screws.Of the 6 patients with bowel and bladder deficits,3 obtained full recovery and 3 partial recovery.The average Gibbons score improved by 2.45 points.One case had mal-placement of iliac screws.No rupture of implants or loss of fracture reduction was seen at the final radiological follow-up. Conclusions U-shaped sacral fracture can result in spino-pelvic instability associated with neurological deficits.Good neurological recovery can be expected after early sacral decompression. Lumbopelvic fixation,providing multi-planer fixation,is effective in restoring the lumbopelvic stability.