CAJ | 학술논문

目的探讨创伤性脊柱骨盆分离的临床特点及后路髂腰内固定治疗该损伤的临床效果.方法回顾性分析2008年7月至2012年12月收治12侧创伤性脊柱骨盆分离患者资料,男8例,女4例;年龄18～50岁,平均(34.6±9.2)岁.致伤原因:坠落伤11例,车祸伤1例.所有骨折均为闭合性损伤,均有不同程度的合并伤.骶骨骨折按形态学分型:U型4例,H型6例,Y型2例.Roy-Camille分型:Ⅱ型6例,Ⅲ型6例.采用髂腰固定对12例患者进行手术治疗,并对6例有明显神经损害表现且有明确手术指征的患者同时行神经减压术.临床疗效评价采用Majeed标准,神经损伤按照Gibbons评价方法进行评定.结果 12例患者均获得随访,随访时间12～36个月,平均(15.5±6.3)个月.9例患者在受伤早期存在误诊或漏诊,12例患者均有不同程度的神经损害表现.术后所有骨折均获得愈合,骨折愈合时间4～8个月,平均(4.8±2.8)个月.根据Majeed标准,优4例、良4例、可2例、差2例,优良率66.7％(8/12).12例患者术后患肢感觉、运动功能恢复率为91.7％(11/12).6例行神经减压术的患者术后感觉、运动功能恢复率为83.3％(5/6).末次随访时,Gibbons神经评分由术前平均(3.25±0.75)分降至术后平均(1.67±0.99)分,差异有统计学意义.结论创伤性脊柱骨盆分离是一种少见的高能量损伤,其合并伤及神经损害的发生率很高;后路髂腰内固定是一种值得推荐的治疗方式,对有指征的患者早期行神经减压有利于神经功能的恢复.
목적 탐토창상성척주골분분리적림상특점급후로가요내고정치료해손상적림상효과.방법 회고성분석2008년7월지2012년12월수치12측창상성척주골분분리환자자료,남8례,녀4례;년령18～50세,평균(34.6±9.2)세.치상원인:추락상11례,차화상1례.소유골절균위폐합성손상,균유불동정도적합병상.저골골절안형태학분형:U형4례,H형6례,Y형2례.Roy-Camille분형:Ⅱ형6례,Ⅲ형6례.채용가요고정대12례환자진행수술치료,병대6례유명현신경손해표현차유명학수술지정적환자동시행신경감압술.림상료효평개채용Majeed표준,신경손상안조Gibbons평개방법진행평정.결과 12례환자균획득수방,수방시간12～36개월,평균(15.5±6.3)개월.9례환자재수상조기존재오진혹루진,12례환자균유불동정도적신경손해표현.술후소유골절균획득유합,골절유합시간4～8개월,평균(4.8±2.8)개월.근거Majeed표준,우4례、량4례、가2례、차2례,우량솔66.7％(8/12).12례환자술후환지감각、운동공능회복솔위91.7％(11/12).6례행신경감압술적환자술후감각、운동공능회복솔위83.3％(5/6).말차수방시,Gibbons신경평분유술전평균(3.25±0.75)분강지술후평균(1.67±0.99)분,차이유통계학의의.결론 창상성척주골분분리시일충소견적고능량손상,기합병상급신경손해적발생솔흔고;후로가요내고정시일충치득추천적치료방식,대유지정적환자조기행신경감압유리우신경공능적회복.
Objective To discuss the clinical features of Traumatic Spinopelvic Dissociation(TSD) and to evaluate the clinical results treated by lumbopelvic fixation by retrospective case study.Methods From July 2008 to December 2012,twelve patients of Traumatic Spinopelvic Dissociations were surgically treated at our department in Tianjin Hospital.There were 8 males and 4 females with a mean age of 34.6±9.2 years(range,18-50 years).The causes of injuries were fall or jump from height (11 patients) and traffic injury (1 patient).All the fractures were closed injuries and associated injuries in different degrees were noted in all the patients.The sacral fractures were classified according to fracture shape,with 4 cases of U shape,6 cases of H shape and 2 cases of Y shape.The transverse part of the sacral fractures were classified by Roy-Camille classification,and there were 6 cases of type Ⅱ and 6 cases of type Ⅲ.All the 12 patients were surgically treated by lumbopelvic fixation of a posterior approach,and 6 patients with significant neurological impairments were performed with sacral decompression via the same approach.The clinical results were evaluated by Majeed functional evaluation and the neurological impairments were evaluated by Gibbons score.Results All the patients were followed up on an average of 15.5±6.3 months (range,12-36 months).The diagnosis of the TSD were missed or delayed in 9 of the 12 patients.There were different neurological impairments in all the 12 patients.All the fractures healed in a mean time of 4.8±2.8 months(range,4-8 months).Clinical outcome was rated excellent in 4 patients,good in 4 patients,fair in 2 patients,and poor in 2 patients,according to the Majeed functional evaluation,and the excellent and good rate was 66.7％ (8/12).The neurological injuries were recovered completely or partially in sensation and motion in 11 of all 12 patients (91.7％).For the neural decompression patients,the neurological injuries were recovered completely or partially in sensation and motion in 5 of all 6 patients (83.3％).At last follow up,the average Gibbons score improved from 3.25 preoperatively to 1.67 postoperatively,with significant difference.Conclusion TSD is a rare high-energy injury pattern.It has a high rate of associated injuries and neurological impairments.The correct diagnosis of the injury pattern is easy to be missed or delayed.Surgical procedure of lumbopelvic fixation via post approach should be considered as the method of choice.Early neural decompression for the patients with obvious indications could be helpful in overall neurological and functional recoveries.