摘要
Abstract
Objective To evaluate the clinical efficacy of ilio-lumbar reconstruction in treatment of unstable sacral fractures with neurological damage.Methods A total of 12 cases with unstable sacral fractures accompanied by neurological damage were selected from our hospital during the period from January 2008 to June 2013 were analyzed retrospectively,including 9 of male and 3 of female,aged from 22 to 50 years old (average (33.6 ± 0.2)).There were 6 cases of zone Ⅱ fracture,4 cases of zone Ⅲ fracture and 2 cases of zone Ⅱ and Ⅲ fracture according to Denis classification.All cases were combined with sacral nerve injury.The Gibbons score was 3 points in 8 cases and 4 points in 4 cases.All the patients were performed the surgery of posterior sacral decompression,iliolumbar fixation and reconstruction,reduction of fracture and posterolateral bone fusion.Fracture reduction and healing were measured by x-ray or CT scan,clinical functional recovery was evaluated by Majeed score,neurological improvement were evaluated by Gibbons'criteria,and the postoperative complications were recorded.Results The operation time ranged from 130 to 200 minutes with an average of (159.3 ± 0.9) minutes,and the blood loss was 750 to 1200 ml with an average of (854.5 ± 2.1) ml.All patients were followed up for 8 to 16 months with an average of (12.9 ±0.8) months.Bone fusion was achieved during 6 months after the operation in all cases without complications as remnant sacrum malformation,fracture displacement,pseudoarticulation formation and deep infection.Neurological functions were completely recovered in 9 cases,significant improvement in 2 cases with foot-drop and disfunction of lower extremity,and poor recovered in 1 case with disfunction of bladder,bowel and lower extremity.According to Majeed scale,the clinical functional outcome was excellent in 8 cases,good in 2,fair in 1 and poor in 1,and the excellent-good rate was 83.3％.Gibbons score improved from preoperative (3.4 ± 0.2) points to postoperative (1.4 ± 0.5)points (P ＜ 0.01).Conclusion The surgery of ilio-lumbar reconstruction can restore the anatomy relationship of lumbar-sacrum-ilium and rebuild the stability of lumbar-sacrum,it can achieve a curative effect for unstable sacral fractures and nerve injury.关键词
髂腰重建术/骶骨骨折/神经损伤Key words
ilio-lumbar reconstruction/sacral fractures/nerve injuries分类
医药卫生
