垂直不稳定型骶骨Ⅱ区骨折致骶丛神经损伤相关因素分析

摘要

Objective To study the mechanism of sacral plexus injury resulting from zone- Ⅱ sacral fractures by axial compression. Methods Six short-term embalmed pelves were obtained with preserving sacral plexus and resected pubic symphysis. A model of zone- Ⅱ sacral fractures by axial compression was established. Quantitative analysis for fracture displacement was carried out to observe the characteristics and mechanisms of sacral plexus injury. The experimental data were analyzed by SPSS 10.0 statistic software.Results In the sacral fracture model of axial compression, the sacral plexus nerves of L5 and S1 were obviously compressed. The sharp border of fracture segment stabbed the nerves as the distal segment of fractures was displaced to superior-anteriorly. When the displacement exceeded 1 cm, the tension injury of sacral plexus nerves became noticeable, especially at L5, S1 and S2. There was no sacral nerve injury when the distal segment of fractures was displaced posteriorly. Conclusion The mechanisms of sacral plexus injury are complicated. And it probably have close correlations with stability, orientation, extent and duration of fracture displacement.%目的 探讨垂直不稳定性骶骨Ⅱ区骨折致骶丛神经损伤相关因素,为临床上此类神经损伤的诊治提供参考.方法 用40%甲醛短期固定的尸体制造垂直不稳定型骶骨Ⅱ区骨折模型,定量分析其移位特点与骶丛神经损伤的相关性,从形态及神经张力上间接反映神经受损机制,提示神经损伤的趋势和可能.结果 骶神经根的压迫伤多见于L5,S1.外侧骨折端向上、前移位时神经的牵拉及骨折块边缘对神经的刺伤显而易见,尤以向上移位为著.神经根牵拉伤以L5,S1和S2为主,易发生在外侧骨折端附近,尤以外侧骨折端向上和前移位＞1 cm内时明显.末见骨折端后移位导致神经损伤.结论 垂直不稳定型骶骨Ⅱ区骨折神经损伤原因复杂,可能不但与骶骨骨折移位方向,程度,时间有关,与骨折移位稳定性关系亦甚为密切.