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.%目的 探讨髂腰重建术治疗不稳定性骶骨骨折并神经损伤的临床疗效. 方法 选取2008年1月～ 2013年6月我院收治的不稳定性骶骨骨折合并神经损伤患者12例,其中男性9例,女性3例,年龄22 ～ 50岁,平均年龄为(33.6±0.2)岁;Denis分型:Ⅱ区6例,Ⅲ区4例,Ⅱ区合并Ⅲ区2例;患者均有明显的骶神经根损伤症状.Gibbons神经损伤评分:8例3分,4例4分.所有患者均行后路骶管减压、神经松解、髂腰固定重建、后外侧植骨融合术,采用X线片或CT观察骨折复位及愈合情况,应用Majeed功能评分评价患者临床功能恢复情况,应用Gibbons标准评分评定患者神经功能改善情况,并观察并发症情况. 结果 本组手术时间130 ～200 min,平均时间(159.3 ±0.9) min,术中出血量750～1200 ml,平均(854.5±2.1)ml.所有患者随访8～16个月,平均(12.9±0.8)个月.术后6个月骨折均骨性愈合,无骨折移位、残留骨盆畸形、假关节形成及深部感染等并发症;9例患者神经功能完全恢复;2例明显改善,但遗留不同程度的足下垂和下肢感觉障碍;1例下肢功能及膀胱、直肠功能均无明显改善.Majeed评分评定:优8例,良2例,可1例,差1例,优良率为83.3％;Gibbons评分由术前平均(3.4±0.2)分恢复至末次随访时的(1.4±0.5)分. 结论 髂腰重建术可恢复腰-骶-髂的解剖关系,重建腰骶复合体的稳定性,对治疗不稳定性骶骨骨折并神经损伤疗效确切.
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