目的 探讨不稳定型骨盆损伤中移位骶骨骨折的手术方法及治疗效果.方法 对2000年9月至2007年9月收治的33例伴有骶骨骨折的骨盆损伤患者行手术治疗.根据AO/OTA的分型方法,骨盆B型损伤5例,C型28例.根据Denis的分型方法,骶骨I型骨折13例、Ⅱ型11例、Ⅲ型9例.其中早期合并原发性神经损伤23例.骶骨骨折应用张力带钢板固定1例;脊柱椎弓根钉棒系统经骨盆后方沿双侧髂嵴横向固定10例,经L_(4,5)或L_5S_1及双侧髂嵴后方纵向固定16例;骶髂螺钉固定3例;骶骨棒固定2例;骶髂螺钉联合骶骨棒固定1例.术中间期行椎板切除、马尾神经减压11例,二期行神经松解、骶前孔扩大术2例.结果 术后随访12～82个月,平均27.3个月.根据Majeed疗效标准,优17例、良7例、可2例、差7例.骶骨I型骨折疗效优良率为92.3%、Ⅱ型为72.7%、Ⅲ型为44.4%.神经损伤恢复情况在手术治疗组中优6例、良4例、无变化3例;在非手术治疗组中优6例、良1例、无变化3例.术后并发症包括腰骶部切口深部感染2例,腰骶僵硬不适2例.神经损伤一过性加重4例,迟发性骶神经损伤3例.结论 手术治疗是改善骶骨骨折复位质量的重要途径,骨盆前、后环损伤的联合制动是提高骨折内同定强度的有效方法.对手术指征明确的骶神经损伤,早期定位减压有助于其功能恢复.%Objective To evaluate the surgical technique and functional results of displaced sacral fractures. Methods From September 2000 to September 2007, thirty-three patients of pelvic injuries with sacral fractures treated with operation were assessed. There were 5 type-B pelvic fractures, and 28 type-C fractures, according to the AO/OTA classification system. Sacral fractures were classified by Denis classification into type- I , type- II, and type-III in 13, 11, and 9 cases, respectively. The patients with neurological injuries were find in 23 cases. Fractures of sacrum were fixed with tension band transiliac plate osteosynthe-sis in 1 case; pedicle rod-screw system placed to the iliac crest posterior to the pelvis for transversal fixation in 10; vertical distraction fixation through L_(4,5), L_5S_1, and bilateral iliac crest in 16; iliosacral screws fixation in 3; sacral bars fixation in 2; and combination of iliosacral screws and sacral bars in 1. Techniques for neural decompression with laminotomy and neurolysis of cauda equina nerve intraoperatively in 11 cases, and with delayed neurolysis and foraminotomy in 2. Results All patients were followed up on an average of 27.3 months. Clinical outcome was rated "excellent" in 17 cases, "good" in 7, "fair" in 2 and "poor" in 7, according to the Majeed functional evaluation. The satisfaction rate of clinical effect for sacral fractures of Denis type- I , type- II, and type-III was 92.3%, 72.7%, and 44.4%, respectively. For the neural decompression patients, neurological injuries from sacral fractures were recovered of "excellent" in 6 cases, "good" in 4 and "no changes" in 3. But for nonoperative group, the degree of recovery viewed "excellent" in 6 cases, "good" in 1, and "no changes" in 3. Complications of surgical treatment included: deep infection in 2 cases; unsatisfactory reduction and lumbosacral pains in 2; transient exacerbation of injured neural function in 4; and delayed sacral nerve injuries in 3. Conclusion Surgical treatment is important for improving reduction of sacral fractures; combination of anterior and posterior pelvic ring fixation enhance the strength of internal fixation effectively; early neural decompression could be helpful to recovery of the neural function.
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