腰椎-髂骨固定术在DenisⅢ区粉碎性骶骨骨折后骨盆环重建中的临床应用

摘要

目的 观察研究髂骨后柱的解剖形态及腰椎-髂骨固定术在Denis Ⅲ区粉碎性骶骨骨折后骨盆环重建中的应用价值.方法 用17具尸体骨和干燥骨对髂骨后柱的形态、特征进行观察,测量髂骨后柱的长度、宽度、安全高度及标准高度,描述髂骨钉的进针点及操作方法.选择9例累及DenisⅢ区的粉碎性骶骨骨折合并神经损伤患者,在减压的同时采用腰椎-髂骨固定技术进行骨盆环重建.术后进行随访,对腰椎-髂骨固定技术的作用及神经康复的结果进行分析.结果 髂骨后柱平均长110.57 mm,宽24.24 mm;标准高度14.54 mm,安全高度31.46 mm.使用固定技术的9例患者术后可即刻行翻身活动,8例进行了13～37个月的随访,重建的骨盆环稳定,坐卧行功能良好,植骨融合,达到保持患肢功能和骨盆稳定性的目的 .结论 髂骨后柱为腰椎-髂骨固定技术提供可靠的解剖基础,在骶骨骨折合并前盆环破裂需要神经减压和固定时,该技术可提供牢固的内固定,对骨盆环重建、术后护理和康复有积极意义.%Objective To study the anatomic morphology of posterior column of ilium(PCI)and valne of lumbo-iliac fixation(LIF)in pelvic ring reconstruction following communited Denis Ⅲ sacral fractures.Methods A total of 17 hemi-sectional pelvis and dry ilia were selected to observe the length,width and height(safety and standard)of PCI,when a detailed description was done on the methods determining entry point and operation techniqus for iliac screws anchoring.Nine patients with eommunited sacral fractures involving Denis Ⅲ areas combined with neurologic deficits were decompressed for recovery of neurological function and reconstruction of pelvic ring by using LIF.Postoperative follow-up was done on role of LIF and result of neural rehabilitation.Results PCI was mean 110.57 mm in length,24.24 mm in width,14.54 mm in standard height and 31.46 mm in safe height.Nine patients could turn over in bed immediately following operation and walk one month later.A follow-up for 13-37 months in eight patients showed stable reconstructed pelvic ring,sound function of movement and bone graft fusion,which met the target of keeping stability of fractured extremity and pelvis.Conclusions pCI can provide anatomic support for LIF.When decompression and fixation is needed for sacral fractures combined with anterior pelvic ring disruptions,LIP can provide stable fixation and play an important role in reconstruction,nursing and rehabilitation of pelvic ring.