骶骨骨折合并神经损伤21例临床分析

摘要

Objective To study the diagnosis and treatment of sacral fracture accompanied by neurological damage.Methods Totally 21 nerve injury patients were admitted in our hospital from 2003 to 2013, including 15 males and 6 females, aged from 18 to 66 years(average 36 years).According to Dennis classification,there were 5 cases of type Ⅰ,13 cases of typeⅡand 3 cases of types Ⅲ.Type Ⅰ and type Ⅱ were treated with conservative methods,and surgery treatment was taken depending on the degree of condition improvement after observation of two to three weeks.Posterior decompression of sacral nerve were performed on type Ⅲ as early as possible.Old frac-ture of type Ⅱand type Ⅲwith neurologic signs were operated in the early stage .Results In 21 cases,conserva-tive treatment was performed in 13 cases.Among them,6 cases were excellent,4 cases were good,2 cases were moderate,1 case was poor,the excellent and good rate was 76.92%;operation treatment was conducted in 8 cases,of which 4 cases were excellent,2 cases were good,1 case was moderate,1 case was poor,the excellent and good rate was 75%.Conclusion The symptoms of sacrum fracture caused by nerve damage are not obvious .For high ener-gy impact injury patients ,the sacral should be examined after routine examination .Patients with sacral fracture and nerve injury should be moderately restored as early as possible .Good reduction,firm internal fixation can signifi-cantly decompress the nerve and reduce the secondary injury .Different surgical treatment should be used according to different types of sacral fracture .Posterior decompression of sacral nerve may be an ideal choice to treat sacral fracture accompanied by neurological damage .Nerve injury is a critical operation indication for old sacral fracture .%目的：探讨骶骨骨折分型与神经损伤之间的关系及治疗方法。方法分析本院2003～2013年期间诊治的21例骶骨骨折合并神经损伤患者的临床资料，其中男性15例，女性6例；年龄18～66岁，平均36岁。根据影像学资料，并按照Denis分型标准将所有患者分为Ⅰ型5例、Ⅱ型13例及Ⅲ型3例，并对Ⅰ、Ⅱ型骨折患者先行骨盆牵引等非手术治疗，观察2～3周后，视症状改善程度确定是否实施手术治疗；对于Ⅲ型骨折患者，则尽早行后路骶椎管减压神经根探查减压手术；对于陈旧性Ⅱ、Ⅲ型骨折患者，只要存在神经损伤症状即实施手术。结果对21例实施非手术治疗13例，经7～36个月随访，其中6例优秀，4例良好，2例中等，1例较差，优良率为76.92％；手术治疗8例，其中优秀4例，2例良好，1例中等，1例较差，优良率为75.00％。结论由于骶骨骨折造成的神经损伤症状不够明显，对于高能量冲击损伤等患者，行常规检查的同时，一般应对骶骨部进行检查；在骶骨骨折中，对于合并神经损伤都要尽早给予良好复位，良好的复位、牢固的内固定均可明显降低骨折对神经的压迫和继发性损伤；对于不同的骨折分型应分别选择非手术或手术等相应的治疗方案，手术方式以后路骶管减压骶神经为宜，陈旧性骨折只要存在神经损伤症状即应行手术探查。