涉及腰骶关节的不稳定型骶骨骨折手术治疗

发布时间：2018-06-01 23:18

  本文选题：不稳定型骶骨骨折 + 骨盆环稳定性　； 参考：《重庆医科大学》2015年硕士论文

【摘要】：目的通过对相关术式的讨论,以及比较不同条件、不同伤情患者的治疗方案,初步探讨涉及腰骶关节的不稳定型骶骨骨折手术治疗方法及临床疗效评价。通过这一研究,讨论各术式在不同方面的优劣势,并对现今多数医疗工作者广泛采用的手术方案进行分析以及总结。方法回顾性分析自2008年1月至2013年6月期间于重庆医科大学附属第一医院进行手术治疗的涉及腰骶关节的不稳定型骶骨骨折患者10例,在所有统计患者中,男性7例,女性3例,患者年龄跨度为28-51岁,平均年龄38.7岁。根据患者临床表现、神经系统查体初步判断是否合并神经系统损伤、以及影像学检查,进行骨折分型(Denis分型及Tile分型)。根据患者骨折解剖区域不同,按Denis方法分型：涉及Ⅱ区2例,涉及Ⅱ区+Ⅲ区5例,涉及Ⅰ区+Ⅱ区+Ⅲ区3例。其中根据Gibbons评分标准：1分4例,3分3例,4分3例。手术方式采用经腰后路行骶神经孔减压+邻近节段腰椎椎弓根螺钉联合骶骨椎弓根螺钉(和/或髂骨螺钉)重建腰-骨盆环稳定性。随访病人中根据Majeed及Gibbons评分评估恢复情况。结果10例病人手术方式采用经腰后路行骶神经孔减压+邻近节段腰椎椎弓根螺钉联合骶骨椎弓根螺钉(和/或髂骨螺钉)重建腰-骨盆环稳定性,手术时间100-210min,平均130min；术中出血量300-700ml,平均480ml。10例患者均获随访,随访时间6-18个月,平均时间为11个月,术后随访所有患者治疗结果均骨性愈合。涉及Ⅱ区2例患者恢复良好,神经功能无明显异常；Ⅱ区+Ⅲ区4例患者恢复良好,1例明显改善(右侧髂骨钉松动,钉棒未断裂,左下肢痛触觉轻度异常,余无明显异常)；Ⅰ区+Ⅱ工区+Ⅲ区1例恢复良好,1例明显改善(右下肢足下垂障碍,余无明显异常),1例改善不明显(双下肢痛触觉明显减退,肌力Ⅱ-Ⅲ级,伴膀胱直肠功能障碍)。结论对于涉及腰骶关节的不稳定型骶骨骨折,早期采取手术治疗往往是首选治疗方案,而手术治疗除摘除碎骨、解除神经根压迫外,还需重视重塑腰-骨盆环的稳定性,腰骶段的重建对于脊柱骨盆的整体稳定性有着重要作用,腰椎椎弓根螺钉联合骶骨椎弓根螺钉(和/或髂骨螺钉)系统能有效重建腰骶段受损结构、坚固骨盆环,是治疗涉及腰骶关节的不稳定型骶骨骨折的有效手段。
[Abstract]:Objective to discuss the surgical treatment of unstable sacral fractures involving lumbosacral joints and evaluate the clinical efficacy by discussing the related operative methods and comparing the treatment schemes of patients with different conditions and different injury conditions. Through this study, we discuss the advantages and disadvantages of different surgical methods, and analyze and summarize the surgical schemes widely used by most medical workers. Methods from January 2008 to June 2013, 10 patients with unstable sacral fractures involving lumbosacral joints were operated at the first affiliated Hospital of Chongqing Medical University. The age span of the patients ranged from 28 to 51 years, with an average age of 38.7 years. According to the clinical manifestations of the patients, nervous system examination to determine whether the nervous system injury or not, as well as imaging examination, fracture classification Denis type and Tile classification. According to the different anatomical regions of fracture, according to the Denis method, there were 2 cases involved in area 鈪，

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