合并神经损伤的骶骨骨折15例救治分析

目的 探讨合并有神经损伤的骶骨骨折的临床处理方法. 方法 对上海交通大学附属第一人民医院2000年3月至2006年8月确诊为合并神经损伤的15例骶骨骨折患者进行回顾性分析,以Gibbons分型系统对神经功能的康复情况进行评估. 结果 15例患者中保守治疗4例;单纯复位内固定6例;单纯神经探查2例;内固定+神经探查3例.根据骨折的具体情况给予相应处理后,患者的神经功能获得一定程度的康复或恢复,其中直肠膀胱功能康复优良率达86%,感觉功能为89%,而运动功能康复优良率仅73%. 结论 骶骨骨折合并的神经损伤与骨折类型及骨盆环稳定性密切相关.早期重建骨盆环的稳定性,恢复骶骨的解剖关系,有利于神经功能的康复.对于神经损伤症状明显的病例,CT、MRI显示骶管或骶前孔破坏并有压迫骶神经可能时,应在内固定的同时进行骶神经探查.晚期手术患者亦可获得一定程度的神经功能恢复.

Treatment of sacrum fracture with nerve injury in 15 cases

Objective To explore the clinic treatment of sacrum fracture with nerve injury. Methods Fifteen patients in Shanghai First People's Hospital from March 2000 to August 2006, who were diagnosed as sacrum fracture with nerve injury, were retrospectively analyzed. Nerve function recovery was evaluated by Gibbons classification. Results The nerve function recovered after treatment, and 86% patients' function of rectum and bladder had a well recovery. 89% patients' function of sensible and 73% of movement recovered. Conclusions Sacrum fracture combined with lumbosacral plexus injury is related to the type of fracture and the stability of the pelvic ring. Reconstructing the stability of pelvic ring, resuming the anatomy of the sacrum will benefit for the nerve function recovery. For the patients with obvious symptoms of nerve injury, the sacral canal and foramina should be decompressed if the CT/MRI found obvious oppression. For the delayed patients, the surgery may have some effects.