经骶骨纵向固定融合治疗创伤性腰骶脱位

目的:报告1例应用经骶骨纵向固定融合方法治疗重度创伤性腰骶脱位,讨论椎弓根钉联合空心钉经骶骨纵向固定融合治疗腰骶脱位的可行性和可靠性.方法:本病例弯腰时被重物砸伤,腰骶关节V度前脱位.L5椎体向S1椎体前方移位.对患者行后路切开减压,复位,空心钉经骶骨纵向固定,同时行L5和S1椎弓根钉联合固定,椎体间加压融合治疗.结果:术后患者无需外固定,2周离床活动.22个月随访神经功能大部分恢复,行走自如.X线和CT三维重建显示获得骨性融合,无进行性滑脱发生.结论:经骶骨空心钉纵向固定融合治疗腰骶关节脱位控制横向剪切力强,固定可靠.

Traumatic lumbosacral dislocation treated by lumbosacral longitudinal fixation and fusion

Objective: To report a case with acute sever e traumatic lumbosacral dislocation with paralysis below L 5 level, which r eceived an operation with posterior approach with decompression, reduction, lumb osacral fixation and fusion. Methods:In the operation, with C -arm fluoroscopy, guiding pins were longitudinally inserted through the sacral ala, and L 5S 1 disc moved to the L 5 body. Then 2 cannulated screws of femoral neck fracture were inserted, as well as the circumferential fusion wi th compressing on the posterior edges of the vertebral bodies together were perf ormed. Results: The patient sat up on bed without brace suppor t after 2 days, and started movements with crutches after 2 weeks. At the 12th a nd 22th month follow-up, there was only occasional slight lower back discomfort remaining. The patient eventually regained some neurological function, includin g incomplete sensation, muscle strength, and bowel and bladder function. Solid f usion mass was found in radiographs and CT three-dimensions reconstruction imag es. No further slippage and signs of the failure of the instrumentations have be en observed. Conclusion: The percutaneous lumbosacral screws f ixation longitudinally can achieve reliable fixation, eliminating the shear forc e of L 5S 1 disc space. The technique combined with circumferential co mpressive fusion is effective for the treatment of high-grade traumatic lumbosa cral dislocation.