腹腔镜下神经松解术治疗骨盆骨折合并腰骶干神经损伤的初步临床疗效评估

目的探讨腹腔镜下腰骶干神经松解术治疗骨盆骨折合并腰骶干神经损伤的初步临床疗效。方法回顾性分析6例接受腹腔镜下腰骶干神经松解术的骨盆骨折合并腰骶干神经损伤患者的资料(2019年12月至2020年12月),其中男5例,女1例;平均年龄(36±15)岁(18~53岁);骨盆骨折Tile分型:C1.3型5例,C3型1例;受伤至手术时间:<3 w 2例,3 w~3月1例,>3月3例。术前根据英国医学研究会神经损伤委员会(BMRC)肌力标准:M0级4例,M1级2例。所有患者在术前均通过查体、骨盆增强CT联合磁共振神经成像(MRN)三维图像融合技术确诊为完全性腰骶干神经损伤且性质为软组织卡压。结果6名患者中有4名顺利完成腹腔镜下神经松解,2名患者由于术中神经松解不彻底加行开放手术。腹腔镜手术平均时间(173±8)min;术中平均出血(112±56)ml。末次随访时肌力恢复情况:M4级3例,M3级1例,2例未恢复。结论腹腔镜下神经松解术是一种精准、微创的手术方式,可能是骨盆骨折伴有软组织卡压的腰骶干神经损伤患者的有效治疗方案。

The effectiveness and feasible of laparoscopic neurolysis for the treatment of pelvic fracture combined lumbosacral trunk injury

ObjectiveTo measure the effectiveness and feasible of laparoscopic neurolysis for the treatment of pelvic fracture combined lumbosacral trunk injury. MethodsFrom December 2019 to December 2020, 6 patients with pelvic fracture combined lumbosacral trunk injury were received laparoscopic neurolysis (Male 5, female 1, mean age: 36±15). Tile classification of pelvic fracture: C1.3 of 5 cases, C3 of 1 cases, one patient was presented nerve injury post sacral-illiac screw fixation. The time before operation were: 2 cases less than 3 weeks, between 3 weeks and 2 month was 1 case, over 2 months were 3 case. The muscle strength of patients before operation were recorded according to the level of Nerve Injuries Committee of the British Medical Research Council (BMRC). M0 of 4 cases, M1 of 2 cases. All cases were diagnosed with soft tissue entrapment of lumbosacral trunk by physical examination and enhanced CT and magnetic resonance neurography (MRN) fusion technique. ResultsFour patients were underwent laparoscopic neurolysis successfully and 2 patients were underwent opening operation due to bony entrapment was observed intra-operatively. The mean operative time of laparoscopic neurolysis was (173±8) min and mean blood loss was (112±56) ml. The muscle strength at the endpoint of follow-up were M4 of 3 cases, M3 of 1 cases, no recover in 2 cases. ConclusionsThe laparoscopic neurolysisis a precise, minimally invasive method for the pelvic fracture combined soft tissue entrapment of lumbosacral trunk and the primary effectiveness is safe and sufficient.