骨盆骨折合并腰骶丛压迫性损伤的早期诊断与手术治疗

目的 探讨骨盆骨折合并腰骶丛压迫性损伤的临床特点和手术疗效.方法 2000年1月至2009年1月,手术治疗19例骨盆骨折合并腰骶从压迫性损伤患者.男13例,女6例;年龄21～56岁,平均34.7岁.骨盆类型按Tile分型,A型2例,B型6例,C型11例;按Young-Burgess分型,前后挤压型1例,侧方挤压型10例,垂直剪切型3例.复合型5例.采用神经减压进行治疗,其中后路减压8例,前路减压6例,前后联合入路减压5例.16例行骨折复位内同定,其中骶髂前路重建钢板内固定6例,经皮骶髂螺钉内崮定3例,后路"M"形钢板内固定4例,髂腰固定3例;同时将前环固定6例.结果 19例患者术中均证实神经有压迫性损伤,手术切口均一期愈合,无皮肤坏死及感染.17例获得随访,随访时间12～72个月,平均27个月.骨折全部临床愈合,愈合时间8～14周,平均10.6周.神经功能完全恢复12例,部分恢复4例,未恢复1例.6例术前合并鞍区感觉减退及排便困难者,4例恢复正常,2例部分恢复.结论 骨盆骨折合并腰骶丛损伤时,应根据临床表现、影像学资料确定神经损伤的性质及部位,如证实神经损伤为骨性压迫,宜尽早手术减压;对骨折移位明显、骨盆不稳者可同期行骨折复位内固定,以获得较好的临床效果.

Operative treatment of pelvis fractures complicated with lumbosacral plexus compression injury

Objective To investigate the characteristics and the operative treatment effect of pelvic fractures complicated with lumbosacral plexus compression injury. Methods From January 2000 to January 2009, 19 patients (13 males, 6 females; mean age 34.7 years) of pelvic fractures complicated with lum-bosaeral plexus compression injury were treated by surgical fixation and neural decompression. The diagnosis of nerve compression were determined by analyzing the clinical manifestation and X-ray and CT imaging findings. The injured nerve were decompressed directly by remove the fracture fragments or callus which compressed the lumbersacralis plexus nerve. Eight cases of nerve decompression were through posterior ap-proach, six through anterior approach, and five through combined approach. Sixteen cases of unstable pelvis fractures were treated by open reducton and internal fixation. Results Seventeen patients were followed up. The mean follow-up time was 27 months (12-72 months). The fractures were clinically healed at 10.6 (8-14) weeks. Regarding the Neural Function of the lower extremity, 12 cases had achieved full recovery, 4 cases had recovered partly, 1 case had no change. Four of the six patients who have bladder and bowel dysfunc-tion had fully recovered while the other two patients still have urinary dysfunction. Conclusion Early and accurate diagnosis of the lumbosacral plexus compression injury accompanied with pelvic fractures were very important. It was key to better outcomes that early decompression the lumbosacral plexus and surgical fixa-tion the pelvis fractures are carried out after injury.