Department of Orthopaedic Surgery, Denver Health Medical Centre, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
Injury. 2009 Apr;40(4):405-9. doi: 10.1016/j.injury.2008.06.039. Epub 2008 Dec 17.
Vertically unstable sacral fractures often make it difficult to achieve rigid fixation and there is no consensus on the optimal fixation technique for these injuries. The purpose of this study was to evaluate complication rate and short-term outcome of vertically unstable sacral fractures treated by posterior transiliac plate fixation. We performed a retrospective review of prospectively collected data of patients who underwent posterior transiliac plating for sacral fractures at two institutions. All patients were treated with the standard posterior approach using a 4.5-mm reconstruction plate and followed for at least 12 months. Patients' demographics, Majeed functional questionnaire surveys, and radiographic outcomes were collected. There were 19 patients with a mean age of 37.5-years. The mean follow-up was 26.3 months. The most frequent mechanism of injury was a fall from a height. According to the AO/OTA classification, there were 10 C1, 6 C2, and 3 C3, which were classified as 2 Denis I, 20 Denis II, and 2 Denis III, including 5 bilateral sacral fractures. Neurological deficit at the initial examination was recorded in 10 patients. The mean ISS was 20.7 and the mean timing of the internal fixation was 6.4 days. Anterior internal fixation of pelvic ring was added in eight patients. A Morel-Lavallee lesion was identified in 5 patients during the operation. Reductions were graded as nine excellent, seven good, and three fair according to the method of Tornetta. There were two postoperative surgical wound infections, both occurring in patients with a Morel-Lavallee lesion. All the sacral fractures united eventually and no implant failure occurred, though there were two patients with a small loss of reduction (<5mm) over the follow-up period. A total of 18 patients completed the functional assessment with a mean score of 78.5 points. Posterior plate fixation of vertically unstable sacral fractures is effective in maintaining fracture reduction even in the presence of significant posterior comminution. We caution its use in the presence of a known Morel-Lavallee lesion, as this may increase the wound complication and infection risk.
垂直不稳定骶骨骨折常使刚性固定变得困难，对于这些损伤，尚无固定技术的最佳共识。本研究旨在评估经后路髂骨板固定治疗垂直不稳定骶骨骨折的并发症发生率和短期疗效。我们对两家机构的患者进行了前瞻性收集数据的回顾性研究，这些患者均通过后路经髂骨板治疗骶骨骨折。所有患者均采用标准后路入路，使用 4.5 毫米重建板，并至少随访 12 个月。收集患者的人口统计学资料、Majeed 功能问卷调查和影像学结果。患者 19 例，平均年龄 37.5 岁，平均随访 26.3 个月。最常见的损伤机制是高处坠落伤。根据 AO/OTA 分类，有 10 例 C1 型、6 例 C2 型和 3 例 C3 型，其中 2 例为 Denis I 型，20 例为 Denis II 型，2 例为 Denis III 型，包括 5 例双侧骶骨骨折。10 例患者在初次检查时存在神经功能缺损。ISS 平均为 20.7，内固定平均时间为 6.4 天。8 例患者加用骨盆环前路内固定。5 例患者术中发现存在 Morel-Lavallee 损伤。根据 Tornetta 方法，复位分级为 9 例优、7 例良、3 例可。术后发生 2 例手术切口感染，均发生于存在 Morel-Lavallee 损伤的患者。所有骶骨骨折最终均愈合，无植入物失败，但有 2 例患者在随访过程中出现小的复位丢失（<5mm）。18 例患者完成了功能评估，平均得分为 78.5 分。后路垂直不稳定骶骨骨折钢板固定可有效维持骨折复位，即使存在明显的后柱粉碎。我们警告在存在已知的 Morel-Lavallee 损伤时使用它，因为这可能会增加伤口并发症和感染风险。
