Trauma Unit Department of Surgery, Academic Medical Centre at the University of Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands.
Injury. 2009 Oct;40(10):1040-8. doi: 10.1016/j.injury.2008.11.027. Epub 2009 May 13.
U-shaped sacral fractures are rare and highly unstable pelvic ring fractures. They are not recognised in the standard classification systems of these fractures. The fracture pattern is associated with significant neurological injury and can lead to progressive deformity and chronic pain if not diagnosed and treated properly. In recent years a variety of surgical strategies have been shown to facilitate early mobilisation and reduce early mortality as compared to non-operative strategies. Poor evidence, however, has hampered the development of a standard treatment algorithm. As for the long-term morbidity, the influence of operative treatment may be difficult to assess due to associated injury. However, evidence exists that there is a significant effect on the long-term morbidity.
To assess the injury characteristics, choice of treatment and quality of life of U-shaped sacral fractures.
Eight polytraumatised patients with U-shaped sacral fractures were identified over a 7-year period and evaluated retrospectively. They were analysed for fracture classification, associated injury, and injury severity. Clinical and Radiological results were evaluated. Neurological outcome was retrospectively classified by Gibbons' criteria. Long-term quality of life outcome was evaluated using the EuroQoL-6D questionnaire.
The study population consists of five women and three men; with a median age of 29 years. All patients sustained severe associated injury. The Injury Severity Score ranged from 17 to 45 (median 23). The median time between trauma and definitive internal fixation was 4 days (range, 2-22 days). Definitive fixation included either percutaneous iliosacral screws (n=2), transsacral plate osteosynthesis (n=1) or triangular osteosynthesis with (n=4) or without transsacral plating (n=1). Early postoperative mobilisation and early partial weight-bearing were encouraged when possible. Follow-up ranged from 5 to 65 months (median, 36 months). Pain, mood disorders and mobility problems mainly influenced patients' present general health status.
U-shaped sacral fractures present a rare and heterogeneous injury. Operative treatment depended mainly on fracture type, associated spinal fractures, and the surgeon's preference. Long-term quality of life is dominated by pain, mood disorders and moderate mobility problems.
U 形骶骨骨折是罕见且极不稳定的骨盆环骨折。它们在这些骨折的标准分类系统中没有被识别。这种骨折模式与严重的神经损伤有关，如果不能正确诊断和治疗，可能会导致进行性畸形和慢性疼痛。近年来，各种手术策略已被证明可以促进早期活动并降低早期死亡率，与非手术策略相比。然而，由于相关损伤，缺乏证据妨碍了标准治疗算法的发展。至于长期发病率，由于相关损伤，手术治疗的影响可能难以评估。但是，有证据表明，它对长期发病率有重大影响。
评估 U 形骶骨骨折的损伤特征、治疗选择和生活质量。
在 7 年期间，确定了 8 例 U 形骶骨骨折的多发伤患者，并进行了回顾性评估。分析了骨折分类、相关损伤和损伤严重程度。评估了临床和放射学结果。回顾性使用 Gibbons 标准对神经功能结果进行分类。使用 EuroQoL-6D 问卷评估长期生活质量结果。
研究人群由 5 名女性和 3 名男性组成，中位年龄为 29 岁。所有患者均有严重的相关损伤。损伤严重程度评分范围为 17 至 45 分（中位数 23 分）。创伤和确定性内固定之间的中位时间为 4 天（范围 2-22 天）。确定性固定包括经皮髂骨螺钉固定（n=2）、经骶骨钢板固定（n=1）或三角固定（n=4）伴或不伴经骶骨钢板固定（n=1）。只要可能，鼓励术后早期活动和早期部分负重。随访时间为 5 至 65 个月（中位数 36 个月）。疼痛、情绪障碍和活动能力问题主要影响患者目前的整体健康状况。
U 形骶骨骨折是一种罕见且异质性的损伤。手术治疗主要取决于骨折类型、相关脊柱骨折以及外科医生的偏好。长期生活质量主要受疼痛、情绪障碍和中度活动能力问题的影响。
