Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Chuo-ku, Kobe City, Hyogo, Japan.
Spine (Phila Pa 1976). 2010 Apr 20;35(9):963-6. doi: 10.1097/BRS.0b013e3181bb85d0.
A retrospective study.
We assessed risk factors for lumbosacral plexus palsy related to pelvic fracture that can be evaluated during the acute injury phase with diagnostics such as computed tomography (CT).
Many patients with pelvic fracture are in vital shock, with polytrauma and loss of consciousness, making an accurate neurologic examination very difficult in the emergency room.
This study included 22 patients who had AO classification type B or C pelvic fractures. The 22 patients had 27 posterior osteoligamentary lesions. The average injury severity score (ISS) was 27.5 (range, 16-50). Age, sex, ISS, suicidal jump, longitudinal displacement, sacral transverse fracture, pubic fracture, lumbar transverse process fracture, type of pelvic fracture (AO), and type of sacral fracture (Denis) were examined for a correlation with the lumbosacral plexus palsy. Using coronal reconstruction CT, we considered a 10 mm or greater displacement at the sacrum or sacroiliac joint to be a longitudinal displacement. Transverse sacral fracture was diagnosed by sagittal reconstruction CT.
Of the 22 patients, 5 (22.7%) had lumbosacral plexus palsy (8 of 27 pelvic fractures) detected during treatment. The incidence of lumbosacral plexus palsy was not related to age, sex, ISS. Incidence of palsy was significantly higher when the patient's affected side had longitudinal displacement. Patients who had made a suicidal jump or had a sacral transverse fracture also had a significantly higher risk for lumbosacral plexus palsy. Palsy was not related to the type of pelvic fracture (AO) or sacral fracture (Denis).
In this study, longitudinal displacement of the pelvis, transverse sacral fracture, and trauma from a suicidal jump were risk factors for lumbosacral plexus palsy. These risk factors were helpful in our examination of patients who had severe pelvic fracture with loss of consciousness.
回顾性研究。
我们评估了与骨盆骨折相关的腰骶丛麻痹的危险因素，这些危险因素可以通过 CT 等诊断方法在急性损伤阶段进行评估。
许多骨盆骨折患者处于生命休克状态，伴有多发创伤和意识丧失，使得在急诊室进行准确的神经检查非常困难。
本研究纳入了 22 例 AO 分类 B 或 C 型骨盆骨折患者。这 22 例患者有 27 例后骨-韧带损伤。平均损伤严重程度评分（ISS）为 27.5（范围，16-50）。年龄、性别、ISS、自杀性跳跃、纵向移位、骶骨横断骨折、耻骨骨折、腰椎横突骨折、骨盆骨折类型（AO）和骶骨骨折类型（Denis）与腰骶丛麻痹进行了相关性检查。我们使用冠状重建 CT，将骶骨或骶髂关节的 10mm 或更大的移位视为纵向移位。通过矢状重建 CT 诊断横断骶骨骨折。
在 22 例患者中，5 例（22.7%）在治疗过程中发现腰骶丛麻痹（27 例骨盆骨折中有 8 例）。腰骶丛麻痹的发生率与年龄、性别、ISS 无关。当患者受影响的一侧有纵向移位时，麻痹的发生率显著升高。有自杀性跳跃或横断骶骨骨折的患者也有更高的腰骶丛麻痹风险。麻痹与骨盆骨折（AO）或骶骨骨折（Denis）类型无关。
在本研究中，骨盆的纵向移位、横断骶骨骨折和自杀性创伤是腰骶丛麻痹的危险因素。这些危险因素有助于我们检查伴有意识丧失的严重骨盆骨折患者。
