Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado Denver, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
Injury. 2012 Apr;43(4):402-8. doi: 10.1016/j.injury.2010.12.011. Epub 2011 Jan 13.
Traumatic spinopelvic dissociation is a rare high-energy injury pattern, characterised by a transverse sacral fracture in conjunction with bilateral sacral fracture-dislocations. It has a high incidence of neurological complications. The true nature of the injury is easily missed and diagnosis is delayed because it commonly presents in patients with severe associated injuries. In the absence of diagnosis and treatment, it can lead to progressive deformity and chronic pain. Early realignment and fixation of the unstable lumbopelvic junction, with adjunctive decompression of compromised lumbosacral roots, are currently thought to provide the best possible environment for early mobilisation of the polytraumatised patient. Plain pelvic radiographs (anteroposterior, inlet, and outlet), lateral sacral radiograph, CT scan and reconstruction are essential to provide optimal imaging and understanding of the fracture pattern. There is no single treatment paradigm and various surgical strategies have been described in the literature. Lumbopelvic fixation or triangular osteosynthesis has recently been recommended by several authors to restore stability at the lumbosacral junction. This article presents a review of the incidence, clinical evaluation, treatment methods and outcomes of this injury pattern.
创伤性骨盆脊柱分离是一种罕见的高能损伤模式，其特征是横突骶骨骨折伴双侧骶骨骨折脱位。它有很高的神经并发症发生率。由于其常见于严重合并伤患者，因此很容易漏诊，诊断延迟。如果不诊断和治疗，它会导致进行性畸形和慢性疼痛。目前认为，早期对不稳定的腰骶连接进行重新排列和固定，并对受影响的腰骶神经根进行辅助减压，为多发伤患者的早期活动提供了最佳环境。骨盆平片（前后位、入口位和出口位）、侧位骶骨片、CT 扫描和重建对于提供最佳的骨折模式成像和理解至关重要。目前没有单一的治疗模式，文献中已经描述了各种手术策略。腰骶固定或三角骨合成术最近被几位作者推荐用于恢复腰骶连接处的稳定性。本文回顾了这种损伤模式的发生率、临床评估、治疗方法和结果。
