Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Tanta University Hospital, University of Tanta, Al-Geish Street, Tanta, Egypt.
Eur Spine J. 2012 Sep;21(9):1815-25. doi: 10.1007/s00586-012-2406-9. Epub 2012 Jun 26.
Displaced spinopelvic dissociation with cauda equina syndrome is still unclear challenging problem with multiple instabilities. This retrospective study tried to evaluate and analyze the results of surgical decompression and lumbopelvic fixation of these injuries.
Twenty-eight polytrauma patients with displaced spinopelvic dissociation and cauda equina syndrome were included. Preoperatively, they had thorough clinical, neurological, and radiological evaluation and classification. Operatively, they underwent primary, secondary, or tertiary decompression then spinopelvic fixation. Postoperatively, they were followed up for an average of 26 months. Hannover pelvic scoring system was applied for outcome evaluation.
The mean age was 33.7 years; 17 cases were males and 11 were females. According to Roy-Camille, 13 cases had type II and 15 cases had type III injuries; cauda equina syndrome was incomplete in 17 cases and complete in 11 cases. Unilateral L5-S1 facet joint injury was detected in 13 cases; 14 cases had direct decompression (50 %) and 14 cases had indirect decompression (50 %). 19 patients (67.9 %) had excellent and good clinical outcome. Primary decompression had significantly increased the chances for neurological recovery (p = 0.024). Initial fracture kyphosis angles had a significant effect on neurological retrieval (p = 0.016). The mean of Gibbons score improved from 3.1 ± 0.83 preoperatively to 1.5 ± 0.84 at the end of follow-up with a highly significant impact (p = 0.001).
Surgical decompression and lumbopelvic segmental fixation can enhance neurological recovery and combat any structural instabilities associated with the displaced spinopelvic dissociation injuries with a hopeful clinical results.
伴有马尾综合征的移位性脊柱骨盆分离仍然是一个具有多重不稳定因素的棘手问题。本回顾性研究旨在评估和分析这些损伤的手术减压和腰骶骨盆固定的结果。
纳入 28 例伴有移位性脊柱骨盆分离和马尾综合征的多发创伤患者。术前进行了全面的临床、神经和影像学评估和分类。手术中，患者接受了一期、二期或三期减压和脊柱骨盆固定。术后平均随访 26 个月。采用汉诺威骨盆评分系统进行疗效评估。
患者平均年龄为 33.7 岁；男性 17 例，女性 11 例。根据 Roy-Camille 分型，13 例为Ⅱ型，15 例为Ⅲ型损伤；马尾综合征不完全 17 例，完全 11 例。单侧 L5-S1 关节突关节损伤 13 例；直接减压 14 例（50%），间接减压 14 例（50%）。19 例（67.9%）患者临床预后良好。初次减压可显著增加神经恢复的机会（p = 0.024）。初始骨折后凸角对神经恢复有显著影响（p = 0.016）。Gibbons 评分从术前的 3.1 ± 0.83 提高到随访结束时的 1.5 ± 0.84，具有显著意义（p = 0.001）。
手术减压和腰骶骨盆节段固定可以增强神经恢复，对抗与移位性脊柱骨盆分离损伤相关的任何结构不稳定，获得有希望的临床结果。
