Department of Orthopaedic Surgery, University of California at Irvine, Orange, CA 92868, USA.
Spine (Phila Pa 1976). 2013 Jul 15;38(16):E1028-40. doi: 10.1097/BRS.0b013e318297960a.
Systematic review.
To identify and describe reconstruction methods for the treatment of transverse sacral fracture (TSF) and to evaluate outcomes based on treatment interventions.
A variety of surgical interventions for stabilization of TSFs exist, yet the optimal management remains unclear. Although there are many individual case reports and series describing techniques to stabilize TSF, prior reviews fail to provide a comprehensive summary of current and past surgical techniques and their individual outcomes.
Our systematic review searched the PubMed database using keywords identifying sacral fractures with a transverse component, requiring internal fixation for stabilization as well as a review of bibliographies and archives from meeting proceedings.
Our search located 417 publications for abstract review, of which 27 (109 patients) with TSF were included. Average follow-up was 22 months (range, 0-82 mo). Thirty-eight patients (34%) underwent spinopelvic fixation (SPF), 53 (49%) underwent posterior pelvic ring fixation (PPRF), and 18 (17%) underwent both. PPRF included iliosacral screws (37 patients), transiliac screws (11 patients), transiliac screws with plating (3 patients), posterior plating (1 patient), and transiliac bar (1 patient). Additional injuries causing lumbosacral instability were seen in 8 patients (42%) who underwent SPF, 2 patients (18%) treated with PPRF, and 5 patients (45%) who were treated with both SPF and PPRF. Of those who presented with a neurological deficit, 5 patients (45%) with SPF, 9 (39%) with PPRF, and 3 (30%) with SPF and PPRF experienced full neurological recovery. Five patients (45%) with SPF, 7 (30%) with PPRF, and 5 (50%) with both regained partial neurological function. One patient (9%) with SPF, 7 (30%) with PPRF, and 2 (20%) with both experienced no neurological recovery.
PPRF seems to be effective for stabilization of TSF. However, in the setting of further injuries causing additional lumbosacral instability, SPF should be used to ensure effective stabilization.
系统评价。
确定并描述治疗横向骶骨骨折（TSF）的重建方法，并根据治疗干预措施评估结果。
存在多种用于稳定 TSF 的手术干预措施，但最佳治疗方法仍不明确。虽然有许多单独的病例报告和系列描述了稳定 TSF 的技术，但之前的综述未能全面总结当前和过去的手术技术及其各自的结果。
我们的系统评价使用关键词在 PubMed 数据库中进行搜索，这些关键词可识别具有横向成分的骶骨骨折，需要内固定以稳定，并对会议记录的文献综述和档案进行了回顾。
我们的搜索共找到了 417 篇可供摘要审查的出版物，其中有 27 篇（109 例）涉及 TSF，被纳入本研究。平均随访时间为 22 个月（范围 0-82 个月）。38 例（34%）患者接受了脊柱骨盆固定（SPF），53 例（49%）患者接受了骨盆后环固定（PPRF），18 例（17%）患者同时接受了这两种治疗。PPRF 包括髂骶螺钉（37 例）、髂骨螺钉（11 例）、带钢板的髂骨螺钉（3 例）、后路钢板（1 例）和髂骨杆（1 例）。在接受 SPF 治疗的 8 例（42%）、接受 PPRF 治疗的 2 例（18%）和同时接受 SPF 和 PPRF 治疗的 5 例（45%）患者中，还存在导致腰骶部不稳定的其他损伤。在出现神经功能缺损的患者中，接受 SPF 治疗的 5 例（45%）、接受 PPRF 治疗的 9 例（39%）和同时接受 SPF 和 PPRF 治疗的 3 例（30%）患者完全恢复了神经功能。接受 SPF 治疗的 5 例（45%）、接受 PPRF 治疗的 7 例（30%）和同时接受 SPF 和 PPRF 治疗的 5 例（50%）患者部分恢复了神经功能。接受 SPF 治疗的 1 例（9%）、接受 PPRF 治疗的 7 例（30%）和同时接受 SPF 和 PPRF 治疗的 2 例（20%）患者未恢复神经功能。
PPRF 似乎是稳定 TSF 的有效方法。然而，在存在导致腰骶部进一步不稳定的其他损伤的情况下，应使用 SPF 以确保有效的稳定。
