Lindahl Jan, Mäkinen Tatu J, Koskinen Seppo K, Söderlund Tim
Injury. 2014 Dec;45(12):1914-20. doi: 10.1016/j.injury.2014.09.003.
Spinopelvic dissociation is a rare high-energy injury, which is frequently associated with lumbosacral plexus and cauda equina deficits. During an 18-year period, 36 consecutive patients with a H-type sacral fracture and spinopelvic dissociation were treated using lumbopelvic fixation with a minimum follow-up of 18 months. We evaluated factors prognostic of outcome after standardised surgical fixation and neural decompression. Neurological recovery was assessed by Gibbons’ criteria. Pelvis Outcome Scale (POS clinical score) was used to evaluate the clinical outcome. Despite excellent or good radiological results in the vertical components of the sacral fractures having been achieved in all patients, 15 patients (42%) had a poor clinical outcome. The degree of initial translational displacement in the transverse sacral fracture was significantly associated with neurological recovery (as defined by a change in Gibbons score) (p = 0.038) and final POS clinical score (p < 0.001). Both neurological recovery and clinical outcome were worse in patients with completely displaced fractures than in patients with a partially displaced sacral fracture. The degree of residual translational displacement and kyphosis in the transverse sacral fracture were also associated with clinical outcome (POS clinical score) (p = 0.011 and p = 0,018, respectively). However, Roy-Camille classification (type 2 vs. type 3), age, gender, ISS, timing of surgery, and sacral laminectomy did not have a statistically significant association with the outcome. Based on the results, Roy-Camille sacral fracture classification (type 2 vs. type 3) was not prognostic of neurological impairment. Thus further categorisation of the transverse sacral fractures as partially displaced or completely displaced could be used to predict the rate of neurological recovery following lumbopelvic fixation. Accurate reduction of all sacral fracture components seems to be associated with better clinical outcome.
脊柱骨盆分离是一种罕见的高能损伤，常伴有腰骶丛和马尾神经功能缺损。在18年期间，对36例连续的H型骶骨骨折合并脊柱骨盆分离患者采用腰骶骨盆固定治疗，随访至少18个月。我们评估了标准化手术固定和神经减压后预后的相关因素。神经功能恢复采用吉本斯标准进行评估。骨盆结果量表（POS临床评分）用于评估临床结果。尽管所有患者骶骨骨折的垂直部分均取得了良好或较好的影像学结果，但15例患者（42%）临床结果较差。骶骨横断骨折初始平移移位程度与神经功能恢复（以吉本斯评分变化定义）显著相关（p = 0.038），与最终POS临床评分也显著相关（p < 0.001）。完全移位骨折患者的神经功能恢复和临床结果均比部分移位骶骨骨折患者差。骶骨横断骨折的残余平移移位程度和后凸畸形也与临床结果（POS临床评分）相关（分别为p = 0.011和p = 0.018）。然而，罗伊 - 卡米尔分类（2型与3型）、年龄、性别、损伤严重度评分（ISS）、手术时机和骶骨椎板切除术与结果无统计学显著关联。基于这些结果，罗伊 - 卡米尔骶骨骨折分类（2型与3型）对神经损伤无预后价值。因此，将骶骨横断骨折进一步分为部分移位或完全移位可用于预测腰骶骨盆固定后的神经功能恢复率。准确复位所有骶骨骨折部位似乎与更好的临床结果相关。
