伴有马尾神经综合征的陈旧性骶骨骨折的治疗：两例报告并文献复习
Management of neglected sacral fracture with cauda equina syndrome: report of two cases with review of literature.
作者信息
Mahajan R, Tandon V, Das K, Nanda A, Venkatesh R, Chhabra H S
机构信息
Indian Spinal Injuries Centre , New Delhi, India.
出版信息
Spinal Cord Ser Cases. 2015 Oct 8;1:15020. doi: 10.1038/scsandc.2015.20. eCollection 2015.
STUDY DESIGN
A retrospective study was performed.
OBJECTIVES
To analyze the outcome of two neglected sacral fractures who presented late to us after 6 weeks of injury with main complaints of incontinence and numbness in sacral region. There are no guidelines for management of complex fractures of sacrum who present late, and available literature is equally perplexing.
METHODS
Patients were evaluated and radiological investigations were done. Anterior-displaced U-shaped fracture was found to be present between S2 and S3 with bony fragments encroaching the canal. Decompression with wide sacral laminectomies was done without any fixation.
RESULTS
Case 1 showed complete recovery of bladder and perineal sensations 6 months post surgery. Second patient (case 2) had partial recovery of bladder control but numbness persisted till last follow-up at 6 months.
CONCLUSION
Neglected fractures of sacrum that present later than 6 weeks post injury with cauda equina syndrome could be given a chance for decompression if imaging shows canal encroachment with bony fragments. Fixation of fracture may not be required in all unstable sacral fractures after 6 weeks.
研究设计
进行了一项回顾性研究。
目的
分析两例被忽视的骶骨骨折患者的治疗结果，这两名患者在受伤6周后才前来就诊，主要症状为大小便失禁和骶部麻木。对于延迟就诊的复杂骶骨骨折，目前尚无治疗指南，现有文献也同样令人困惑。
方法
对患者进行评估并进行影像学检查。发现S2和S3之间存在向前移位的U形骨折，骨碎片侵入椎管。进行了广泛的骶椎板切除术减压，未进行任何固定。
结果
病例1在术后6个月膀胱和会阴感觉完全恢复。第二例患者（病例2）膀胱控制部分恢复，但麻木一直持续到6个月的最后一次随访。
结论
对于受伤6周后出现马尾综合征的被忽视的骶骨骨折，如果影像学显示有骨碎片侵入椎管，则可给予减压机会。6周后并非所有不稳定的骶骨骨折都需要进行骨折固定。
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