Irifune Hideto, Hirayama Suguru, Takahashi Nobuyuki, Chiba Mitsumasa, Yamashita Toshihiko
Department of Emergency Medicine Advanced Critical Care and Emergency Center, Sapporo Medical University School of Medicine, Sapporo, Japan.
Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
Adv Orthop. 2018 May 23;2018:6098510. doi: 10.1155/2018/6098510. eCollection 2018.
Herein, we demonstrate the clinical results of closed reduction in a hyperextended supine position with transsacral-transiliac (TSTI) and iliosacral (IS) screw fixations for Denis zone III sacral fractures.
Sixteen consecutive patients with Denis zone III sacral fractures who were treated between January 2009 and September 2016 were evaluated. All patients were treated using percutaneous TSTI/IS screw fixation during closed reduction performed with patients placed in a hyperextended supine position with body manipulation. The clinical and radiological results were evaluated, and the neurological outcomes were retrospectively assessed using Gibbon's classification system. The clinical outcomes were evaluated using the German Multicenter Study Group Pelvic Outcome Scale (POS).
The sacral kyphotic angle was reduced by 18.06° ± 15.26° (mean kyphotic angle: pre-OP, 39.44° ± 20.56°; post-OP, 21.38° ± 7.39°), and fracture translation was reduced by 5.93 ± 4.95 mm (mean fracture translation: pre-OP, 8.69 ± 8.03 mm; post-OP 2.75 ± 3.97 mm). The mean initial Gibbon's score was 3.00 ± 1.32. Among 15 patients with a follow-up duration of over 12 months, the mean reduction loss in the sacral kyphotic angle was 5.87° ± 10.40° and was 1.00 ± 3.00 mm for the fracture translation. The final Gibbon's score was 1.80 ± 1.21, and 73.3% of patients had good results based on the POS score.
Although closed reduction in a hyperextended supine position with percutaneous posterior screw fixation is associated with some surgical limitations and technical difficulties, the procedure is minimally invasive and highly effective for stabilizing Denis zone III sacral fractures.
在此，我们展示了采用经骶-经髂（TSTI）和髂骶（IS）螺钉固定，在仰卧过伸位下行闭合复位治疗Denis III区骶骨骨折的临床结果。
对2009年1月至2016年9月间连续收治的16例Denis III区骶骨骨折患者进行评估。所有患者均在仰卧过伸位通过身体手法进行闭合复位时采用经皮TSTI/IS螺钉固定治疗。评估临床和影像学结果，并使用吉本分类系统对神经功能结果进行回顾性评估。使用德国多中心研究组骨盆结果量表（POS）评估临床结果。
骶骨后凸角减小了18.06°±15.26°（平均后凸角：术前，39.44°±20.56°；术后，21.38°±7.39°），骨折移位减小了5.93±4.95mm（平均骨折移位：术前，8.69±8.03mm；术后，2.75±3.97mm）。初始吉本评分的平均值为3.00±1.32。在15例随访时间超过12个月的患者中，骶骨后凸角的平均复位丢失为5.87°±10.40°，骨折移位为1.00±3.00mm。最终吉本评分为1.80±1.21，基于POS评分，73.3%的患者结果良好。
尽管仰卧过伸位经皮后路螺钉固定闭合复位存在一些手术局限性和技术困难，但该手术具有微创性，对于稳定Denis III区骶骨骨折非常有效。
