Shetty Ajoy Prasad, Renjith Karukayil Ramakrishnan, Perumal Ramesh, Anand Sri Vijay, Kanna Rishi Mugesh, Rajasekaran Shanmuganathan
Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt. Ltd., Coimbatore, India.
Asian Spine J. 2021 Oct;15(5):575-583. doi: 10.31616/asj.2020.0337. Epub 2020 Dec 28.
This is a retrospective study.
Recent advances in intraoperative imaging and closed reduction techniques have led to a shifting trend toward surgical management in every unstable sacral fracture. This study aimed to evaluate the clinicoradiological outcome of the sacroiliac (SI) screw and lumbopelvic fixation (LPF) techniques and thereby delineate the indications for each.
Optimal management guidelines for unstable sacral fractures are still lacking probably due to the rarity of these injuries and varying fixation trends.
Out of the 67 patients, 40 and 27 were in the SI and LPF groups, respectively. The electronic medical record for each patient was reviewed, including patient demographic data, mode of trauma, coexisting injuries, neurological status (Gibbon's four-grade system), Injury Severity Score, time from admission to operative stabilization, type of surgical stabilization, complications, return to the operating room, and treatment outcome measures using Majeed's functional grading system and Matta's radiological criteria. The minimum follow-up period was 2 years.
Noncomminuted longitudinal injuries with normal neurology and acceptable closed reduction have undergone SI screw fixation (n=40). Irreducible, comminuted, or high transverse fractures associated with dysmorphic anatomy or neurodeficit were managed by LPF (n=27). Excellent and good Majeed and Matta scores at 86.57% and 92.54% of the patients, respectively, were postoperatively achieved.
Unstable sacral fractures can be effectively managed with percutaneous SI screw including vertically unstable injuries by paying strict attention to preoperative patient selection whereas LPF can be reserved for comminuted fractures, unacceptable closed reduction, associated neurodeficit, lumbosacral dysmorphism, and high transverse fractures.
这是一项回顾性研究。
术中成像和闭合复位技术的最新进展已导致在各类不稳定骶骨骨折的治疗上出现向手术治疗转变的趋势。本研究旨在评估骶髂（SI）螺钉和腰骶骨盆固定（LPF）技术的临床放射学结果，从而明确每种技术的适应证。
由于这些损伤罕见且固定趋势各异，目前仍缺乏不稳定骶骨骨折的最佳治疗指南。
67例患者中，40例和27例分别纳入SI组和LPF组。回顾了每位患者的电子病历，包括患者人口统计学数据、创伤方式、并存损伤、神经状态（吉本四级系统）、损伤严重程度评分、入院至手术稳定的时间、手术稳定类型、并发症、返回手术室情况，以及使用马吉德功能分级系统和马塔放射学标准的治疗结果指标。最短随访期为2年。
神经功能正常且闭合复位可接受的非粉碎性纵向损伤采用SI螺钉固定（n = 40）。与畸形解剖结构或神经功能缺损相关的不可复位、粉碎性或高位横形骨折采用LPF治疗（n = 27）。术后分别有86.57%和92.54%的患者获得了马吉德和马塔评分的优和良。
对于不稳定骶骨骨折，包括垂直不稳定损伤，通过严格注意术前患者选择，经皮SI螺钉固定可有效治疗，而LPF可用于治疗粉碎性骨折、不可接受的闭合复位、相关神经功能缺损、腰骶部畸形和高位横形骨折。
