Romoli S, Petrella L, Becattini Eleonora, Pisano A, Wembagher G C, De Biase P
Spine Surgery Unit, Careggi University Hospital, Largo Palagi 1, 50137, Florence, Italy.
Traumatology and General Orthopedic Surgery, Careggi University Hospital, Florence, Italy.
Eur Spine J. 2023 Jan;32(1):93-100. doi: 10.1007/s00586-022-07330-8. Epub 2022 Aug 14.
The aim of our retrospective study is to analyze how spinopelvic dissociations (SPDs) were treated in a single center trying to better understand how to improve surgical and non-surgical options.
Twenty patients of a single center surgically treated for SPDs between 2013 and 2021 were retrospectively included in this study. Three surgical techniques have been used: modified triangular stabilization, triangular stabilization and double iliac screws stabilization. Follow-up was assessed for up to 11.6 ± 9.9 months through ODI, MRS, NRS, IIEF or FSFI, a CT scan and whole spine X-ray examination.
Twenty patients were admitted to our ER for traumatic spinopelvic dissociation. Surgical treatment for spinopelvic dissociation has been performed on average 11.5 ± 6.7 days after the trauma event. Eighteen fractures were C3 type and two C2 types. Neurological examination showed nerve root injury (N2) in 5 patients, incomplete spinal cord injury (N3) in 4 patients and cauda equina syndrome in two patients (N4). In case of neurologic deficits, routinary nerve decompression was performed. Three different surgical techniques have been used: 8 triangular fixations (Group 1), 6 modified triangular stabilization (Group 2) and 6 double iliac screws triangular fixation (Group 3).
In patients with post-traumatic neurological deficit, decompression surgery and fracture reduction seem to be associated with clinical improvement; however, sexual disorders seem to be less responsive to the treatment. Some open stabilization techniques, such as the double iliac screw, could help in restoring the sagittal balance in case of severe deformities.
我们这项回顾性研究的目的是分析在单一中心如何治疗脊柱骨盆分离（SPD），以更好地了解如何改进手术和非手术治疗方案。
本研究回顾性纳入了2013年至2021年间在单一中心接受手术治疗的20例脊柱骨盆分离患者。采用了三种手术技术：改良三角稳定术、三角稳定术和双髂螺钉稳定术。通过Oswestry功能障碍指数（ODI）、Majeed功能评分（MRS）、数字疼痛评分（NRS）、国际勃起功能指数（IIEF）或女性性功能指数（FSFI）、CT扫描和全脊柱X线检查对患者进行了长达11.6±9.9个月的随访。
20例患者因创伤性脊柱骨盆分离入住我院急诊室。脊柱骨盆分离的手术治疗平均在创伤事件发生后11.5±6.7天进行。18例骨折为C3型，2例为C2型。神经学检查显示，5例患者有神经根损伤（N2），4例患者有不完全脊髓损伤（N3），2例患者有马尾综合征（N4）。对于神经功能缺损患者，进行了常规神经减压。采用了三种不同的手术技术：8例三角固定（第1组）、6例改良三角稳定术（第2组）和6例双髂螺钉三角固定（第3组）。
对于创伤后神经功能缺损患者，减压手术和骨折复位似乎与临床改善相关；然而，性功能障碍对治疗的反应似乎较差。一些开放稳定技术，如双髂螺钉，在严重畸形情况下有助于恢复矢状面平衡。
