Department of Orthopaedics & Physical Performance, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Injury. 2024 Nov;55(11):111825. doi: 10.1016/j.injury.2024.111825. Epub 2024 Aug 13.
Historically, fractures causing lumbopelvic dissociation have been managed with open lumbosacral fusion and instrumentation. Our aim was to evaluate outcomes and complications following surgical management of unstable transverse sacral fractures with percutaneous lumbopelvic fixation.
Design: Retrospective case series.
Academic Single Center, Level I Trauma Center. Patient Selection Criteria: Patients with lumbopelvic dissociation undergoing surgery. Outcome Measures and Comparisons: Patient demographics, mechanism of injury, ISS, associated injuries, radiographic classification (Roy-Camille), patient-reported outcomes (PROMIS PI, PF, D, and ODI), and complications were collected.
27 patients were enrolled with an average follow-up of 18.7 ± 17.6 months and age of 54.4 ± 25.1 years. All patients underwent lumbar pedicle screw and iliac screw placement. Sacral laminectomy was performed if the patient had a preoperative neurological deficit. Patients were counseled on instrumentation removal at 6-12 months. 67 % of patients sustained a fall, and 33 % were involved in an MVA. 52 % were Roy-Camille Type 2, and 32 % and 20 % were Types 1 and 3, respectively. The mean EBL was 261 ± 400 ml. 37 % required concurrent sacral laminectomy. There were no intraoperative complications and four postoperative complications, including surgical site infection, rod dislodgment, and deep venous thrombosis. 63 % underwent removal of instrumentation after fracture healing. ODI scores significantly improved from 6 weeks post-op (35.5 ± 4.5) to one-year follow-up (18.3 ± 9.6, p = 0.005), two-year follow-up (20.3 ± 10.0, p = 0.03), and final follow-up (16.4 ± 8.8, p = 0.002). Statistically significant improvements were observed in the PROMIS PI, PF, and D domains (p < 0.05).
Our study demonstrates that lumbopelvic instrumentation leads to successful management of unstable transverse sacral fractures, with improvement in PRO. The combination of percutaneous instrumentation without arthrodesis did not result in any fracture non-union.
Level IV.
历史上，腰骶骨盆分离导致的骨折采用开放腰骶融合和内固定治疗。我们的目的是评估经皮腰骶固定治疗不稳定横突骶骨骨折的手术治疗结果和并发症。
设计：回顾性病例系列。
学术单中心，1 级创伤中心。患者选择标准：行手术治疗的腰骶骨盆分离患者。
收集患者人口统计学、损伤机制、ISS、合并损伤、影像学分类（Roy-Camille）、患者报告的结果（PROMIS PI、PF、D 和 ODI）和并发症。
共纳入 27 例患者，平均随访 18.7±17.6 个月，年龄 54.4±25.1 岁。所有患者均行腰椎椎弓根螺钉和髂骨螺钉固定。如果患者术前有神经功能缺损，则行骶骨椎板切除术。患者在术后 6-12 个月接受器械去除咨询。67%的患者为跌倒伤，33%为机动车事故伤。52%为 Roy-Camille 2 型，32%和 20%分别为 1 型和 3 型。平均失血量为 261±400ml。37%需要同期行骶骨椎板切除术。术中无并发症，术后发生 4 例并发症，包括手术部位感染、棒移位和深静脉血栓形成。63%的患者在骨折愈合后取出了内固定物。ODI 评分从术后 6 周（35.5±4.5）显著改善至 1 年随访（18.3±9.6，p=0.005）、2 年随访（20.3±10.0，p=0.03）和最终随访（16.4±8.8，p=0.002）。PROMIS PI、PF 和 D 域的评分均有显著改善（p<0.05）。
我们的研究表明，经皮腰骶骨盆内固定可成功治疗不稳定的横突骶骨骨折，患者的 PRO 得到改善。不融合的经皮器械固定组合并未导致任何骨折不愈合。
IV 级。
