Khalid Zubair, Nadeem Umair, Ul Haq Jawad, Nawaz Khan Awais, Uz Zaman Atiq
Department of Orthopedic and Spine Center Ghurki Trust Teaching Hospital Lahore, Pakistan.
J Clin Orthop Trauma. 2025 May 15;67:103045. doi: 10.1016/j.jcot.2025.103045. eCollection 2025 Aug.
Sacral fractures constitute a significant portion of pelvic fractures, ranging from 10 % to 45 %. Among sacral fractures, 17 %-30 % are categorized as unstable. The objective of the study was to investigate the clinical and radiological outcomes associated with lumbopelvic fixation (LPF) in Isler II and Isler III unstable sacral fractures.
A Prospective cohort study was conducted at tertiary care Hospital Lahore from January 2019 to December 2021. Patients were followed up till July 2023. Patients diagnosed with unstable Isler II and Isler III sacral fractures who underwent LPF utilizing a posterior triangular osteosynthesis (PTO) were analyzed. Comprehensive clinical and radiological assessments were conducted preoperatively and postoperatively (following a 2-year follow-up period). Evaluation of clinical and radiological outcomes was made.
In a total of 13 patients, the majority were male (8 patients, 61.5 %), with an average age of 27.46 ± 3.73 years at the time of surgery. Neurologic function was impaired in 9 patients (69.2 %). Seven patients (53.8 %) had Isler II fractures, while the remaining 6 patients (46.2 %) had Isler III fractures. The mean preoperative Visual Analog Scale (VAS) score improved significantly from 6.62 ± 1.12 to 1.85 ± 0.80 postoperatively (p < 0.0001). The mean postoperative Oswestry Disability Index (ODI) score improved from 82.15 ± 6.61 to 17.61 ± 1.45 (p < 0.0001). Radiologically, complete fracture healing was observed in all patients, with none requiring revision surgery. Residual deformity was present in 4 patients (30.8 %), but it was deemed clinically insignificant. Two patients (15.4 %) experienced superficial surgical site infections (SSI), which were effectively treated with antibiotics.
Lumbopelvic fixation for Isler II and III unstable sacral fractures significantly improved pain and disability scores, with complete fracture healing observed in all patients. Residual deformities were clinically insignificant, and the procedure demonstrated a favorable safety profile.
骶骨骨折占骨盆骨折的很大一部分，比例在10%至45%之间。在骶骨骨折中，17% - 30%被归类为不稳定骨折。本研究的目的是调查伊勒II型和伊勒III型不稳定骶骨骨折行腰骶骨盆固定术（LPF）后的临床和影像学结果。
2019年1月至2021年12月在拉合尔三级护理医院进行了一项前瞻性队列研究。对患者随访至2023年7月。分析了诊断为不稳定伊勒II型和伊勒III型骶骨骨折并采用后三角骨合成术（PTO）进行LPF的患者。在术前和术后（2年随访期后）进行了全面的临床和影像学评估。对临床和影像学结果进行了评估。
总共13例患者中，大多数为男性（8例，61.5%），手术时平均年龄为2�46 ± 3.73岁。9例患者（69.2%）神经功能受损。7例患者（53.8%）为伊勒II型骨折，其余6例患者（46.2%）为伊勒III型骨折。术前视觉模拟量表（VAS）平均评分从6.62 ± 1.12显著改善至术后的1.85 ± 0.80（p < 0.0001）。术后奥斯维斯特里功能障碍指数（ODI）平均评分从82.15 ± 6.61改善至17.61 ± 1.45（p < 0.0001）。影像学上，所有患者均观察到骨折完全愈合，无一例需要翻修手术。4例患者（30.8%）存在残余畸形，但临床认为无显著意义。2例患者（15.4%）发生浅表手术部位感染（SSI），经抗生素有效治疗。
伊勒II型和III型不稳定骶骨骨折行腰骶骨盆固定术可显著改善疼痛和功能障碍评分，所有患者均观察到骨折完全愈合。残余畸形在临床上无显著意义，该手术显示出良好的安全性。
