Reynier Y, Grisoli F, Delarque A, Vigouroux R P
Neurochirurgie. 1982;28(1):25-32.
Transverse sacral fractures with cauda equina lesion appear only sporadically in the world literature. In our medical center 667 spine fractures were admitted during a twelve year period and we report only 2 cases of sacral fractures with neurological lesions (0,20%). The neurological abnormalities that occur are a perianal sensory loss with bladder and anal sphincters disturbance. Sphincters electromyographic studies and cystometric examination show a lower motor neuron lesion. In one of our cases, the nervous lesion was more spread with an unilateral sensory loss S1-S2 and a motor loss L4-L5 S1 in the same side. The high level of sacral lesion (S1-S2), the association with other pelvic fractures and fractures of the lower lumbar transverse processes, suggests the mechanism of injury (sudden flexion). Radiological studies show that sacral fractures are often difficult to detect (necessity of lateral view). Lumbar metrizamide exploration seems not very interesting. Sacral laminectomy which permits the decompression of sacral roots appears like the best treatment. The post-operative course, studied by clinical findings, electromyographic and cystometric examinations, shows the habitual resolution of neurological deficit (incomplete nevertheless in our 2 patients).
伴有马尾神经损伤的骶骨横断骨折在世界文献中仅偶尔出现。在我们的医疗中心，12年间收治了667例脊柱骨折患者，而我们仅报告了2例伴有神经损伤的骶骨骨折（0.20%）。出现的神经异常表现为肛周感觉丧失以及膀胱和肛门括约肌功能障碍。括约肌肌电图检查和膀胱测压显示为下运动神经元损伤。在我们的1例病例中，神经损伤范围更广，出现同侧S1 - S2节段单侧感觉丧失以及L4 - L5、S1节段运动功能丧失。骶骨损伤的高位水平（S1 - S2）、与其他骨盆骨折及下腰椎横突骨折的关联提示了损伤机制（突然屈曲）。放射学研究表明，骶骨骨折往往难以检测（需要侧位片）。腰椎甲泛葡胺造影似乎不太有意义。能够对骶神经根进行减压的骶骨椎板切除术似乎是最佳治疗方法。通过临床检查、肌电图和膀胱测压检查对术后病程进行研究，结果显示神经功能缺损通常会得到缓解（不过在我们的2例患者中仍为不完全缓解）。
