Ebraheim N A, Biyani A, Salpietro B
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo, USA.
Spine (Phila Pa 1976). 1996 Oct 15;21(20):2390-6. doi: 10.1097/00007632-199610150-00020.
Case reports.
To define the radiologic characteristics, management, and results of Zone III fractures of the sacrum.
Zone III fractures of the sacrum are rare. There are few case reports of longitudinal fractures of the sacrum involving Zone III.
The authors report eight (four transverse, four longitudinal) Zone III fractures of the sacrum. Seven patients were treated surgically by posterior sacral decompression with or without transiliac bar fixation, and one neurologically intact patient with undisplaced longitudinal fracture was treated conservatively.
Two neurologically compromised patients had return of normal bladder and rectal function, and another had bladder recovery only. The rest continued to show neurogenic bladder and required intermittent self-catheterization. The patient with bilateral foot drop had partial motor recovery and did not require an ankle-foot orthosis.
These fractures may be difficult to diagnose in polytraumatized patients and require a high index of suspicion. The longitudinal fractures may not be apparent on anteroposterior radiographs, and computed tomography scan may be necessary for establishing the diagnosis. The transverse fractures may show a characteristic step ladder sign on anteroposterior radiographs when the fracture is displaced severely. Proper lateral radiographs often are difficult to obtain, particularly in obese polytraumatized patients. Routine computed tomography scan may overlook the diagnosis. Therefore 2- to 3-mm computed tomography cuts are recommended, which may show double neural foramina in presence of significant anteroposterior displacement and overriding of the fracture fragments. Sagittal computed tomography reconstructions are useful in evaluating the transverse fractures. Posterior sacral decompression is safe and probably promotes nerve root recovery. Longitudinal fractures may be stabilized satisfactorily by transiliac rod fixation.
病例报告。
明确骶骨Ⅲ区骨折的放射学特征、治疗方法及结果。
骶骨Ⅲ区骨折较为罕见。涉及Ⅲ区的骶骨纵向骨折的病例报告较少。
作者报告8例骶骨Ⅲ区骨折（4例横行骨折，4例纵向骨折）。7例患者接受了后路骶骨减压术，部分患者同时进行了或未进行髂骨棒固定手术治疗，1例神经功能完好的无移位纵向骨折患者接受了保守治疗。
2例神经功能受损患者膀胱和直肠功能恢复正常，另1例仅膀胱功能恢复。其余患者仍表现为神经源性膀胱，需要间歇性自我导尿。双侧足下垂患者运动功能部分恢复，无需佩戴踝足矫形器。
这些骨折在多发伤患者中可能难以诊断，需要高度怀疑。纵向骨折在前后位X线片上可能不明显，可能需要计算机断层扫描来确诊。严重移位的横行骨折在前后位X线片上可能显示特征性的阶梯征。通常很难获得合适的侧位X线片，尤其是在肥胖的多发伤患者中。常规计算机断层扫描可能会漏诊。因此，建议进行2至3毫米的计算机断层扫描层厚，这在骨折块存在明显前后移位和重叠时可能显示双神经孔。矢状面计算机断层扫描重建有助于评估横行骨折。后路骶骨减压术安全，可能促进神经根恢复。纵向骨折通过髂骨棒固定可能获得满意的稳定效果。
