[Fracture dislocation of the sacral spine with cauda equina lesion. Report of two cases (author's transl)].
[Fracture dislocation of the sacral spine with cauda equina lesion. Report of two cases (author's transl)].
复制标题
[骶椎骨折脱位伴马尾病变。
DOI：
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发表时间：
1982
期刊：
影响因子：
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通讯作者：
R. Vigouroux
中科院分区：
文献类型：
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作者：
Y. Reynier;F. Grisoli;A. Delarque;R. Vigouroux
骶骨横形骨折合并马尾神经损伤在世界文献中仅零星出现。在我们的医疗中心，在12年的时间里，共收治了667例脊柱骨折，我们仅报告了2例骶骨骨折伴神经系统病变（0.20%）。发生的神经系统异常是肛门周围感觉丧失伴膀胱和肛门括约肌障碍。括约肌肌电图检查和膀胱测压检查显示下运动神经元病变。在我们的一个病例中，神经病变更广泛，单侧感觉丧失S1-S2，同侧运动丧失L4-L5 S1。高位骶骨损伤（S1-S2），与其他骨盆骨折和下腰椎横突骨折相关，提示损伤机制（突然屈曲）。影像学研究表明骶骨骨折通常很难发现（需要侧位片）。腰椎甲泛葡胺检查似乎不太有趣。骶骨椎板切除术允许骶神经根减压似乎是最好的治疗方法。通过临床表现、肌电图和膀胱测压检查研究，术后病程显示神经功能缺损习惯性消退（但我们的2例患者不完全）。
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).