Isolated u-shaped sacral fracture with cauda equina injury.
Isolated u-shaped sacral fracture with cauda equina injury.
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DOI：
10.3928/01477447-20110228-25
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发表时间：
2011-04-11
期刊：
影响因子：
1.1
通讯作者：
Pan, Jun
中科院分区：
文献类型：
--
作者：
Chen, Hong-Wei;Liu, Guo-Dong;Pan, Jun
孤立性u型骶骨骨折无骨盆前环骨折，合并马尾损伤，是一种高度不稳定的神经损伤，临床上罕见，治疗方法尚不明确。当患者从高处坠落，下肢极度屈曲着地，骶骨是直接触地点时，就会发生这种情况。对骶骨的直接冲击和通过脊柱的垂直挤压能量可能是损伤的主要机制。u型骶骨骨折很容易被误诊，由于骨折和肠影呈角状，骨盆正位片难以发现，因此诊断往往延迟。当临床症状提示可能的u型骶骨骨折时，2- 3毫米切口ct扫描冠状面和矢状面重建可以提供最佳成像来识别和评估骶骨骨折。本文描述了2例患者，一名16岁的女孩和一名40岁的男性，他们患有u形骶骨骨折。患者伤后1周内行骶后椎板切除术，术后恢复满意。随访显示骨愈合，无进一步移位或内固定失败、伤口感染、愈合延迟或钢板和螺钉压迫皮肤。结果表明后路椎板减压重建钢板内固定手术创伤小，并发症少，效果满意。
A highly unstable and neurological injury, the isolated U-shaped sacral fracture without pre-pelvic ring fracture but combined with cauda equina injury is rare in clinics, and the treatment method remains unclear. It can occur when patients fall from a height, the lower extremities hit the ground in extreme flexion, and the sacrum is the direct touchdown point. The direct impact on the sacrum and the vertical extrusion energy through the spinal column may be the main mechanism of injury. The U-shaped sacral fracture is easily missed, and diagnosis is often delayed as it is difficult to detect on anteroposterior view pelvic radiograph due to angulation of the fracture and bowel shadow. When clinical signs suggested a possible U-shaped sacral fracture, a 2- to 3-mm cut computed tomography scan with coronal and sagittal reconstruction can provide optimal imaging to identify and evaluate the sacral fracture.This article describes 2 patients, a 16-year-old girl and a 40-year-old man, with U-shaped sacral fractures. The patients were treated with posterior sacral laminectomy within 1 week after injury and achieved satisfactory postoperative recovery. Follow-up showed bony union with no further displacement or internal fixation failure, wound infection, delayed healing, or compression of the skin by the plate and screws. The results show that posterior vertebral plate decompression and reconstructive plate internal fixation can obtain a satisfactory outcome with minor operation trauma and few complications.