中国组织工程研究

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (31): 5034-5040.doi: 10.3969/j.issn.2095-4344.0567

• 骨与关节综述 bone and joint review • 上一篇    下一篇

骶骨解剖、骨折分型及不同内固定治疗的特点

贾文超1，薛 飞2，冯 卫2，贾燕飞2   

  1. 1内蒙古医科大学研究生学院，内蒙古自治区呼和浩特市 010059；2内蒙古医科大学第二附属医院，内蒙古自治区呼和浩特市 010030
  • 出版日期:2018-11-08 发布日期:2018-11-08
  • 通讯作者: 通讯作者：冯卫，博士，教授，内蒙古医科大学第二附属医院，内蒙古自治区呼和浩特市 010030 并列通讯作者：贾燕飞，教授，主任医师，内蒙古医科大学第二附属医院，内蒙古自治区呼和浩特市 010030
  • 作者简介:贾文超，男，1991 年生，内蒙古自治区呼和浩特市人，汉族，内蒙古医科大学在读硕士。主要从事骨科的相关研究。 并列第一作者：薛飞，内蒙古医科大学第二附属医院，内蒙古自治区呼和浩特市 010030
  • 基金资助:

    内蒙古自然科学基金(2017MS0836)；内蒙古自治区高等学校科学研究项目(NJZZ14143)；内蒙古医科大学青年创新基金

Anatomy, classification and internal fixation of sacral fractures

Jia Wen-chao1, Xue Fei2, Feng Wei2, Jia Yan-fei2   

  1. 1Graduate School of Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China; 2the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010030, Inner Mongolia Autonomous Region, China
  • Online:2018-11-08 Published:2018-11-08
  • Contact: Corresponding author: Feng Wei, MD, Professor, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010030, Inner Mongolia Autonomous Region, China Corresponding author: Jia Yan-fei, Professor, Chief physician, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010030, Inner Mongolia Autonomous Region, China
  • About author:Jia Wen-chao, Master candidate, Graduate School of Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China Xue Fei, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010030, Inner Mongolia Autonomous Region, China Jia Wen-chao and Xue Fei contributed equally to this work.
  • Supported by:

    the Natural Science Foundation of Inner Mongolia Autonomous Region, No. 2017MS0836; the Scientific Research Project of Universities in Inner Mongolia Autonomous Region, No. NJZZ14143; the Youth Innovation Foundation of Inner Mongolia Medical University

PDF

386

摘要：

文章快速阅读：

 
 
文题释义：
不稳定型骶骨骨折：因骶骨上接脊柱，下联骨盆，其部分类型的骨折会严重影响到脊柱及骨盆的稳定性。目前，多数学者认为骶骨骨折移位 > 10 mm或移位≤10 mm但合并有L5横突骨折、骶髂韧带撕脱骨折、骶结节韧带撕脱骨折或骶骨矢状面的骨折线经过DenisⅡ、Ⅲ型时，均可造成骨盆后环不稳定，这些不稳定骨折无论是否存在神经损伤，均应考虑手术治疗。
腰骶部损伤分类系统(LSSIC)：2012年由Lehman等提出用于指导临床复杂骶骨骨折手术的治疗。腰骶部损伤分类系统是仿照脊柱、下颈椎损伤分类(SLIC)系统和胸腰椎损伤分类系统(TLICS)设计的分类系统。该分类依据骨折的形态、骶后韧带复合体、以及神经损伤后的表现来综合评分，从3个类别中创建一个求和得分，称为累积损伤严重分数，总得分在1-10之间。如总和> 4分，建议手术治疗；=4分，需按照患者的具体情况来决定；<4分，则建议保守治疗。
 
摘要
背景：高能量损伤所致不同类型的骶骨骨折越来越常见，神经损伤后严重的临床表现及预后的未知性，以及部分类型的骨折常常导致腰骶结合部的不稳定，使得骶骨骨折的研究逐渐成为热点。目前临床上常用的分型方法是Denis分型、Tile分型、Yuong-Burgess分型等，近几年腰骶椎损伤分类及损伤程度评分系统作为治疗方法的选择逐渐在临床上得到应用。虽然现在可应用于骶骨骨折的内固定种类很多，但不同内固定方式都有各自的适应证，作为临床医生应严格把握适应证。
目的：综述骶骨骨折的分型及不同内固定方式治疗骶骨骨折的研究进展。
方法：由第一作者应用计算机检索PubMed数据库、Embase数据库、CNKI 数据库中从 1976年10月至2017年12月出版的文献，英文检索词：“Sacral fracture；sacrum fractures，sacrum fracture，anatomy，Classification，bones，therapy，3D fluoroscopy-based navigation，internal fixation，Sacroiliac screw fixation，minimal invasive”；中文检索词：“骶骨骨折，解剖，分型，骨，治疗，计算机导航，内固定，骶髂螺钉固定术，微创”。选择与骶骨骨折分型及治疗相关的文章，排除重复、较陈旧的文献及Meta分析。
结果与结论：①近30年来国内外学者从各个层面对骶骨骨折手术的方式展开了研究，分析和总结各种术式的优缺点，基本明确了不稳定骶骨骨折手术的指征；②文章通过综述形式对骶骨的解剖及其骨折的分型及治疗特点进行描述，表明目前微创手术已成为一种发展趋势；③随着对骶骨骨折治疗前后神经损伤的恢复、术后并发症、术后康复时间等方面的深入了解，作者认为在未来的医学研究道路上，仍任重而道远。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0001-7633-278X(贾文超)

关键词: 骶骨骨折, 解剖, 分型, 骨, 治疗, 计算机导航, 内固定, 骶髂螺钉固定术, 微创, 骨科植入物

Abstract:

BACKGROUND: Various types of sacral fractures caused by high energy injury are becoming more and more common, and the severe clinical manifestations after nerve injury, unknown prognosis, and unstable lumbosacral junction in some fractures make sacral fracture become a hotspot. The classifications commonly used in the clinic are Denis, Tile and Young-Burgess. In recent years, classifications of the lumbosacral lesions and scoring systems of the injury severity have often been used for treatment selection. Although there are many kinds of internal fixation used for sacral fracture, different internal fixation methods have their own indications. As clinicians, the indications should be strictly identified and controlled.

OBJECTIVE: To summarize the research progress in the classification and internal fixation treatments of sacral fractures.
METHODS: A computer-based online retrieval of PubMed, Embase and CNKI databases was performed for relevant literatures published from October 1976 to December 2017 with the keywords of “sacral fracture, sacral fractures, sacrum fracture, anatomy, classification, bones, therapy, 3D fluoroscopy-based navigation, internal fixation, sacroiliac screw fixation, minimal invasive” in Chinese and English, respectively. The articles concerning classification and treatment of sacral fractures were collected, and those outdated and repetitive studies and meta-analysis studies were excluded.
RESULTS AND CONCLUSION: (1) In the past 30 years, the operative methods for sacral fracture at all levels have been studied, and the advantages and disadvantages of various types of surgeries are analyzed and summarized. The surgical indications of unstable sacral fracture have been confirmed. (2) We summarize the anatomy, classification and treatment of sacral fractures, which suggests that the minimally invasive surgery has become popular. (3) With the full understanding of the recovery of the nerve injury, postoperative complications, and the recovery time of the sacral fracture, a further investigation is needed. 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Sacrum, Fractures, Bone, Dissection, Internal Fixators

中图分类号: