Clinical Study Of Ilio-lumbar Fixation Treating Vertically Unstable Sacrum Fractures In Zone Denis â…¡ Or â…¢

Objective:To explore the outcomes of treatment of zone Denis II or III vertically unstable sacrum fractures with Ilio-lumbar fixation.Methods:Clinical retrospect method is adopted. During April2009to April2011,60patients with zone Denis Ⅱ or Ⅲ vertically unstable sacrum fractures were treated by ilio-lumbar fixation (USS Fixture, Synthes). The patients were positioned prone. A midline skin incision was made. The longitudinal fascial incision was lateral to spinous processes in short segment fixation. Otherwise, the fascial incision was located in midline. The longitudinal fascial incision should also be made in both posterior superior and inferior iliac spines. Two vertebral bodies and two parallel iliac schantzs per ilium were applied in patients who had Spondylolisthesis, old fracture and who were fatter over30%. Others only one vertebral body and one iliac schantz per ilium were applied. A multi-axle4.5mm pedicle screw was placed vertebral body by Dick method. A6.0mm Schantz pin was placed in pylon area of Richard M Schwend’s concept. How to make reduction of sacrum fracture by Synthes’USS Fixture and what is the theory. The displacement of sacral fracture is likely the displacement between two planes. The parallel migration in verticality and horizontal should be thought. At the same time, the angulating migration in coronal plane, horizontal plane and sagittal plane should also be considered. After suitable connection of nails and rods, the reduction in verticality mainly depends on moving along rods. The reduction in horizontal mainly depends on rotating rods and fixing cross bar. The disposal of angulating migration in coronal plane mainly depends on broadening between fractural lines and implanting bone. The disposal of angulating migration in horizontal plane mainly depends on rotating schantz along the rod. The disposal of angulating migration in sagittal plane mainly depends on rotating schantz along the fixing clamp of schantz. The cross bar also makes the fixation integrate. The anterior pelvic ring fixation should be applied when pelvic rotating stabilization is not good enough, or anterior pelvic ring is destroyed.Results:60patients were followed up from24months to36months (average30months). Clinical healing time was8-12weeks (10weeks on average). According to Mears Radiological assessment, the displacements in verticality and horizontal are measured pre-operation and post-operation. Paired t-test is used to analyse the data. There is statistical differences between pre-operative and post-operative data (p<0.05). The Average Gibbons score improved from3.4to1.3. The Majeed functional evaluation was excellent in48cases, good in8, fair in4and poor in0. The main complications included:deep infection in4case, iliac screw prominence in8and rod breakage in4.Conclusions:Ilio-lumbar fixation is a demanding technique to vertically unstable sacrum fractures in zone Denis Ⅱ or Ⅲ.