| Objective: To retrospectively analyze the relationship between thedisplacement degree of Denis II sacral fractures and the injury of sacral nerves.Denis Ⅱ fracture zone is fracture line involving sacral pore fracture, in viewof the sacrum fracture Ⅱ area all have different degrees of displacement onthe surface of the coronary, it can be divided into compression fracture andseparation fracture of two subtypes. At different positions of the sacrumfracture, different incidence of nerve injury, including Ⅱ area of the sacrumfracture nerve injury cases accounted for23.5%(19/81).Sacrum shift directionand degree is related to the sacral nerve injury. However, By searchingMedline, Chinese knowledge network, such as database, failed to find thequantitative research data of the relationship between the degree of Denis Ⅱfracture displacement and sacral nerve injury, need to in-depth study. Thisstudy through the analysis of lateral sacral II data, measuring the degree offracture displacement on CT images, Denis type II fracture displacement ofdifferent direction and degree of relationship with sacral nerve damage,provide a reference for diagnosis and treatment of sacral Denis type IIfracture.Materials and Methods:General Information:Using medical record query system query from January2005toDecember2008Denis Ⅱ area of the sacrum fracture patients. Inclusioncriteria: patient age>18years of age, preoperative diagnosis of X-ray and CTimage Ⅱ area of the sacrum fracture patients, patients with clearconsciousness after injury. Exclusion criteria: past medical history have L5and S1, S2nerve root and sacral plexus nerve injury, peripheral arteryinflammation, neural degeneration diseases, diabetes and so on lead to disease of peripheral neuropathy. Record their age, gender, injury location,combination of injury and causes, Read the nerve muscle electromyographyexamination report and physical examination records, determine whethernerve damage has occurred.Image examination:Use of picture archiving and communication system (PACS) patientswith preoperative X-ray and CT images to be obtained, observe whether theshift. According to Ⅱ area of the sacrum fracture displacement direction, onthe surface of the coronary CT image can be divided into compression fractureand separation fracture of two subtypes, on the basis of divided the patientsinto compression fracture and separation of fracture groups. ApplicationRadiAnt DICOM Viewer software on the cross section of a pelvic CT imagemeasuring lateral compression or separation of maximum displacementdistance and Anterior-posterior shift maximum displacement distance, And onthe coronal image measuring a maximum distance of fracture shift up anddown. Statistics of the two groups anterior-posterior displacement, left andright shifting and rotation displacement of fracture cases.Statistical treatment:Application support SPSS11.5statistical software, using t testcompression and separation group were compared with and withoutneurological damage cases of fracture in the biggest shift compression orseparation. By chi-square test two groups were compared with sacral nerveinjury without sacral nerve injury cases with sacral fractures of up and downdisplacement, anterior-posterior shift and rotation displacement distance datasuch as whether there is a difference. Set P <0.05for the difference wasstatistically significant.Result: The study included62cases of sacral fracture Ⅱ area, including41cases of male, female21cases, the average age of35.55(18~57), on theleft side of the30cases, on the right side of26cases,6cases on both sides.40patients with combined injuries, including4cases of clavicle fracture of ribfracture3cases,16cases of lumbar vertebral fracture,5cases of tibiofibula fracture,3cases of humerus fracture, ankle injury in5cases,6cases offemoral fracture,7cases of acetabulum fracture, foot radius fractures in2cases, toe bone fracture3cases,2cases of scapula fracture. For patients withan average of ISS score22(9-42points). Causes include car accident injury33cases, blunt trauma8cases, high falling injury11cases, accidental fall in7cases,3cases of unknown cause trauma. All sacral fractures coronal planewere displacement, for compression of44fractures displaced (compressionfracture group), for the separation of24fractures displaced (separationfracture group); Have a anterior-posterior45fractures displaced,23fractureswith rotating shift (table1). This group of patients with20cases with nervedamage, damaged area is L5~S2control area.Compression fracture group:15fractures with nerve damage, and the average compression distance(7.43+2.98) mm;29fractures without neurological damage, the averagecompression distance was (4.40+3.02) mm; The fractures compressiondistance is similar between the two groups was statistically significant (P=0.003). With nerve injury cases,13fractures with anterior-posteriordisplacement,2fractures without anterior-posterior displacement. No nerveinjury cases,16fractures with anterior-posterior displacement fracture,13fractures without anterior-posterior displacement，there is a comparisondifference in the two groups was statistically significant (P=0.037). Withnerve injury cases,10fractures with rotation displacement fracture,5fractureswithout rotation; displacement fracture. No nerve injury cases,4fractures withrotation displacement fracture,25fractures without rotation displacementfracture. Compare the difference was statistically significant(P=0.001)(table2).Separate fracture group:8fractures with nerve damage, average separation distance (8.24+5.51)mm;16fractures without neurological damage, and the average separationdistance (6.91+2.78) mm; The two groups comparison difference has nostatistical significance (P=0.437). With nerve injury cases,6fractures with anterior-posterior displacement fracture,2fractures without. No nerve injurycases,10fractures with anterior-posterior displacement fracture,6fractureswithout; comparison difference in the two groups has no statisticalsignificance (P=0.535). Accompanied by nerve injury cases,6fractures withrotation displacement,2fractures without rotation; No nerve injury cases,3fractures with rotation displacement,13fractures without rotation; The twogroups comparison difference was statistically significant (P=0.007)(table3).Conclusion: we found that the degree of compression fractures highlyassociated with sacral nerve injuries, and it is much easier to have nerveinjuries when the fracture is present with both front and rear shifts or rotationdisplacement in compression fracture cases. On the other hand, in separationfractures, there is no significant relationship between the separation level andthe sacral nerve injuries, but the separation of fractures with end rotating shiftwill more likely cause the sacral nerve injuries. |
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