The Clinical Study Of Lumbar-sacurm- Iliac Screws Fixtion On The Treatment Of Complicated Sacral Fractures

Objective:To discuss the lumbar-sacurm- iliac screws clinical curative effect for the treatment of complex fractures of the sacrum.Methods:Retrospective analysis of our hospital from January 2012 to October 2014 were up to the standard of the 18 patients with complex fractures of the sacrum, these patients patients with unstable pelvic fractures and varying degrees of horsetail nerve dysfunction. Men in 11 cases, 7 cases of female patients. An average of 32 years old. Cause: 11 cases, falling, 5cases of traffic accident injury, 2 cases of heavy parts. All patients have different parts and different levels of united injury. According to Gibbons classification standard, all of the patients on admission Gibbons ratings are 4 points. Patient condition allows, after the completion of preoperative preparation, using the way of posterior lumbar-sacurm- iliac screws fixtion and lumbosacral canal decompression to treat those patients.During intraoperation,place the L5 pedicle screws, S1 universal screw.If affected by fracture fixed phase can be extended to L4, S2 level. Place iliac screws: on the posterior spine by rongeur to remove 2 cm on the part of the posterior spine bone cortex(1.5 cm x 1.5 cm), forming a small trough. Here in a certain operating mode implanted iliac screws(see detailed steps paper). After nailing according to patients with neurological damage and fracture shift condition for sacral canal decompression, carefully observe the nerve root injury situation,cautious, release the lumbosacral nerve roots in searches(preventing secondary injury of nerve). After sufficient decompression, fixed link connection on both sides of the screw,respectively by alternately fixed iliac screws and sacral screw, open to correct vertical displacement and rotational displacement, finally placed horizontal even. Follow-up:postoperative patients into a monthly review within three months, after 3 months once every half a year to review. Improve the preoperative and postoperative related inspection data,according to the preoperative patients with postoperative Gibbos score, Majeed score to evaluate recovery of neurological function.By measuring the angles formed by the sacrum fracture end deformity to evaluate fracture restoration situation.Using SPSS 17.0 software for statistical analysis. Paired t test for patients with the comparison of measurement data application, for patients with Fisher’s exact test count data application, P < 0.05 think the difference was statistically significant.Results:Time from injury to the surgical treatment of 18 patients undergoing surgery in 2 days-21 days treatment, an average of 10.2 days. The scope of the operation time is 150-240 minutes, the average is 180 minutes. Intraoperative bleeding is the range of 600-200 ml, the average is 1100 ml. The scope of the postoperative follow-up time is 13 to 34 months, an average of 23.4 months. After an average follow-up of 23.4 months, Gibbons average score from four points preoperatively to 2.78 points. Patients with preoperative average alpha Angle of 42.89 degrees, 21.94 degrees after surgery. 18 patients with postoperative Majeed scoring average: 64.5. Postoperative efficacy: outstanding 3 cases, good in 3 cases, reluctant to 7 cases, is poor in 5 cases. Fine rate was 33.33%.Conclusions:1. The waist sacroiliac screw joint fixed pelvic physical power transmission can imitate the spine, provide higher stability, reduce invasive on the human body, treatment of complex fractures of the sacrum satisfactory effect. 2. Nerve damage in patients with incomplete contact some recovery of neural function, and there is no exact of rectum and bladder function recovery. 3.The nerves of dominating the rectum and bladder are more rich than the nerves of dominating sensory and motor. Because of this reason to reduce the unilateral lumbosacral nerve root damage on the negative impact of the rectum and bladder function recovery.4. Clinical surgical intervention treatment time is determined by the state of patients.In the process of treatment is still not sure the relationship between the decompression time and neural functional recovery.