Comparison On Efficacy Of Unstable Sacral Fructure With Three Kinds Of Fixatoion

Objective:To investigate the efficacy of unstable sacral fracture with three surgical methods of treatment,and comparative analysis of them. Methods: Collected 32 cases of unstable sacral fracture patients from January 2008 to December 2015 in the Fitst Affiliated Hospital of Fujian Medical University,all of the cases were treated surgically. According to the DENIS type:?type:11 cases,?type 11 cases,?type 10 cases. The clinical data and follow-up improvement.All patients underwent pelvic radiographs, the pelvic CT scan and three-dimensional reconstruction and other related checks,including 2 cases of posterior plates fixation and sacroiliac screws fixation.9 of them were treated with posterior plates fixation,17 of them were treated with sacroiliac screws fixation, the other 8 patients were underwent pedical screw systems. The data of operation time,length of incision,degree of postoperative pain,postoperative incisional infection were compared among the three groups.The clinical efficacy was evaluated based on neurological outcome and Majeed standards.Neurological outcome was measured by Gibbons criteria. Results:All cases were followed up for 3-38 months,average 12.5±11.2 months. Sacroiliac screws fixation group had two cases of sacral nerve injury after operation, taking a good recovery after removing internal fixation,the other cases did not have intraoperative neurovascular injury,.All cases showed no internal fixation loose or breakage.6 patients developed wound infections.All patients are good in fracture healing,without fracture delayed union or nonunion.In the aspect of postoperative pain,mild in sacroiliac screw group,moderate in posterior plate group,moderate to severe in pedical screw system group.In patients with neurologic impairment,5 patients did not improve,the others had partial to full neurologic recovery,the average Gibbons score improved from 3.00 preoperatively to 1.88 after the operation,preoperative and postoperative differences in paired comparison is statistically significant(P<0.05).There were significant statistical differences in operative time and length of incision among three groups.There were no statistical differences in incisional infection and Majeed standards.Conclusion: According to the type and severity of the fracture, select the appropriate surgical approach.Posterior plates fixation is better than sacroiliac screwsfixation and pedical screw systems fixation in operation time.In terms of length of incision and degree of postoperative pain,sacroiliac screws fixation has a large advantage,followed by posterior plates fixation,pedical screw systems fixation poor.Sacroiliac screws fixation and pedical screw systems fixation have greater surgical risk,ask higher technology;But pedical screw systems fixation is easier to be operated,more convenient to be promoted.The three methods fix firmly,satisfactory clinical efficacy.Patients with nerve injury,early opening reduction,internal fixation and nerve decompression can restore stability of the posterior ring of pelvis,improve the symptoms of nerve injury.