Operation treatment of unstable sacral fractures involving the lumbosacral joint

WANG Yao; QUAN Zheng-xue

Abstract：Objective To study the clinical effect and treatment method of unstable sacral bone fracture re-lates to the lumbosacral joint.Methods A retrospective analysis of 10 patients with unstable sacrum fracture from Jan.2008 to Jun.2013 was carried out in our department.Among the patients 7 were male and 3 were female. Their age ranged from 28 to 51 years and the average age was 38.7 years.According to clinical manifestations, whether complicated with nervous system damage and imaging examination, fracture types were decided. Patients with fracture in different anatomical regions according to the Denis method type were divided into as follows:2 cases involving regionⅡ,5 cases involving both regionⅡandⅢand 3 cases involving all the three regions ( regionⅠ,ⅡandⅢ).According to the Gibbons score:4 cases were 1,3 cases were 3 and 3 cases were 4.Patients were op-erated with posterior sacral foramen decompression and lumbar pedicle screws combined with sacral pedicle screws ( and/or iliac screws) to reconstruct the stability of pelvic ring.Majeed and Gibbons scores were employed to evalu-ate the recovery during follow-up.Results The operation time was 100 to 210 minutes with an average of 130 mi-nutes;intraoperative blood loss was 300 to 700 mL and the average was 480mL.All patients were followed up for 6-18 months with an average of 11 months.All patients were healed after operation.Two patients involving region II recovered well without any abnormal nerve function;four cases of patients involving regionⅡandⅢachieved good recovery with remarkable improvement in 1 case;among patients involving all the three regions,1 case recovered well,1 case improved significantly and 1 case had no obvious improvement.Conclusion For unstable sacral bone fracture related to the lumbosacral joint,early operation is often the first choice of treatment.During the treatment, except for removing the broken bone pieces and relieving nerve root compression,attention also needs to be paid to reshape the stability of the pelvic ring.Reconstruction of the lumbosacral segment plays an important role in the sta-bility of the whole weight of spine and pelvis.Lumbar pedicle screws combined with sacral pedicle screws( and/or iliac screws) system can effectively reconstruct damaged lumbosacral structures.It is effective in the treatment of unstable sacral fractures involving the lumbosacral joint.