骶骨骨折合并神经损伤的诊断与治疗_医学论文.docVIP

骶骨骨折合并神经损伤的诊断与治疗_医学论文 骶骨骨折合并神经损伤的诊断与治疗_医学论文 【摘要】 ［目的］总结骶骨骨折合并骶神经损伤的诊断与治疗方法。［方法］1999～2004年收治骶骨骨折合并神经损伤患者12例，男9例，女3例。所有患者经详细体格检查及X线片、CT、MRI扫描等获得确诊。依据影像学资料进行Denis分型：Ⅰ型2例，Ⅱ型6例，Ⅲ型4例。不同分型采取相应的治疗方法：Ⅰ、Ⅱ型骨折先行骨盆牵引等保守治疗，观察4～6周，若症状改善不显著则转为手术治疗；Ⅲ型骨折尽早行后路骶椎管减压神经根探查松解手术；陈旧性Ⅱ、Ⅲ型骨折只要存在神经损伤表现，仍主张手术。共保守治疗7例，手术治疗5例。［结果］12例患者经6个月～3年随访，2例Ⅰ型骨折，6例Ⅱ型骨折患者完全恢复。4例Ⅲ型骨折患者中，1例完全恢复，2例显著改善，1例略有恢复。［结论］骶骨位置隐蔽，骨折所造成的神经损伤症状不明显，临床容易漏诊，需详细体检并结合影像学检查以提高确诊率。不同分型骨折可采用不同的治疗方法，手术方式以后路骶管减压骶神经松解为宜，陈旧性骨折只要存在神经损伤症状就有手术探查必要。 【关键词】 骶骨骨折；神经损伤；诊断； 治疗 　　Diagnosis and surgical treatment of sacral fracture accompanied by neurological damage 　　Abstract：［Objective］To study the diagnosis and treatment of sacral fracture accompanied by neurological damage.［Method］Twelve patients with sacral fracture accompanied by nerve injuries were treated and analyzed during 1999 to 2004,including 9 males and 3 females. Final diagnosis was given according to the evaluation of physical examination,X-ray,CT and MRI examinations. Dennis classification found 2 cases of I type,6 cases of Ⅱ type and 4 cases of Ⅲ types.The surgical approach of these patients were selected according to the Dennis　classification,Type Ⅰ and type Ⅱ were treated with conservative methods,and operations were　taken if little symptom was no or a little improved. Posterior approach enlargement for sacral nerve canal,exploration and endoneurolysis on sacral nerve were performed on type Ⅲ as early as possible.Old fracture of type Ⅱ and type Ⅲ with neurologic signs had to be operated early.Conservative and operative treatments were taken 7 and 5 respectively.［Result］After six months to three years following up,two cases of Denis type Ⅰ,six cases of Denis type Ⅱ and one in four Denis type Ⅲ cases were recovered　completely.Two cases of Denis Ⅲ were improved significantly while one case was improved a little.［Conclusion］The anatomical position of sacrum is not conspicuous and the symptom caused by neurological damage is too tiny to detect.Carefully physical examination comb