Diagnosis and surgical treatment of sacral fracture accompanied by neurological damage / 中国矫形外科杂志

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 combined with image analysis is necessary to elevate the rate of final diagnosis.Different surgical treatments were used to different type of sacral fracture. Posterior approach enlargement for sacral nerve canal and exploration and endoneurolysis on sacral nerve may be an ideal choice to treat sacral fracture accompanied by neurological damage.Nerves injuries is an critical operation indication for delayed sacral fracture.