Surgical treatment of complex Denis zone Ⅲ sacral fractures / 中华创伤骨科杂志

ABSTRACT

Objective To investigate the surgical treatment of complex Denis zone Ⅲ sacral fractures.Methods A retrospective study was conducted on the 15 complex Denis zone Ⅲ sacral fractures which had been treated from June 2011 to September 2015 in our hospital.They involved 9 men and 6 women,with an average age of 28.8 years (from 15 to 55 years).There were 8 U-shaped,6 H-shaped and 3 lambda fractures.By the Gibbons grading for the sacral nerve injury,3 cases were rated preoperatively as grade Ⅱ,5 cases as grade Ⅲ and 7 as grade Ⅳ.Of them,10 received π-shaped lumbopelvic fixation and sacral decompression 2 weeks after injury,one had lumbosacral fixation and sacral decompression 6 days after injury,and 4 underwent only sacral decompression 3 months after injury when they presented with symptoms of neural injury after fracture malunion.Their sacral malformation angle,visual analogue scale and EQ-5d scale were compared between preoperation and postoperation.Results The 15 cases were followed up for 9 to 47 months (average,24.9 months).Their full-weight-bearing time ranged from 8 to 14 weeks (average,9.9 months).All the incisions healed well without any infection,pressure sore,implant loosening or breakage.There was no significant difference between the preoperative angle of malformation (35.7° ± 5.0°,from 15° to 90°) and the postoperative value (27.9°±6.0°,from 8° to 90°) (t =1.003,P=0.324).Their VAS pain score decreased significantly from preoperative 7.0 ±0.3 to postoperative 1.9 ±0.2,and their EQ-5D score increased significantly from preoperative 0.20 ± 0.03 to postoperative 0.79 ± 0.04 (P ＜ 0.05).The final follow-ups revealed more or less recovery of neural function in all the patients.Conclusions π-shaped lumbopelivic fixation is an effective treatment for complex Denis zone Ⅲ sacral fractures.Effective decompression and stable fixation are prerequisites for early neurological and functional recovery.Simple sacral decompression can effectively promote nerve recovery in patients with old complex Denis zone Ⅲ sacral fractures.