To evaluate clinical efficacy and surgical methods of sacroiliac joint dislocation with ipsilateral sacrosacral wing fracture / 中华骨科杂志

ABSTRACT

Objective:To investigate the surgical methods of sacroiliac joint dislocation with ipsilateral sacrosacral wing fracture through the lateral-rectus approach (LRA) for exposure, fracture reduction and fixation, and nerve exploration and decompression, and to evaluate its clinical efficacy.Methods:Data of 12 patients with sacroiliac joint dislocation and ipsilateral sacral wing fracture treated with LRA for exposure, reduction and fixation of sacroiliac wing fracture and sacroiliac joint dislocation, lumbosacral trunk nerve exploration and decompression (combined with lumbosacral trunk nerve injury) were retrospectively analyzed from January 2016 to July 2019. They were 3 males and 9 females, aged 34.35±16.32 years (13-58 years). The time from injury to operation was 29.25±25.49 d (7-96 d). By the Tile classification, there were 7 cases of type C1.3, 1 case of type C2, 4 cases of type C3. Among them, 8 cases were combined with ipsilateral or bilateral lumbosacral nerve injury. The grade of nerve injury 6 cases of complete injury and 2 cases of partial injury. Interval time from injury to surgery less than 1 week 1 case, 1-2 weeks 2 cases, 2-3 weeks 4 cases, >3 weeks 5 cases. Surgery was performed through LRA, the sacroiliac joint was exposed outside the peritoneum, and the sacral fracture and sacroiliac joint dislocation were reduced. At the same time, the lumbosacral nerve was decompressed and loosened for patients with lumbosacral nerve injury. Then the posterior ring was fixed with a sacroiliac screw or a transsacroiliac joint plate attached to the bony surface.Results:All the 12 cases underwent the operation successfully. The average surgical time was 172.08±36.8 min (range, 105-230 min) and the mean blood loss was 981.67±369.44 ml (range, 400-1 700 ml). Postoperative X-ray and CT indicated an excellent reduction of fracture. One patient with bladder dysplasia had wound fat liquefaction after operation, and no other surgery-related complications. During the follow-up period of 12-72 months, all sacral fractures healed, and the healing time was 7.7±3.38 weeks (6-12 weeks) without complications such as loss of fracture reduction and internal fixation failure. At the 1-year follow-up, 6 of the 8 patients with lumbosacral nerve injury recovered completely, one recovered partially, and the other one had no recovery without nerve exploration.Conclusion:LRA is an ideal surgical approach for treatment of sacroiliac joint dislocation complicated with ipsilateral sacral wing fracture and lumbosacral nerve injury, because it can well expose the medial pelvic joint from the sacroiliac joint to the symphysis pubis, allow direct release of the lumbosacral plexus nerve compressed and stretched, and together with traction of the lower limbs, lead to satisfactory fracture reduction.