不稳定Isler II型和III型骶骨骨折腰骨盆固定治疗的临床和影像学结果

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-15 DOI:10.1016/j.jcot.2025.103045

Zubair Khalid , Umair Nadeem , Jawad Ul Haq , Awais Nawaz Khan , Atiq Uz Zaman

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引用次数: 0

摘要

背景：骶骨骨折占骨盆骨折的很大一部分，从10%到45%不等。在骶骨骨折中，17% - 30%属于不稳定型。本研究的目的是探讨腰骨盆固定（LPF）治疗Isler II型和Isler III型不稳定骶骨骨折的临床和影像学结果。方法2019年1月至2021年12月在拉合尔三级医院进行前瞻性队列研究。随访至2023年7月。我们分析了诊断为不稳定Isler II型和Isler III型骶骨骨折的患者，他们采用后三角骨固定术（PTO）进行LPF。术前和术后（随访2年）进行全面的临床和放射学评估。对临床和影像学结果进行评价。结果13例患者中，男性占多数（8例，占61.5%），手术时平均年龄27.46±3.73岁。神经功能受损9例（69.2%）。II型Isler骨折7例（53.8%），III型Isler骨折6例（46.2%）。术前视觉模拟评分（VAS）平均评分由6.62±1.12显著改善至术后1.85±0.80 (p <；0.0001)。术后平均Oswestry残疾指数（ODI）评分由82.15±6.61改善至17.61±1.45 (p <；0.0001)。放射学观察，所有患者骨折完全愈合，无一例需要翻修手术。4例患者（30.8%）存在残留畸形，但临床认为不显著。2例患者（15.4%）发生手术部位浅表感染（SSI），经抗生素有效治疗。结论腰骨盆固定治疗Isler II型和III型不稳定骶骨骨折可显著改善疼痛和残疾评分，所有患者骨折均完全愈合。残留的畸形在临床上是微不足道的，并且该手术显示了良好的安全性。

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Clinical and radiological outcomes of lumbopelvic fixation in unstable Isler type II and III sacral fractures

Background

Sacral fractures constitute a significant portion of pelvic fractures, ranging from 10 % to 45 %. Among sacral fractures, 17 %–30 % are categorized as unstable. The objective of the study was to investigate the clinical and radiological outcomes associated with lumbopelvic fixation (LPF) in Isler II and Isler III unstable sacral fractures.

Methods

A Prospective cohort study was conducted at tertiary care Hospital Lahore from January 2019 to December 2021. Patients were followed up till July 2023. Patients diagnosed with unstable Isler II and Isler III sacral fractures who underwent LPF utilizing a posterior triangular osteosynthesis (PTO) were analyzed. Comprehensive clinical and radiological assessments were conducted preoperatively and postoperatively (following a 2-year follow-up period). Evaluation of clinical and radiological outcomes was made.

Results

In a total of 13 patients, the majority were male (8 patients, 61.5 %), with an average age of 27.46 ± 3.73 years at the time of surgery. Neurologic function was impaired in 9 patients (69.2 %). Seven patients (53.8 %) had Isler II fractures, while the remaining 6 patients (46.2 %) had Isler III fractures. The mean preoperative Visual Analog Scale (VAS) score improved significantly from 6.62 ± 1.12 to 1.85 ± 0.80 postoperatively (p < 0.0001). The mean postoperative Oswestry Disability Index (ODI) score improved from 82.15 ± 6.61 to 17.61 ± 1.45 (p < 0.0001). Radiologically, complete fracture healing was observed in all patients, with none requiring revision surgery. Residual deformity was present in 4 patients (30.8 %), but it was deemed clinically insignificant. Two patients (15.4 %) experienced superficial surgical site infections (SSI), which were effectively treated with antibiotics.

Conclusion

Lumbopelvic fixation for Isler II and III unstable sacral fractures significantly improved pain and disability scores, with complete fracture healing observed in all patients. Residual deformities were clinically insignificant, and the procedure demonstrated a favorable safety profile.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.