Objective: To evaluate the effectiveness of lumbopelvic fixation using the combination of closed multi-axial screws (CMAS) iliosacral fixation system and the posterior segmental spinal fixation for unstable sacral fractures.
Methods: Between January 2013 and November 2014, 25 patients (39 sides) with unstable sacral fractures were treated with lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation. There were 17 males and 8 females, aged 19-55 years (mean, 33.9 years). The causes were traffic accident injury in 15 cases, falling injury from height in 8 cases, and crushing injury in 2 cases. The interval of injury and operation was 1-13 days (mean, 3.5 days). Fracture was classified as Denis type I in 2 sides, type II in 20 sides, and type III in 17 sides; nerve injury was rated as Gibbons grade I in 2 cases, grade II in 2 cases, grade III in 7 cases, and grade IV in 9 cases. The reduction quality was evaluated by Matta criterion, the clinical function outcome by Majeed, and nerve function by Gibbons criterion.
Results: The average operation time was 110 minutes (range, 80-150 minutes). The average blood loss was 570 mL (range, 250-1 400 mL). Superficial wound infection occurred in 2 patients, and was cured after debridement and antibiotic therapy. All patients were followed up for an average of 18 months (range, 15-22 months). Postoperative X-ray and CT examination showed clinical healing of sacral fractures at 8-12 weeks after operation (mean, 10 weeks). The mean removal time of internal fixation was 13 months (range, 12-20 months). No screw loosening and fracture, adhesion of internal fixation to surrounding tissue, and obvious electrolysis phenomenon occurred. According to Matta criterion, reduction was rated as excellent in 32 sides, good in 6 sides, fair in 1 side, and the excellent and good rate was 97.5%. According to Majeed functional scoring at last follow-up, the mean score was 84.7 (range, 64-98); the results were excellent in 18 cases, good in 5 cases, and fair in 2 cases, and the excellent and good rate was 92.0%. The nerve function was significantly improved when compared with preoperative one; nerve injury was rated as Gibbons grade I in 8 cases, grade II in 8 cases, grade III in 3 cases, and grade IV in 1 case.
Conclusion: Lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation is a relatively effective fixation for unstable sacral fractures. Not only is the fracture fixation rigid for early full weight-bearing, but also nerve decompression can be performed which facilitates nerve function recovery.
目的: 评价应用闭口万向螺钉（closed multi-axial screws，CMAS）骶髂固定系统联合后路部分脊柱内固定系统行腰椎-骨盆内固定治疗不稳定型骶骨骨折的临床效果。.
方法: 回顾分析 2013 年 1 月—2014 年 11 月采用 CMAS 骶髂固定系统联合后路部分脊柱内固定系统行腰椎-骨盆内固定治疗的 25 例（39 侧）不稳定型骶骨骨折患者临床资料。其中男 17 例，女 8 例；年龄 19～55 岁，平均 33.9 岁。致伤原因：交通事故伤 15 例，高处坠落伤 8 例，挤压伤 2 例。受伤至入院时间 1～13 d，平均 3.5 d。骨折按 Denis 分型：Ⅰ型 2 侧，Ⅱ型 20 侧，Ⅲ型 17 侧。术前 20 例伴神经损伤，根据 Gibbons 评分Ⅰ级 2 例，Ⅱ级 2 例，Ⅲ级 7 例，Ⅳ级 9 例。术后 2 d 根据 Matta 标准对骨折复位质量进行评价，根据 Majeed 功能评分标准及 Gibbons 评分标准分别对临床功能和神经功能进行评价。.
结果: 手术时间 80～150 min，平均 110 min；术中出血量 250～1 400 mL，平均 570 mL。2 例术后出现切口感染，经清创术及抗生素治疗后愈合。25 例患者均获随访，随访时间 15～22 个月，平均 18 个月。X 线片及 CT 复查示骶骨骨折均达临床愈合，愈合时间 8～12 周，平均 10 周。根据 Matta 评分标准评估骨折复位质量，获优 32 侧、良好 6 侧、一般 1 侧，优良率 97.5%。术后 12～20 个月，平均 13 个月取出内固定物，无螺钉松动、断裂，内固定物与周围组织无粘连，未见明显电解离现象发生。末次随访时，根据 Majeed 标准评价临床功能，为 64～98 分，平均 84.7 分；获优 18 例、良好 5 例、一般 2 例，优良率 92.0%。20 例神经损伤者其神经功能较术前明显恢复，Gibbons 评分获Ⅰ级 8 例，Ⅱ级 8 例，Ⅲ级 3 例，Ⅳ级 1 例。.
结论: 应用 CMAS 骶髂固定系统联合后路部分脊柱内固定系统行腰椎-骨盆内固定治疗不稳定型骶骨骨折，不仅为骶骨骨折提供了坚强固定，实现早期完全负重，而且可进行术中骶神经探查及减压以促进神经功能恢复。.
Keywords: Sacral fracture; closed multi-axial screws; lumbopelvic fixation; pelvic fracture.