背景:先前有报道称,30%至40%的成年患者会发生骶骨畸形。在骨盆的出口X射线视图上已通过6个广泛接受的参数进行了描述:陡峭的鼻翼坡度,保留的S1-S2磁盘,存在的乳腺,圣化L5,槽SI关节中的舌,和非圆形神经孔。研究集中于识别畸形对于安全治疗具有畸形上骶骨段的骨盆骨折的重要性。关于畸形是否可以预防创伤,人们知之甚少。据我们所知,没有研究集中在畸形骶骨与非畸形(ND)骶骨相比如何骨折,以及手术率是否不同。
目的:评估骨盆畸形和ND骶骨之间的骶骨骨折的手术固定率,以及组间骨折形态是否存在差异。
方法:这是一个单一1级创伤中心的回顾性队列研究。研究参与者包括那些患有骨盆环损伤的人,他们年龄在18岁或以上,接受了骨科手术。有CT成像,并且没有单独的髋臼骨折。355名受试者包括671名回顾的骨盆环损伤。骶骨如果满足六个畸形特征中的至少一个被认为是畸形的,并确定他们是否接受了手术干预。在CT成像上确定了骨折分类和模式。P值设定为<0.05。
结果:我们发现,有44%的夹杂物具有变形骶骨,最常见的特征是陡峭的鼻翼斜坡(68%)。有ND骶骨的患者中有17.17%接受了治疗,而真性骶骨的患者为16.56%。手术固定率无统计学差异(p=.879)。然而,我们发现同侧后SI关节增宽的骨折类型不同(p=0.020).
结论:我们的研究表明,根据组间手术率的差异,骶骨畸形对手术固定没有保护作用。然而,我们的数据支持,根据观察到的其他骨盆环损伤的差异,有畸形骶骨的骨盆可能会有不同的骨折。
BACKGROUND: Sacral
dysmorphism has been previously reported to occur in 30 % to 40 % of adult patients. It has been described by 6 widely accepted parameters on outlet x-ray views of the pelvis: steep alar slope, retained S1-S2 disk, presence of mamillary bodies, sacralized L5, tongue in groove SI joint, and non-round neural foramina. Studies have focused on the importance of identifying
dysmorphism for safe treatment of fractures in pelvises with dysmorphic upper sacral segments. Less is known regarding whether
dysmorphism may be protective against trauma. To our knowledge no studies have focused on how dysmorphic sacrums fracture compared to non-dysmorphic (ND) sacrums, and whether operative rates are different.
OBJECTIVE: To assess the rate of operative fixation of sacral fractures between pelvises with dysmorphic and ND sacrums, as well as whether a difference exists in fracture morphology between groups.
METHODS: This is a retrospective cohort study out of a single level 1 trauma center. Study participants consisted of those sustaining a pelvic ring injury who were 18 years or older in which orthopaedics was consulted, had CT imaging available, and did not have isolated acetabulum fractures. 355 subjects were included of 671 reviewed pelvic ring injuries. Sacrums were deemed dysmorphic if they met at least one of the six dysmorphic features, and it was determined whether they underwent operative intervention. Fracture classifications and patterning were identified on CT imaging. P values were set <0.05.
RESULTS: We found that 44 % of inclusions had a dysmorphic sacrum with the most common feature to be a steep alar slope (68 %). 17.17 % of subjects with a ND sacrum underwent treatment versus 16.56 % for dysmorphic sacrums. No statistical difference regarding operative fixation rates was uncovered (p = .879). However, we found a difference in fracture patterns regarding ipsilateral posterior SI joint widening (p = 0.020).
CONCLUSIONS: Our study suggests that sacral
dysmorphism is not protective against operative fixation based on no difference in operative rates between groups. However, our data supports that pelvises with dysmorphic sacrums may fracture differently based on the difference observed regarding other pelvic ring injuries.