The Correlative Study Between The Classification Of Pelvic Fracture And The Nerve Injury In Pelvic

Objective:On the basis of neural anatomy In the pelvic area, combined with clinical data in Cases of pelvic fracture and nerve injury such as the imaging, electrophysiology and surgical conditions。Discuss the relationship between 2 classification of pelvic fracture (Young-Burgess and Tile) and nerve damage in pelvic fracture and its diagnosis and treatment.Methods:607 cases of pelvic fractures were treated with complete data from January 1993 to June 2010. To imaging data based on, such as a common X-ray (anteroposterior position,entrance position exit position,obturator foramen oblique position,ilio oblique position), spiral CT scanning, three-dimensional CT reconstruction and MRI other inspection, combined surgical treatment of operated patients with intraoperative findings in pelvic fracture displacement of the actual direction, extent, severity, etc., by at least two experienced physicians to determine all cases of pelvic fracture Young-Burgess and Tile classification type, determine Denis classification of sacral fractures in cases of sacral fractures. According to the clinical signs and physical examination of each pelvic fracture patients,make a diagnosis of Whether there is nerve injury, most of the patients diagnosed after surgery and confirmed that nerve damage during surgery, some patients further confirmed by electrophysiological examination, Including spontaneous potential (fibrillation, positive phase potential) availability, the time limit for motor unit potential amplitude, and sensory and motor conduction velocity, etc. distinguish the reason of nerve injury caused by pelvic fracture or iatrogenic injury, caused by the fracture of the pelvic nerve injury, nerve injury to further clarify the location, nature and extent. Analysis the relationship between 2 classification of pelvic fracture (Young-Burgess and Tile),Denis classification of sacral fractures and nerve damage in pelvic fracture, obtained the significance of Several typing methods in respect of nerve injury pelvic fracture, Compared the difference of the classification system in the incidence of nerve injury for each type, location, nature of injury, Investigate diagnosis and treatment in nerve injury of pelvic fracture.Results:All 607 cases of pelvic fracture were classified in accordance with the Young-Burgess classification system:APC type (anteroposterior compression type) 222 cases, LC type (lateral compression type) 271 cases, VS type (vertical shear type) 42 cases, CM type (compound type) of 72 cases; according to Tile classification system, A type (stable) 148 cases, B type (rotating unstable) 151 cases,C type (rotating vertical unstable) 308 cases. In 92 patients with nerve injury and pelvic fractures, except for 3 cases of femoral nerve iatrogenic injury,2 cases of sciatic nerve iatrogenic injury, the remaining 87 nerve injury cases of pelvic fracture was caused by fracture itself, A total of 114 site were injuried:32 cases of lumbosacral nerve,9 cases of cauda equina,15 cases of lumbosacral trunk,35 cases of the sciatic nerve,6 cases of common peroneal nerve,12 cases of femoral nerve,3 cases of obturator nerve,2 cases of lateral femoral cutaneous nerve; nature of injury were:46 cases of traction injury,63 cases of compression injury,5 cases of laceration.In accordance with the Young-Burgess classification system nerve injuries as follows:APC type incidence of 14.86%,33 cases and 48 positions; LC type incidence of 13.28%,36 cases and 43 positions; VS type incidence of 9.5%,4 cases and 6 positions; CM type incidence of 19.44%,14 cases and 17 positions.In accordance with the Tile classification system nerve injuries as follows:A type incidence of 10.81%,16 cases and 18 positions; B type incidence of 15.89%,24 cases and 35 positions; C type incidence of 15.26%,47 cases and 61 positions. Sacral fractures concomitant lumbosacral nerve or cauda equina 33 cases, according to Denis classification:Ⅰtype incidence of 9.26%,5 cases.Ⅱtype incidence of 56.25%,18 cases.Ⅲtype incidence of 62.50%,10 cases (5 cases of transverse fracture,2 cases of H-type fracture).23 cases of lumbosacral nerve injury,5 cases of cauda equina injury, both injuries 5 cases,in 28 cases of lumbosacral nerve injury, L5 injury in 13 cases, S1 injury in 12 cases, S2 injury in 2 cases, S3 injury in 1 case, No S4,5 nerve injury.21 patients made electrophysiological examinations, the results suggestted different degrees of nerve injury,2 cases were found intraoperative transient nerve injury. Treatment of the injured nerve, neurolysis in 12 cases, bone removal decompression in 10 cases,2 cases of neural transplantation and nerve anastomosis in 2 cases,1 case of residual closed off section.Conclusion:1. The nerve which most likely to injury is sacral nerve and sciatic nerve (peroneal nerve injury more likely), followed by dry lumbosacral plexus, femoral nerve and cauda equina, obturator nerve and lateral femoral cutaneous nerve.The type of nerve injury pelvic fracture up to compression injury, followed by traction injury, laceration at least, of which the most common compression injury is the sacral nerve and sciatic nerve, traction injury is the lumbosacral nerve, sciatic nerve, lumbosacral plexus dry and femoral nerve, laceration injury is lumbosacral nerve.2. the relationship between 2 classification of pelvic fracture (Young-Burgess and Tile) and nerve injury:Young-Burgess classification system was based on injury mechanism of violence. Fracture displacement is mainly determined by the nature of the violence, the pelvic fracture and nerve injury has related to fracture displacement, so Young-Burgess pelvic fracture classification can indirectly reflect the possibility location and type of nerve injury. According to type nerve injury in pelvic fracture incidence by turn is:CM>APC>LC>VS.APC type the most common site of injury is the sciatic nerve peroneal nerve and sacral nerve, the most common type of injury is traction injury, and most of laceration injury type seen in APC; LC type the most common site of injury is the sciatic nerve, The most common type of injury is compression injury; VS type the most common site of injury is the lumbosacral nerve, the most common type of injury is compression injury; CM type the most common site of injury is the lumbosacral nerve plexus dry, the most common type of injury is traction injury.Tile classification system was based on pelvic anatomy of anterior and posterior ring and their stability, can reflect the severity of pelvic fracture to a certain extent, pelvic fracture nerve injury depends on the degree and direction of fracture displacement. The type of unstable pelvic ring (rotation and vertical) change in the fracture displacement have significantly different, although the B and C type nerve injury in pelvic fracture there was no significant difference (significantly higher than A type), but in nerve Injury site and type there was differentiation. A type the most common site of injury is the sciatic nerve, the most common type of injury is compression injury; B type the most common site of injury is the sciatic nerve, The most common type of injury is compression injury; C type the most common site of injury is the lumbosacral nerve, the most common type of injury is traction and compression injury, and all laceration type found in C-type.3. the relationship between Denis classification of sacral fracture and nerve injury:32.35% sacral fracture caused lumbosacral nerve and cauda equina injury, According to Denis classification of sacral fracture nerve injury in sacral fracture incidence by turn is:Ⅲ>Ⅱ>Ⅰ. According to Denis classification of sacral fracture, lumbosacral nerve injury most likely to occurred in zone II fracture, followed by zoneⅢfracture; cauda equina injury most likely to occurred in zone III fracture, followed by transverse fractures. Almost all of the lumbosacral nerve injury were L5 and S1, only 5% were other nerve injury.4. Iatrogenic nerve injury is significantly reduced, but still needs attention. Currently the most common iatrogenic nerve injury was the femoral nerve and the sciatic nerve, most of them was intraoperative traction injury. Routine pelvic surgery to protect lateral femoral cutaneous nerve and sciatic nerve to iatrogenic lateral femoral cutaneous nerve and the sciatic nerve injury may be greatly reduced. Knowing well the nerve anatomy in pelvic and paying attention to regulating the operation is the most basic requirement to avoid iatrogenic nerve injury.5. Electrophysiology in the diagnosis of nerve injury in pelvic fractures should be taken seriously. Except for careful clinical neurological examination, the application of electrophysiological can be increase accuracy in diagnosis of pelvic fractures nerve injury. In addition, using electrophysiology in surgery,the effect of preventing iatrogenic nerve injury should be recognized.6. Nerve injury is one of the most serious complication in pelvic fracture, disability in all factors of pelvic fractures, the most common is permanent nerve damage and recovery in the treatment is slow and ineffective. If nerve injury was timely detected and treated, by early surgical exploration and release nerve decompression.most pelvic fractures nerve injury can recovere well. The greatest nerve injury is avulsion injury, surgery had little effect. Neural transplantation as a new therapeutic approach, some progress has been made.