The surgical outcome of sacral decompression and lumbopelvic fixation for H-shaped sacral fracture and correlation factors analysis

Objective To investigate the correlation factors for surgical outcome of sacral decompression and lumbopelvic fixation in H-shaped sacral fracture and the methods to prevent and treat the complications. Methods From January 2008 to January 2016, 45 patients with H-shaped sacral fracture treated by sacral decompression and lumbopelvic fixation were respectively analyzed, including 29 men and 16 women, mean age 41.2 (range, 24-53 years), mean follow-up time 52.6 months (range, 16-93 months). The surgical outcome was evaluated by pelvic outcome score, and correlation factors were analyzed. We analyzed whether each factor was in correlation with pelvic outcome score. Then we integrated the statistically significant indicators into Logistic regression equation to determine the related factors. Postoperative complications were all recorded. Results The average operation time was 161.2 min (range, 100-220 min), average blood loss was 491.6 ml (range, 370-1 000 ml), injury-surgery interval was 7.2 d (range, 1-23 d). In terms of pelvic outcome score, 31 (68.9%) patients had satisfactory result and 14 (31.3%) patients had unsatisfactory result. Univariate χ2 analysis suggested that cauda equina injury, Roy-Camille classification, L5S1 facet injury, fracture line, kyphotic angle, injury-surgery interval, decompression approach and inserting sacral screws were correlated with pelvic outcome score, but gender, age, injury mechanism and L5 pedicle fracture had no relation with pelvic outcome score. The multivariate Logistic regression analysis showed that cauda equina injury, Roy-Camille classification, fracture line, kyphotic angle, injury-surgery interval, decompression approach and inserting sacral screws were closely related to pelvic outcome score, but L5S1 facet injury was excluded. 2 patients required early surgical procedures with proper antibiotics for deep wound infection; 3 patients complained pain related to hardware prominence and the pain subsided after removal of implants; 1 patient got unilateral rod breakage at 3-6 months and achieved bony fusion after nine months of observation. Conclusion Sacral decompression and lumbopelvic fixation is effective in neurological recovery and early ambulation in treating H-shaped sacral fracture. Better surgical outcome is related to timely surgery, preoperative or intraoperative bone traction, sacral screws insertion, incomplete cauda equina injury, Roy-Camille type II, fracture line penetrating S2 and kyphotic angle less than 40°. Key words: Sacrum; Fractures, bone; Fracture fixation; Internal fixators; Root cause analysis