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  • Title: [MRI diagnosis of sacral fracture with sacral neurological damage and its clinical application].
    Author: Tian Z, Bai J, Xi L, Chen H.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2008 Sep; 22(9):1096-9. PubMed ID: 18822737.
    Abstract:
    OBJECTIVE: To study the MRI diagnosis of sacral fracture with sacral neurological damage and its clinical application. METHODS: From October 1999 to October 2007, 20 cases of sacral fracture (Denis classification, Type II) with sacral neurological damage were examined by oblique coronal MRI of sacrum to show the whole length of sacral nerve. There were 17 males and 3 females, aged 30-55 years. The time from injury to hospitalization varied from 1 day to 23 months. The injury was caused by traffic accident in 10 cases, smash of heavy object in 8 cases and crush in 2 cases. Eight cases were accompanied by pubis fracture and 4 cases by urethral disruption. All patients accepted the examination of X-ray, CT and spiral CT 3D reconstruction. X-ray showed the displacement of fracture fragment was backwards and upwards, and sacral-hole line was vague, asymmetric and distorted. CT showed that sacral neural tube was left-right asymmetry, the displacement of fracture fragment was backwards and upwards, combining with the compression and intruding to sacrum center at different section levels. The clinical manifestations, international standards for Neurological Classification of Spinal Cord Injury recommended by American Spinal Injury Association International Spinal Cord Society, comparison between normal and abnormal MRI and Gierada's results were the basis for clinical diagnose and MRI diagnose, which was confirmed by operation. RESULTS: Nerve injury diagnosed by clinical manifestation were S1 (17 cases), S2 (14 cases), S3 (7 cases), and S4 (6 cases). Nerve injury diagnosed by MRI were S1 (17 cases), S2 (14 cases), S3 (3 cases), and S4 (2 cases). Nerve injury confirmed by operation were S1 (17 cases), S2 (14 cases), S3 (7 cases), and S4 (1 case). Oblique coronal MRI of sacrum showed the whole length of sacral nerve and its adjacent relationship, detecting bone fragment compression and route alteration of never were evident in 5 cases, the fat disappearance around the site of nerve root injury in 19 cases, narrowness of sacral nerve canal in 17 cases and the abnormally enlarged sacral nerve in 11 cases. CONCLUSION: Oblique coronal MRI of sacrum is of great value in the localization and the qualitative diagnosis of sacral neurological damage.
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