Surgical technique and effectiveness of titanium elastic nail assisted retrograde channel screw implantation in superior pubic branch_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Xiaotian , WANG Xiaopan , ZHAO Peishuai , LI Renjie , JIA Junliang ,  WU Min

Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233004, P. R. China;

Corresponding author：

WU Min, Email: wumin200207@163.com

Keywords：

Titanium elastic nail; retrograde channel screw of superior pubic branch; acetabular fracture; pelvic fracture

DOI：

10.7507/1002-1892.202212093

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Objective To investigate the surgical technique and effectiveness of titanium elastic nail (TEN) assisted retrograde channel screw implantation of superior pubic branch. Methods The clinical data of 31 patients with pelvic or acetabular fractures treated with retrograde channel screw implantation in superior pubic branch between January 2021 and April 2022 were retrospectively analyzed. Among them, 16 cases were implanted with assistance of TEN (study group) and 15 cases were implanted under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification of pelvic fracture, Judet-Letournal classification of acetabular fracture, and time from injury to operation between the two groups (P>0.05). The operation time, fluoroscopy times, and intraoperative blood loss of each superior pubic branch retrograde channel screw were recorded during operation. X-ray films and three-dimensional CT were reexamined after operation, the quality of fracture reduction was evaluated by Matta score standard, and the position of channel screw was evaluated by screw position classification standard. The fracture healing time was recorded during the follow-up, and the postoperative functional recovery was evaluated by Merle D’Aubigne Postel score system at last follow-up. Results Nineteen and 20 retrograde channel screws of superior pubic branch were implanted in the study group and the control group, respectively. The operation time, fluoroscopy times, and intraoperative blood loss of each screw in the study group were significantly less than those in the control group (P<0.05). According to the postoperative X-ray films and three-dimensional CT, none of the 19 screws in the study group penetrated out of the cortical bone or into the joint, and the excellent and good rate was 100% (19/19); in the control group, there were 4 screws of cortical bone penetration, and the excellent and good rate was 80% (16/20); the difference between the two groups was significant (P<0.05). Matta score standard was used to evaluate the quality of fracture reduction, there was no patient in the two groups with poor reduction results, and the difference was not significant between the two groups (P>0.05). The incisions of the two groups healed by first intention, and there was no complication such as incision infection, skin margin necrosis, and deep infection. All patients were followed up 8-22 months, with an average of 14.7 months. There was no significant difference in healing time between the two groups (P>0.05). At last follow-up, the difference in functional recovery evaluated by the Merle D’Aubigne Postel scoring system between the two groups was not significant (P>0.05). Conclusion TEN assisted implantation technique can significantly shorten the operation time of retrograde channel screw implantation of superior pubic branch, reduce the times of fluoroscopy, and have less intraoperative blood loss and accurate screw implantation, which provides a new safe and reliable method for minimally invasive treatment of pelvic and acetabular fractures.

Citation： CHEN Xiaotian, WANG Xiaopan, ZHAO Peishuai, LI Renjie, JIA Junliang, WU Min. Surgical technique and effectiveness of titanium elastic nail assisted retrograde channel screw implantation in superior pubic branch. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 431-437. doi: 10.7507/1002-1892.202212093 Copy

1.	Routt ML, Simonian PT, Grujic L. The retrograde medullary superior pubic ramus screw for the treatment of anterior pelvic ring disruptions: a new technique. J Orthop Trauma, 1995, 9(1): 35-44.
2.	Yu T, Qu Y, Zhang XW, et al. A screw-view model of navigation aid retrograde transpubic screw fixation for anterior pelvic ring fracture: A case report with 28 months follow-up and technical note. Medicine (Baltimore), 2018, 97(51): e13646. doi: 10.1097/MD.0000000000013646.
3.	Wong JSY, Lau JCK, Chui KH, et al. Three-dimensional-guided navigation percutaneous screw fixation of fragility fractures of the pelvis. J Orthop Surg (Hong Kong), 2019, 27(1): 2309499019833897. doi: 10.1177/2309499019833897.
4.	胡鹏宇, 王海涛, 余志平, 等. 虚拟现实技术联合电磁导航手术机器人辅助治疗复杂骨盆骨折一例. 中国修复重建外科杂志, 2020, 34(6): 807-808.
5.	赵斌, 李金奇, 赵春鹏, 等. 基于5G技术的骨科机器人远程导航辅助植入经皮骨盆通道螺钉固定骨盆及髋臼骨折. 中国修复重建外科杂志, 2022, 36(8): 923-928.
6.	刘可心, 由梦真, 黄默冉, 等. 天玑骨科机器人联合ArtisZeego系统微创治疗骨盆骨折的初步应用研究. 中国修复重建外科杂志, 2022, 36(8): 929-933.
7.	Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
8.	赵春鹏, 王军强, 苏永刚, 等. 机器人辅助经皮螺钉内固定治疗骨盆和髋臼骨折. 北京大学学报 (医学版), 2017, 49(2): 274-280.
9.	D’Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg (Am), 1954, 36-A(3): 451-475.
10.	Grewal IS, Starr AJ. What’s new in percutaneous pelvis fracture surgery? Orthop Clin North Am, 2020, 51(3): 317-324.
11.	Walls A, McAdam A, McMahon SE, et al. The management of osteoporotic acetabular fractures: Current methods and future developments. Surgeon, 2021, 19(5): e289-e297.
12.	马利杰, 王鑫贵, 郑占乐, 等. CT三维重建模型下模拟髋臼前柱2种经皮置钉方法的比较. 中国微创外科杂志, 2020, 26(3): 254-258.
13.	阳宏奇, 雷青, 蔡立宏, 等. 3D打印导板辅助空心螺钉内固定治疗不稳定性骨盆骨折. 中国修复重建外科杂志, 2018, 32(2): 145-151.
14.	蔡鸿敏, 成传德, 李红军, 等. 改良经皮逆行耻骨上支或髋臼前柱髓内螺钉置入技术治疗骨盆髋臼损伤. 中华创伤骨科杂志, 2018, 20(9): 750-756.
15.	黄淑明, 兰树华, 邢海林, 等. 钝头弹性敲击技术建立髋臼前柱逆行螺钉通道的应用研究. 中华创伤骨科杂志, 2019, 21(3): 218-225.
16.	Wang H, Wu G, Chen CY, et al. Percutaneous screw fixation assisted by hollow pedicle finder for superior pubic ramus fractures. BMC Surg, 2022, 22(1): 216. doi: 10.1186/s12893-022-01659-z.
17.	黄晨, 任亚明, 谢美明, 等. 双C型臂X线机引导逆行经皮耻骨上支螺钉置入技术治疗骨盆骨折. 中国骨与关节杂志, 2022, 11(9): 690-695.
18.	Comadoll SM, Matuszewski PE, Liu B, et al. Factors associated with failure of superior pubic ramus screws. J Orthop Trauma, 2021, 35(4): 181-186.
19.	Grossterlinden L, Nuechtern J, Begemann PG, et al. Computer-assisted surgery and intraoperative three-dimensional imaging for screw placement in different pelvic regions. J Trauma, 2011, 71(4): 926-932.

1. Routt ML, Simonian PT, Grujic L. The retrograde medullary superior pubic ramus screw for the treatment of anterior pelvic ring disruptions: a new technique. J Orthop Trauma, 1995, 9(1): 35-44.
2. Yu T, Qu Y, Zhang XW, et al. A screw-view model of navigation aid retrograde transpubic screw fixation for anterior pelvic ring fracture: A case report with 28 months follow-up and technical note. Medicine (Baltimore), 2018, 97(51): e13646. doi: 10.1097/MD.0000000000013646.
3. Wong JSY, Lau JCK, Chui KH, et al. Three-dimensional-guided navigation percutaneous screw fixation of fragility fractures of the pelvis. J Orthop Surg (Hong Kong), 2019, 27(1): 2309499019833897. doi: 10.1177/2309499019833897.
4. 胡鹏宇, 王海涛, 余志平, 等. 虚拟现实技术联合电磁导航手术机器人辅助治疗复杂骨盆骨折一例. 中国修复重建外科杂志, 2020, 34(6): 807-808.
5. 赵斌, 李金奇, 赵春鹏, 等. 基于5G技术的骨科机器人远程导航辅助植入经皮骨盆通道螺钉固定骨盆及髋臼骨折. 中国修复重建外科杂志, 2022, 36(8): 923-928.
6. 刘可心, 由梦真, 黄默冉, 等. 天玑骨科机器人联合ArtisZeego系统微创治疗骨盆骨折的初步应用研究. 中国修复重建外科杂志, 2022, 36(8): 929-933.
7. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
8. 赵春鹏, 王军强, 苏永刚, 等. 机器人辅助经皮螺钉内固定治疗骨盆和髋臼骨折. 北京大学学报 (医学版), 2017, 49(2): 274-280.
9. D’Aubigne RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg (Am), 1954, 36-A(3): 451-475.
10. Grewal IS, Starr AJ. What’s new in percutaneous pelvis fracture surgery? Orthop Clin North Am, 2020, 51(3): 317-324.
11. Walls A, McAdam A, McMahon SE, et al. The management of osteoporotic acetabular fractures: Current methods and future developments. Surgeon, 2021, 19(5): e289-e297.
12. 马利杰, 王鑫贵, 郑占乐, 等. CT三维重建模型下模拟髋臼前柱2种经皮置钉方法的比较. 中国微创外科杂志, 2020, 26(3): 254-258.
13. 阳宏奇, 雷青, 蔡立宏, 等. 3D打印导板辅助空心螺钉内固定治疗不稳定性骨盆骨折. 中国修复重建外科杂志, 2018, 32(2): 145-151.
14. 蔡鸿敏, 成传德, 李红军, 等. 改良经皮逆行耻骨上支或髋臼前柱髓内螺钉置入技术治疗骨盆髋臼损伤. 中华创伤骨科杂志, 2018, 20(9): 750-756.
15. 黄淑明, 兰树华, 邢海林, 等. 钝头弹性敲击技术建立髋臼前柱逆行螺钉通道的应用研究. 中华创伤骨科杂志, 2019, 21(3): 218-225.
16. Wang H, Wu G, Chen CY, et al. Percutaneous screw fixation assisted by hollow pedicle finder for superior pubic ramus fractures. BMC Surg, 2022, 22(1): 216. doi: 10.1186/s12893-022-01659-z.
17. 黄晨, 任亚明, 谢美明, 等. 双C型臂X线机引导逆行经皮耻骨上支螺钉置入技术治疗骨盆骨折. 中国骨与关节杂志, 2022, 11(9): 690-695.
18. Comadoll SM, Matuszewski PE, Liu B, et al. Factors associated with failure of superior pubic ramus screws. J Orthop Trauma, 2021, 35(4): 181-186.
19. Grossterlinden L, Nuechtern J, Begemann PG, et al. Computer-assisted surgery and intraoperative three-dimensional imaging for screw placement in different pelvic regions. J Trauma, 2011, 71(4): 926-932.

Chinese Journal of Reparative and Reconstructive Surgery

Surgical technique and effectiveness of titanium elastic nail assisted retrograde channel screw implantation in superior pubic branch

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