Objective To explore the effectiveness of Colorado 2TM system in the stabil ity reconstruction of sacroil iac joint fracture and dislocation in Tile C pelvic fracture. Methods Between February 2009 and January 2011，8 cases of Tile C pelvic fracture were treated with Colorado 2TM system. There were 3 males and 5 females with an average age of 34.4years (range，22-52 years). Fractures were caused by traffic accident in 3 cases, by fall ing from height in 3 cases，and by crash of heavy object in 2 cases. According to Tile classification, 5 cases were classified as C1-2, 2 cases as C1-3，and 1 case as C2. The time between injury and operation was 5-10 days (mean, 7 days). After skeletal traction reduction, Colorado 2TM system was used to fix sacroil iac joint, and reconstruction plate or external fixation was selectively adopted. Results The postoperative X-ray films showed that the reduction of vertical and rotatory dislocation was satisfactory, posterior pelvic ring achieved effective stabil ity. All the incisions healed by first intention, and no blood vessel or nerve injury occurred. Eight patients were followed up 6-24 months (mean, 12 months). No loosening or breakage of internal fixation was observed and no re-dislocation of sacroil iac joint occurred. The bone heal ing time was 6-12 months (mean, 9 months). According to Majeed’s functional criterion, the results were excellent in 5 cases, good in 2 cases, and fair in 1 case at last follow-up. Conclusion Colorado 2TM system could provide immediate stabil ity of pelvic posterior ring and good maintenance of reduction effect, which is an effective method in the therapy of sacroil iac joint fracture and dislocation in Tile C pelvic fracture.
Objective To evaluate the effectiveness of operation via anterior approach in treating pelvic crescent fra cture. Methods Between June 2007 and December 2009, 18 patients with pelvic crescent fracture were treated, including 11 males and 7 females with an average age of 32 years (range, 19-52 years). The locations were the right in 8 cases and the leftin 10 cases. Fractures were caused by traffic accident in 10 cases, by fall ing from height in 5 cases, and by crushing with heavy weights in 3 cases. All patients suffered lateral compression injuries of the pelvis. The mean time from injury to operation was 7.8 days (range, 3-22 days). The preoperative mean displacement of the posterior pelvic ring was 13.7 mm (range, 5-24 mm) according to the method described by Matta et al. The operation time, intraoperative blood loss, displacement correction of the posterior pelvic ring, fracture heal ing time, and Hannover pelvic score were recorded. Results The average operation time was 175 minutes (range, 110-230 minutes); the average intraoperative blood loss was 561.7 mL (range, 300-1 100 mL); the postoperative mean displacement of the posterior pelvic ring was 1.2 mm (range, 0-3 mm); and the mean displacement correction of the posterior pelvic ring was 12.6 mm (range, 4-23 mm). No intraoperative lumbosacral nervous injury occurred. Superficial wound infection occurred in 2 cases and was cured after 1 week of wound drainage and appl ication of antibiotic. The others achieved heal ing of incision by first intention. Fifteen patients were followed up 16.1 months on average (range, 13-22 months). The X-ray films showed fracture heal ing in all patients. The fracture heal ing time was 3.6 months on average (range, 3-4 months). No patient had loss of reduction or failure of internal fixation. The cl inical outcome was excellent in 10 cases (66.7%) and good in 5 cases (33.3%) according to Hannover pelvic score; social reintegration was complete in 13 cases (86.7%) and incomplete in 2 cases (13.3%). Conclusion Operation via anterior approach is a good choice in the treatment of pelvic crescent fracture.
目的 通过对保留不同平面骶骨的新鲜人骨盆模型进行生物力学测试，分析骶骨切除平面与骨盆稳定性的关系，明确骶骨切除保留至何种程度时需行腰骶髂稳定性重建。 方法 选用6具正常成年男性新鲜尸体腰5-骨盆标本，采用200 N增量分级加载，以1.4 mm/min速率平稳加载直至1 000 N，依次测试保留完整骶骨及不同平面骶骨切除骨盆模型的最大主应力、剪切应力、位移及刚度变化，比较各组间的差异。最后测量1/2S1组骨盆环的极限载荷，记录骨折发生部位和骨折类型。 结果 随骶骨切除平面增高，最大主应力、剪切力及骶骨下沉位移在各测试点均有不同程度增大，骨盆的轴向刚度不断减小。当切除平面达骶1时，变化明显，尤其以经过骶1下1/4～下1/2时变化显著，与完整骶骨组比较，差异有统计学意义（P＜0.05）。骶1椎体下1/2平面切除后，骨盆的极限载荷是（2 375.97 ± 162.41）N，骨盆的破坏形态为经骶髂关节或骶椎的骨折。 结论 骶骨切除范围与骨盆环的稳定性密切相关，随着骶骨切除平面升高，残留骶髂关节各种应力急剧增高，骨盆的稳定性明显下降。当骶骨切除涉及骶1椎体时，极易发生骨折，需要进行腰骶髂局部重建以增强骶髂关节的稳定性。
目的 探讨CT导航下经皮骶髂螺钉固定技术治疗骨盆环损伤的安全性及临床疗效。 方法 对2009年1月－2011年3月期间我科收治的16例骨盆后环骨折脱位患者资料进行回顾性分析，所有患者均在计算机导航系统辅助下采用经皮骶髂螺钉固定技术进行治疗。 结果 16例患者骶1平面共植入18枚骶髂螺钉，其中14例单侧植入1枚螺钉。14例患者获得随访，随访时间14～49个月，平均19个月。根据Majeed临床效果评定标准：满意8例，良好5例，差1例。所有随访患者均无神经、血管损伤、骶髂螺钉松动、断裂等并发症。 结论 经皮骶髂螺钉固定技术是恢复骨盆后环稳定性的一种安全、有效的方法，具有创伤小、临床效果好、并发症少、手术操作简便、性价比高等优势，值得临床推广。
目的 探讨强直性脊柱炎（AS）受累骶髂关节、腰椎小关节及髋关节的病变CT表现特点，以提高诊断与鉴别诊断水平。 方法 2011年1月－10月对临床确诊的强直性脊柱炎患者44例骶髂关节、28例腰椎及14例髋关节行CT扫描，回顾性分析骶髂关节、腰椎小关节及髋关节的CT表现。 结果 AS患者的CT表现特点为病变主要累及骶髂关节滑膜部的髂骨侧，腰椎小关节及髋关节则表现为关节间隙改变、关节面毛糙及囊状破坏、面下骨硬化或吸收等改变。 结论 AS骶髂关节、腰椎小关节及髋关节的CT表现具有一定特征，CT具有重要的诊断及鉴别诊断价值。
【摘要】 目的 分析骶髂关节特殊CT征象及临床意义。 方法 分析近两年86例患者的正常骶髂关节CT资料。采用倾角度扫描方法获取关节纵断面完整图像，观察两侧关节形态差异、个体形态差异，分析其特殊CT表现。 结果 4例13～16岁少年骶髂关节间隙宽而平直，骶侧关节面不规则。成人骶髂关节呈凹凸状交互崁合，两侧关节无镜像对称，个体间形态差异大。关节边缘局部不规则或粗糙结节样改变24例（27.9%），可见不同程度的骨质增生47例（54.7%），关节狭窄32例（37.2%），关节积气61例（70.9%）。 结论 骶髂关节边缘不规则，骨质硬化，关节间隙不对称或狭窄，关节积气等表现可见于正常骶髂关节。【Abstract】 Objective To analyze the specific CT signs of sacroiliac joint and its clinical significance. Methods CT scanning with tilt angle was performed in 86 patients of normal sacroiliac joint. The morphological differences and specific CT manifestations were analysed on both sides of the joints and different individuals. Results In four patients from 13 to 16 years old, the sacroiliac joints space were straight and in normal range of width, and the sacral articular surface was irregular. The sacroiliac joints in adults were bump-like. Both sides of the joint were not completely symmetrical, and individual difference was large. The partial articular edge in 24 patients (27.9%) was irregular, rough or nodular. Other special signs of the joints include cortical hyperplasia in 47 patients (54.7%), stenosis in 32 patients (37.2%) and intra-articular gas in 61 patients (70.9%). Conclusion Irregular articular edge, bone sclerosis, asymmetric joint space or stenosis and intra-articular gas could be seen in the normal sacroiliac joint.
ObjectiveTo develop an instrument for sacroiliac joint fixation with less injury and less complications. MethodsFirstly, 18 adult pelvic specimens (8 males and 10 females) were used to measure the anatomical data related to the locking plates and locking screws on the sacrum and ilium, and the polyaxial locking plate screw system of the sacroiliac joint was designed according to the anatomic data. This system was made of medical titanium alloy. Then 4 adult male plevic specimens were harvested and the experiment was divided into 3 groups:group A (normal pelvic), group B (the dislocated sacroiliac joint fixed with sacroiliac screws), and group C (the dislocated sacroiliac joint fixed with polyaxial locking plate screw system). The vertical displacement of sacroiliac joint under the condition of 0-700 N vertical load and the horizontal displacement on angle under the condition of 0-12 N·m torsional load were compared among the 3 groups by using the biological material test system. Finally, the simulated application test was performed on 1 adult male cadaveric specimen to observe soft tissue injury and the position of the locking plate and screw by X-ray films. ResultsAccording to the anatomic data of the sacrum and ilium, the polyaxial locking plate screw system of the sacroiliac joint was designed. The biomechanical results showed that the vertical displacement of the sacroiliac joint under the condition of 0-700 N vertical load in group A was significantly bigger than that in group B and group C (P < 0.05), but there was no significant difference between group B and group C (P>0.05). The horizontal displacement on angle under the condition of 0-12 N·m torsional load in group A was significantly less than that in group B and group C (P < 0.05). The horizontal displacement on angle under the condition of 0-6 N·m torsional load in group B was bigger than that in group C, and the horizontal displacement on angle under the condition of 6-12 N·m torsional load in group B was less than that in group C, but there was no significant difference between group B and group C (P>0.05). The test of simulating application showed that the specimen suffered less soft tissue injury, and this instrument could be implanted precisely and safely. ConclusionThe polyaxial locking plate screw system of the sacroiliac joint has the advantages of smaller volume and less injury; polyaxial fixation enables flexible adjustment screw direction. The simulated application test shows satisfactory fixing effect.
ObjectiveTo assess the safety, feasibility, and effectiveness of medical calcium sulfate (OsteoSet) mixed with powder for injection of rifampicin after radical debridement in the treatment of sacroiliac joint tuberculosis. MethodsA retrospective analysis was made on the clinical data from 27 patients with sacroiliac joint tuberculosis who underwent debridement surgery and local bone graft of OsteoSet artificial bone impregnated with powder for injection of rifampicin between August 2006 and August 2010. There were 10 males and 17 females with an average age of 35.2 years (range, 16-64 years). The mean disease duration was 7.5 months (range, 1.5-16 months). The left sacroiliac joint was involved in 16 cases, the right side in 10 cases, and both sides in 1 case; Of them, 18 cases had iliac fossa abscess and 6 cases of buttocks abscess. According to the classification system by Kim, there were 9 cases of type Ⅲ and 18 cases of type ⅠV. The preoperative Majeed score was 61.23±6.49, including good in 4 patients, general in 19 patients, and poor in 4 patients. ResultsAll patients achieved wound healing by first intention; no complications of pelvic infection, peripheral nerve injury, and lower extremity deep vein thrombosis occurred. Twenty-six patients were followed up 16 months on average (range, 12-24 months). All the patients had normal sense and movement of both lower limbs; no perineum sensory disturbance was found. One case of multi-drug resistant had local recurrence at 3 months after operation, which was cured after adjusting anti-tuberculosis drugs, nutritional support, enhancing immunity with thymopentin, and second operation. Bone union was observed at 10.5 months on average (range, 9-12 months) in 25 patients, and clinical symptoms disappeared with no recurrence or complication, and they returned to previous work. The Majeed score at last follow-up was 92.31±3.36, showing significant difference when compared with preoperative score (t=-32.76, P=0.00). The results were excellent in 22 patients, good in 4 patients, and the excellent and good rate was 100%, showing significant follow-up was 92.31±3.36, showing significant difference when compared with preoperative score (t=-32.76, P=0.00). The results were excellent in 22 patients, good in 4 patients, and the excellent and good rate was 100%, showing significant difference compared with the preoperative one (χ2=31.93, P=0.00). ConclusionBone graft interbody fusion surgery with rifampicin loaded OsteoSet is one of the effective methods to treat sacroiliac joint tuberculosis.
ObjectiveTo investigate the effectiveness of percutaneous double-segment lengthened sacroiliac screws internal fixation assisted by three-dimensional (3D) navigation technology in treatment of Denis type Ⅱ and Ⅲ sacral fractures. Methods A clinical data of 45 patients with the Denis type Ⅱ and Ⅲ sacral fractures admitted between January 2017 and May 2020 was retrospectively analyzed. There were 31 males and 14 females, with an average age of 48.3 years (range, 30-65 years). The pelvic fractures were all high energy injuries. According to the Tile classification standard, there were 24 cases of type C1, 16 cases of type C2, and 5 cases of type C3. The sacral fractures were classified as Denis type Ⅱ in 31 cases and type Ⅲ in 14 cases. The interval between injury and operation was 5-12 days (mean, 7.5 days). The lengthened sacroiliac screws were implanted in S1 and S2 segments respectively under the assistance of 3D navigation technology. The implantation time of each screw, the intraoperative X-ray exposure time, and the occurrence of surgical complications were recorded. After operation, the imaging reexamination was used to evaluate the screw position according to Gras standard and the reduction quality of sacral fractures according to Matta standard. At last follow-up, the pelvic function was scored with Majeed scoring standard. Results The 101 lengthened sacroiliac screws were implanted with the assisting of 3D navigation technology. The implantation time of each screw was 37.3 minutes on average (range, 30-45 minutes), and the X-ray exposure time was 46.2 seconds on average (range, 40-55 seconds). All patients had no neurovascular or organ injury. All incisions healed by first intention. The quality of fracture reduction was evaluated according to Matta standard as excellent in 22 cases, good in 18 cases, and fair in 5 cases, and the excellent and good rate was 88.89%. The screw position was evaluated according to Gras standard as excellent in 77 screws, good in 22 screws, and poor in 2 screws, and the excellent and good rate was 98.02%. All patients were followed up 12-24 months (mean, 14.6 months). All fractures healed and the healing time was 12-16 weeks (mean, 13.5 weeks). Pelvic function was evaluated according to Majeed scoring standard as excellent in 27 cases, good in 16 cases, fair in 2 cases, and the excellent and good rate was 95.56%. Conclusion Percutaneous double-segment lengthened sacroiliac screws internal fixation for the treatment of Denis type Ⅱ and Ⅲ sacral fractures is minimally invasive and effective. With the assistance of 3D navigation technology, the screw implantation is accurate and safe.