ObjectiveTo investigate the effectiveness of anterior subcutaneous internal fixator combined with posterior plate in the treatment of unstable pelvic fractures.MethodsBetween January 2015 and January 2019, 26 cases of unstable pelvic fractures were treated with anterior subcutaneous internal fixator combined with posterior plate. There were 16 males and 10 females, with an average age of 42.8 years (range, 25-66 years). According to the Tile classification, 9 of them belonged to type B2, 6 to type B3, 7 to type C1, 3 to type C2, 1 to type C3. The injury severity score (ISS) was 6-43 (mean, 18.3). Four cases combined with brain injury, 7 with limb fractures, 3 with hemopneumothorax, 1 with sciatic nerve injury. The time from injury to operation was 4-12 days (mean, 6.4 days). The intraoperative blood loss, operation time, and the complications were recorded. The fracture reduction and the postoperative function of patients were evaluated.ResultsAll patients were followed up 12-26 months (mean, 16.8 months). The operation time was 65-142 minutes (mean, 72.5 minutes) and the intraoperative blood loss was 42-124 mL (mean, 64.2 mL). There were 2 cases of unilateral lateral femoral cutaneous nerve stimulation, 1 case of femoral nerve paralysis, and 1 case of superficial infection of incision, which were cured after corresponding treatment. X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, according to Matta criteria for fracture reduction, the results were excellent in 8 cases, good in 15 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 88.5%. According to Majeed scoring system for pelvic function, the results were excellent in 10 cases, good in 12 cases, and fair in 4 cases, with an excellent and good rate of 84.6%.ConclusionFor unstable pelvic fractures, the anterior subcutaneous internal fixator combined with posterior plate has fewer operative complications, high security, and achieve good effectiveness.
Objective To explore the choice for the internal fixation in treatment of pelvic posterior lesions. Methods From May 2000 to June 2005, the treatment was given to 40 patients (28 males, 12 females,aged 21-58 years) with pelvic posterior ring fracture and dislocation. Of the patients, 23 had a traffic accident, 11 had a crush injury and 6 had a fall. As for the state of an injury to the pelvic posterior ring, 22 patients had disloation of the sacroiliac joint, 12 had a sacrum fracture dislocation, and 6 had an ala iliac fracture and disloation of the sacroiliac joint. According to the Denis(1988) classification, fracture of the (sacral region Ⅰ was found in 6 cases, fracture of the scaral) region Ⅱ in 3 cases, and fracture of the scaral region Ⅲ in 3 cases. As for the complication of the pelvic front ring fracture:separation of the symphysis pubis was found in 14 cases, fraclure of the superior ramus and inferior ramus of the pubis on one side in 10 cases. The two-side superior ramus of publis and inferion ramus of pubisin 8 cases, homopleural acetabular fracture on one side in 4 cases, acetabularfracture on one side and contralateral superior ramus and inferior ramus fracture of the pubis in 3 cases, and acetabular fracture on the opposite side in 1 case.As for the operation, 28 patients underwent the stillplate internal fixation of the sacroiliac joint from anterior at 24 h to 15 days after the injury, 2 underwent the screwinternal fixation of the sacroiliac joint from posterior, and remaining 10 underwent the internal fixation by the Galveston Technique associated with the ISOLAsystem. The therapeutic results were analyzed. Results The followup of the 40 patients for 6 months to 3 years revealed that before operation 3 had a sacral plexus nerve injury, and after operation 1 patient developed perineum numbness and urinary incontinence, 1 developed claudication，3 developed posterior urethral fragmentation, and 2 developed urinary bladderrupture; however, they had a complete recovery after the reparative surgery. Conclusion In treatment of the pelvic posterior ring lesions，an appropriate internal fixation can be chosen according to the type of the pelvic fracture，applicability of internal fixation， condition of the patient，equipment available, and the doctor’s experience.
Objective To explore the effectiveness of reduction robot combined with navigation robot-assisted minimally invasive treatment for Tile type B pelvic fractures. Methods Between January 2022 and February 2023, 10 patients with Tile type B pelvic fractures were admitted. There were 6 males and 4 females with an average age of 45.5 years (range, 30-71 years). The fractures were caused by traffic accident in 5 cases, bruising by heavy object in 3 cases, and falling from height in 2 cases. The interval between injury and operation ranged from 4-13 days (mean, 6.8 days). There were 2 cases of Tile type B1 fractures, 1 case of Tile type B2 fracture, and 7 cases of Tile type B3 fractures. After closed reduction under assistance of reduction robot, the anterior ring was fixed with percutaneous screws with or without internal fixator, and the posterior ring was fixed with sacroiliac joint screws under assistance of navigation robot. The time of fracture reduction assisted by the reduction robot was recorded and the quality of fracture reduction was evaluated according to the Matta scoring criteria. The operation time, intraoperative fluoroscopy frequency and time, intraoperative bleeding volume, and incidence of complications were also recorded. During follow-up, the X-ray film of pelvis was taken to review the fracture healing, and the Majeed score was used to evaluate hip joint function. Results The time of fracture reduction was 42-62 minutes (mean, 52.3 minutes). The quality of fracture reduction according to the Matta scoring criteria was rated as excellent in 4 cases, good in 5 cases, and poor in 1 case, with excellent and good rate of 90%. The operation time was 180-235 minutes (mean, 215.5 minutes). Intraoperative fluoroscopy was performed 18-66 times (mean, 31.8 times). Intraoperative fluoroscopy time was 16-59 seconds (mean, 28.6 seconds). The intraoperative bleeding volume was 50-200 mL (range, 110.0 mL). No significant vascular or nerve injury occurred during operation. All patients were followed up 13-18 months (mean, 16 months). X-ray films showed that all fractures healed with the healing time of 11-14 weeks (mean, 12.3 weeks). One case of ectopic ossification occurred during follow-up. At last follow-up, the Majeed score was 70-92 (mean, 72.7), and the hip joint function was rated as excellent in 2 cases and good in 8 cases, with the excellent and good rate of 100%. Conclusion The reduction robot combined with navigation robot-assisted minimally invasive treatment for Tile type B pelvic fractures has the characteristics of intelligence, high safety, convenient operation, and minimally invasive treatment, which can achieve reliable effectiveness.
Pelvic fractures are often caused by high-energy trauma. The condition of patients is complex and requires active therapy. The treatment of pelvic fractures includes conservative and surgical treatment. Surgical treatment is suitable for patients with unstable pelvic fractures. In recent years,the anterior subcutaneous internal fixator (INFIX) for the treatment of unstable pelvic fractures has been popularized and achieved extraordinary outcomes. INFIX is a relatively novel technology for the treatment of anterior pelvic ring fractures. It has excellent biomechanical properties, a wide range of indications, and has the advantages of minimally invasive, convenient care, fewer complications, and better clinical outcomes. If patients with anterior pelvic ring fractures have the indications for INFIX after careful evaluation, INFIX is recommended. This article summarizes the research progress of INFIX in the treatment of anterior pelvic ring fractures, and summarizes its surgical methods, biomechanical properties, indications, advantages, complications and clinical outcomes.
ObjectiveTo assess the effectiveness of anterior subcutaneous internal fixation (INFIX) combined with posterior percutaneous iliosacral screw for the treatment of unstable pelvic fractures.MethodsBetween August 2016 and November 2017, 19 cases of unstable pelvic fractures were treated with anterior subcutaneous INFIX combined with posterior percutaneous iliosacral screw. There were 14 males and 5 females, with an average age of 40.6 years (range, 17-69 years). Causes of injury included traffic accident injury in 11 cases, falling from height in 5 cases, bruise injury by heavy object in 3 cases. According to Tile classification, there were 2 cases of type B1, 6 cases of type B2, and 11 cases of type C. Anterior ring injuries included bilateral pubic ischial ramus fractures in 12 cases, unilateral pubic ischial ramus fractures in 5 cases, and symphysis pubis separation in 2 cases. Posterior ring injuries included sacroiliac ligament injuries in 2 cases, unilateral iliac bone fractures in 3 cases, unilateral sacral fractures in 11 cases, unilateral sacroiliac joint dislocation in 2 cases, and bilateral sacral fracture in 1 case. The intraoperative blood loss and operation time were recorded, and the fracture healing and postoperative complications were observed. Matta score was used to evaluate the reduction of fracture, and Majeed score was used to evaluate the postoperative function of patients.ResultsThe operation time was 47-123 minutes (mean, 61.4 minutes) and the intraoperative blood loss was 50-115 mL (mean, 61.1 mL). One case had superficial infection at the site of screw implantation, and 1 case had unilateral cutaneous nerve stimulation, which were cured after corresponding treatment. There was no damage of urinary system, reproductive system, and intestine. All cases were followed up 12-25 months (mean, 18.1 months). All the fractures healed after operation, the average healing time was 9.5 weeks (range, 8-13 weeks); no nonunion, delayed healing, internal fixation loosening, fracture, and other situations occurred. Of the 2 patients with lumbosacral plexus injury before operation, 1 recovered completely and 1 had residual mild claudication. At last follow-up, the reduction of fracture was evaluated by Matta scoring standard, the results were excellent in 13 cases and good in 6 cases, with an excellent and good rate of 100%; the function was evaluated by Majeed scoring standard, the results were excellent in 15 cases and good in 4 cases, with an excellent and good rate of 100%.ConclusionMinimally invasive pelvic stabilization by using anterior subcutaneous INFIX and posterior percutaneous iliosacral screw for treatment of unstable pelvic fractures, can achieve good fracture reduction and definitive stabilization with minimum complications and obtain excellent functional outcomes.
Objective To investigate the effectiveness of modified internal fixator (INFIX) to fix the anterior pelvic ring for Tile C1.3 pelvic fracture by comparing with the traditional INFIX. MethodsThe patients with Tile C1.3 pelvic fractures admitted between April 2018 and June 2021 were taken as the study objects. Of them, 55 cases were included in the study according to the selection criteria. During operation, the anterior pelvic ring was fixed with the modified INFIX in 30 cases (modified group) and with the traditional INFIX in 25 cases (control group). The posterior pelvic ring in 55 cases was fixed with sacroiliac screws. There was no significant difference between the two groups in gender, age, cause of injury, time from injury to operation, and combined injury (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. The X-ray film was taken to evaluate the reduction of the anterior pelvic ring after operation, grade the reduction according to the Matta scoring standards, and observe the fracture healing and healing time. The function was evaluated according to Majeed scoring standards during follow-up. Results The operation time of the modified group was significantly longer than that of the control group (Z=–3.837, P<0.001), but there was no significant difference in the intraoperative blood loss between the two groups (t=–1.831, P=0.076). All patients were followed up 12-18 months (mean, 14 months). X-ray film reexamination showed that the excellent and good rate of Matta scoring for anterior pelvic ring reduction in the modified group was 88.00%, which was significantly better than that in the control group (63.33%) (χ2=4.373, P=0.037). All fractures healed, and the fracture healing time of the modified group and the control group was (12.04±3.59) and (14.83±4.83) weeks respectively, with a significant difference (t=2.401, P=0.020). At last follow-up, the excellent and good rates of Majeed scoring were 80.00% in the modified group and 76.67% in the control group, with no significant difference (χ2=0.089, P=0.766). In the modified group, 2 cases (8%) had complications, all of which were incision infection above pubic symphysis. In the control group, 9 cases (30%) had complications, including 5 cases of lateral femoral cutaneous nerve injury, 2 cases of femoral nerve paralysis, and 2 cases of delayed fracture healing. The incidence of complications was significantly lower in the modified group than in the control group (χ2=4.125, P=0.042). ConclusionCompared with the traditional INFIX, the modified INFIX to fix the anterior pelvic ring for Tile C1.3 pelvic fracture has fewer complications, better stability, shorter fracture healing time, and lower risk of nerve injury.
Objective To investigate the clinical characteristics of unstable pelvic fractures and to find out an alternative for the treatment. Methods From October 2000 to June 2004, fifty-six patients with unstable pelvic fractures were treated by open reduction and pelvic-reconstructed plate fixation to recover the anatomical structure of pelvis and acetabulum. According to Tile classification, 33 cases were type B (15 cases were Tile B1, 11 cases were Tile B2, 7 cases were Tile B3); 23 cases were type C (10 cases were Tile C1, 8 cases were Tile C2, 5 cases were Tile C3). Results The 56 cases were followed up 12 to 68 months(26 months in average).All cases with fractures got healed during 3 to 6 mouths. According to the Majeed evaluation, 40 cases were excellent, 11 cases were good, 4 cases were fair, and only one case was a failure. The rate of excellency and goodness was 91.07%.The pelvic abnormity was rectified; partial patients felt light pain in iliac scar. Conclusion The choice of the proper operative approach and pelvic-reconstructed plate fixation by allowingfor fracture classification is a good and dependable means for treating unstablepelvic fractures.
【Abstract】 Objective To evaluate the effectiveness of percutaneous fixation of pelvic fracture by Acutrak full thread headless hollow compression screw. Methods Between March 2008 and April 2010, 31 patients with pelvic fracture underwent percutaneous fixation surgery with Acutrak full thread headless hollow compression screw (surgical group). The effectivenss was compared with those of 14 patients with pelvic fracture treated conservatively (control group). There was no significant difference in age and sex between 2 groups (P gt; 0.05). The injury was more severe in surgical group than in control group. The standard of short-term recovery was active turning over and walking for 5 steps with walking aids. The standard of long-term recovery was pain, gait, fracture healing, and function recovery. Results In surgical group, the other patients reached the standard of short-term recovery at 1-4 days after injury except 1 patient who had sacral plexus injury; in control group, the patients could turn over at 9-13 days (Tile type A2) and 17-25 days (Tile type B2) respectively, and could walk at 17-21 days (Tile type A2) and at 45-57 days (Tile type B2) respectively. The patients of 2 groups were followed up 6-19 months. The time of fracture healing was 2-6 months. The long-term results were excellent in 29 cases and good in 2 cases in surgical group, and were excellent in 8 cases and good in 6 cases in control group, showing significant difference between 2 groups (χ2=6.636, P=0.017).Conclusion Percutaneous internal fixation combined with Acutrak full thread headless hollow compression screw can provide more effective treatment. It can alleviate patients, pain quickly, improve life quality, and has better long-term effectiveness.
ObjectiveTo introduce the experience of intelligent monitoring system assisted pelvic fracture closed reduction to treat complex pelvic fracture in a minimally invasive method.MethodsA 30-year-old male patient with complex pelvic fracture caused by a falling injury was treated in December 2019. The pelvic fracture was diagnosed by X-ray film and CT three-dimensional reconstruction. The AO/Orthopaedic Trauma Association (AO/OTA) classification was 61-C3.3 type (H-shaped sacrum fracture with pubic symphysis separation). At 48 hours after injury, the vital signs were stable, and the operation was performed. The pelvic fracture was reduced with the help of pelvic reduction frame and skeletal traction, the intelligent monitoring system, and fixed with the channel screws.ResultsThe intraoperative blood loss was 50 mL, the operation time was 180 minutes, and the fluoroscopy time was 45 seconds. The incision healed well after operation. The X-ray film of pelvis was taken on the next day after operation, and the fracture reduction was evaluated as anatomical reduction according to Matta standard; CT three-dimensional reconstruction showed that the fixation screws were all located in the cortex of bone, without penetrating the cortex of bone.ConclusionThe intelligent monitoring system assisted pelvic fracture closed reduction is reliable in the minimally invasive treatment of complex pelvic fractures, which can achieve good results and reduce intraoperative fluoroscopy.
ObjectiveTo evaluate the effectiveness of three-dimensional (3D) printing assisted internal fixation for unstable pelvic fractures.MethodsThe clinical data of 28 patients with unstable pelvic fractures admitted between March 2015 and December 2017 were retrospectively analyzed. The patients were divided into two groups according to different surgical methods. Eighteen cases in the control group were treated with traditional anterior and posterior open reduction and internal fixation with plate; 10 cases in the observation group were treated with 3D printing technology to make pelvic models and assist in shaping the subcutaneous steel plates of the anterior ring. Sacroiliac screw navigation template was designed and printed to assist posterior ring sacroiliac screw fixation. There was no significant difference between the two groups in gender composition, age, cause of injury, fracture type, and time interval from injury to surgery (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, incision length, waiting time for weight-bearing exercise, and fracture healing time were recorded and compared between the two groups. Majeed score was used to evaluate the function at last follow-up. At immediate after operation, the reduction was evaluated according to Matta imaging scoring criteria, and the success of sacroiliac joint screw implantation in the observation group was evaluated. The deviation of screw entry point and direction between postoperative screws and preoperative simulated screws were compared in the observation group.ResultsAll the operation was successfully completed, and all patients were followed up 6-18 months (mean, 14.4 months). In the control group, 1 case had wound infection and 2 cases had deep vein thrombosis. No serious complication such as important blood vessels, and nerve injury and pulmonary embolism occurred in other patients in the two groups. No screw pulling out or steel plate breaking occurred. The operation time, intraoperative blood loss, fluoroscopy times, incision length, and waiting time for weight-bearing exercise of the control group were significantly more than those of the observation group (P<0.05); there was no significant difference in fracture healing time between the two groups (t=0.12, P=0.90). There was no significant difference in reduction quality between the two groups at immediate after operation (Z=–1.05, P=0.30); Majeed score of the observation group was significantly better than that of the control group at last follow-up (Z=–2.42, P=0.02). The success rate of sacroiliac joint screw implantation in the observation group reached category Ⅰ. In the observation group, the deviation angle of the direction of the screw path between the postoperative screw and the preoperative simulated screw implant was (0.09±0.22)°, and the deviation values of the entry points on the X, Y, and Z axes were (0.13±0.63), (0.14±0.58), (0.15±0.53) mm, respectively. There was no significant difference when compared with those before the operation (all values were 0) (P>0.05).ConclusionComputer design combined with 3D printing technology to make personalized pelvic model and navigation template applied to unstable pelvic fractures, is helpful to accurately place sacroiliac screw, reduce the operation time, intraoperative blood loss, and the fluoroscopy times, has good waiting time for weight-bearing exercise and function, and it is an optional surgical treatment for unstable fractures.