Objective To investigate the effectiveness of minimally invasive plate fixation in treatment of unstable pelvic fractures. Methods Between May 2006 and December 2009, 21 patients with unstable pelvic fractures were treated. There were 13 males and 8 females with an average age of 39 years (range, 21-66 years). The causes of injury included traffic accident in 9 cases, falling from height in 6 cases, and heavy pound injury in 6 cases. The time from injury to hospitalization was 1 to 4 hours with an average of 2.8 hours. According to Tile’s classification, there were 12 cases of type B and 9 cases of type C. After admission, bone traction and exo fixation were performed, and minimally invasive plate fixation was given at 5-24 days after injury. Results All incisions healed by first intention, and no complications of nerve and vessel injuries occurred. According to the reduction criteria of Matta radiography, anatomic reduction was achieved in 16 cases, satisfactory reduction in 4 cases, and fair reduction in 1 case. All patients were followed up 12 months. The X-ray films showed all fractures healed at 2-4 months (mean, 2.6 months). According to Majeed clinical evaluation, the results were excellent in 12 cases, good in 7 cases, and fair in 2 cases. Conclusion Minimally invasive plate fixation can provide effective fixation, reconstruct pelvic ring, and reduce perioperative complications in the treatment of unstable pelvic fractures.
【Abstract】 Objective To evaluate the effectiveness of percutaneous fixation with il iosacral screw in the management of unstable pelvic fractures. Methods From March 2003 to January 2007, 15 patients with unstable pelvic fractures were treated by percutaneous fixation with il iosacral screws. There were 6 males and 9 females, aged 21-56 years. Fractures were caused by traffic accident in 8 cases, high fall ing in 6 cases and crushing injury in 1 case. The disease course ranged from 4 hours to 3 days. Of 15 patients, 7 had fractures of pubium and sacrum; 2 had fractures of il ium and sacrum; 4 had dislocation of sacroil iac joint with fractures of pubic rami; and 2 had dislocation sacroil iac joint with fracture of sacrum of pubium. Anterior fixation was performed by means of plating in 3 cases, by external fixation in 7 cases, and by both in 5 cases. Results The blood loss was from 1 000 to 1 500 mL in 4 patients with acetabular fracture and about 50 mL in the others. The average operative time was 153.6 minutes (range, 60-305 minutes). Fifteen patients were followed up 6 months to 3 years with an average of 18months. According to Matta criterion for fracture reduction, the results were excellent in 14 cases and good in 1 case. After a follow-up of 28.8 months, fracture union was achieved in all patients. Screw loosening occurred in 1 case, pain of lumbosacral region in 3 cases after tiredness and mild claudication in 2 cases. Nine patients returned to their occupation, three patients changed occupation, and 3 patients could not work at last follow-up. According to Majeed functional scoring, the results were excellent in 11 cases and good in 4 cases. Conclusion Percutaneous il iosacral screw fixation is a useful method in treatment of unstable pelvic fracture.
ObjectiveTo evaluate the effectiveness of unstable pelvic fractures treated by cannulated screw internal fixation with the assistance of three-dimensional (3D) printing insertion template.MethodsThe clinical data of 10 patients who underwent surgical treatment for unstable pelvic fractures by cannulated screw internal fixation with the assistance of 3D printing insertion template between May 2015 and June 2016 were retrospectively analysed. There were 7 males and 3 females with an average age of 37.5 years (range, 20-58 years). The causes of injury included falling from height in 5 cases, crushing from heavy load in 1 case, and traffic accidents in 4 cases. The interval from injury to admission was 1-5 hours (mean, 3.1 hours). The fracture situation included 6 cases of sacral fracture, 1 case of right sacroiliac joint dislocation, and 3 cases of iliac bone fracture. There were 10 cases of superior and inferior pubic rami fracture, including 3 cases on the left side (2 cases of suprapubic fracture adjacent to symphysis pubis), 2 cases on the right side, and 5 cases on the bilateral. All fractures were classified according to the Tile system, there were 4 cases of type B2, 1 of type B3, 4 of type C1, and 1 of type C2. The radiological outcome was evaluated by Matta scale, and the positions of the iliosacral screw and superior pubic ramus screw were evaluated according to 3D reconstruction of CT postoperatively. The functional outcome was evaluated by Majeed function scale.ResultsThe average time of each screw implantation was 30 minutes, and the average blood loss per screw incision was 50 mL. The time of implantation of each sacroiliac screw was 24-96 seconds (mean, 62 seconds), and the time of implantation of each suprapubic screw was 42-80 seconds (mean, 63.2 seconds). The hospitalization duration was 17-90 days (mean, 43.7 days). All incisions healed by first intention. All patients were followed up 12-22 months (mean, 15.6 months). The radiological outcome was excellent in 8 cases and good in 2 cases according to Matta scale; and 3D reconstruction of CT demonstrated that all the 9 iliosacral screws were placed as type Ⅰ, and all the 13 suprapubic ramus screws were placed as grade 0 on the first postoperative day. No complication such as neurovascular injury, screw back out or rupture, or secondary fracture displacement was observed during the follow-up. At 6 months after operation, the X-ray films showed good fracture healing in all the 10 patients. The functional outcome was excellent in 9 cases and good in 1 case according to Majeed scale at 1 year after operation. One patient sustained Tile C2 pelvic disruption complicated with L5 nerve root injury achieved complete nervous functional recovery at last follow-up.ConclusionIt has advantages of precise screw insertion and lower risk of neurovascular injury to treat unstable pelvic fractures by cannulated screw internal fixation with the assistance of 3D printing insertion template, which can be a good alternative for the treatment of unstable pelvic fractures.
ObjectiveTo evaluate the effectiveness of unstable pelvic fractures treated with minimally invasive percutaneous bridge internal fixator or traditional external fixator.MethodsThe clinical data of 45 patients with unstable pelvic fractures who met the selection criteria between January 2013 and February 2018 were retrospectively analyzed. According to the different surgical methods, they were divided into two groups. In the observation group (25 cases), minimally invasive percutaneous bridge internal fixators were used, and three-dimensional printing pelvic models were used to simulate the reduction and fixation before operation to develop individual reduction strategies. In the control group (20 cases), external fixators were used. There was no significant difference between the two groups in gender, age, cause of injury, fracture type (according to Tile classification), and time from injury to operation (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between the two groups. The reduction quality was evaluated according to the Matta standard, and functional recovery was evaluated according to the Majeed scoring standard.ResultsAll patients were followed up 12-20 months (mean, 15 months). The operation time of the observation group was significantly longer than that of the control group (t=2.719, P=0.009); no significant difference in intraoperative blood loss was found between the two groups (t=0.784, P=0.437). There was no significant difference between the two groups in fracture healing time (t=0.967, P=0.341). According to the Matta standard, the excellent and good rate of the observation group was 92%, and that of the control group was 70%, showing no significant difference between the two groups (χ2=3.748, P=0.053). At last follow-up, according to the Majeed scoring standard, the excellent and good rate of the observation group was 88%, and that of the control group was 60%, showing significant difference between the two groups (χ2=4.717, P=0.030). The incidences of incision and nailway infection, secondary displacement of fracture, and malunion in the observation group were significantly lower than those in the control group (P<0.05); the differences in incidences of iatrogenic injury of lateral femoral cutaneous nerve, deep vein thrombosis, and loosening of fixation between the two groups were not significant (P>0.05).ConclusionMinimally invasive percutaneous bridge internal fixator is a safe and effective method for the treatment of unstable pelvic fractures. It has the advantages of minimal trauma, stable fixation, less interference to patients’ daily life, early functional exercise, and quickly recovery after operation.