Chinese Journal of Reparative and Reconstructive Surgery
Supervisor： National Health Commission of the People's Republic of ChinaSponsor： Chinese Association of Rehabilitation Medicine , Sichuan University Editor-in-chief：Bin Shen Publishing period：
Monthly
ISSN：1002-1892CN：51-1372/R
Objective To investigate the advantages and effectiveness of ISO-C3D guided percutaneous sacroiliac joint screw internal fixation for treatment of pelvic posterior ring injuries by comparing with anterior opened reduction and reconstruction plate internal fixation.
Methods A retrospective analysis was made on the clinical data of 54 patients with posterior ring injury treated between June 2013 and January 2016. Of 54 patients, 33 underwent ISO-C3D guided percutaneous sacroiliac joint screws internal fixation (group A), and 21 underwent anterior opened reduction and reconstruction plate internal fixation (group B). There was no significant difference in gender, age, cause of injuries, injury to operation time, fractures type, combined injuries, and injury severity score (ISS) between 2 groups (P > 0.05). The operation time, intraoperative blood loss, length of operative incision, hospitalization time, postoperative pain degree, reduction evaluation, and functional evaluation were compared between 2 groups.
Results Group A was significantly better than group B in operation time, length of operative incision, and hospitalization time (P < 0.05). The intraoperative blood loss of group A (10-20 mL) was significantly less than that of group B[(524.1±160.1) mL]. All patients of the 2 groups were followed up 7 to 24 months with an average of 11.6 months. No injury of vessel or nerve occurred in group A; worse neurological symptoms of lower limbs and incision infection were observed in 2 patients of group B respectively, and the other patients achieved primary healing of incision. At 48 hours after operation, the visual analogue scale (VAS) score of group A (1.7±0.7) was significantly lower than that of group B (8.2±0.8) (t=-30.463, P=0.000). Radiological examination showed fracture reduction. According to the Matta score standard, the reduction results were excellent in 21 cases (63.6%), good in 10 cases (30.3%), and fair in 2 cases (6.1%) in group A; the reduction results were excellent in 16 cases (76.2%), good in 4 cases (19.1%), and fair in 1 case (4.7%) in group B; and there was no significant difference between 2 groups (χ2=0.961, P=0.618). Fracture or dislocation healed well in 2 groups, and the walking function was restored. According to the Majeed standard for evaluation, the results were excellent in 23 cases (69.7%), good in 9 cases (27.3%), and fair in 1 case (3.0%) in group A; the results were excellent in 14 cases (66.7%), good in 5 cases (23.8%), and fair in 2 cases (9.5%) in group B; no significant difference was shown between 2 groups (χ2=1.501, P=0.591).
Conclusion Compared with anterior opened reduction and reconstruction plate internal fixation, ISO-C3D navigation percutaneous sacroiliac joint screw internal fixation is an ideal surgical method to treat pelvic posterior ring injury, with the characteristics of less trauma, less pain, precise screw implant and safety.
Citation：WANGXiaozhen, WANGGuodong, MENGChengfei, LIUXiming, CAIXianhua. ISO-C3D NAVIGATION FOR PERCUTANEOUS SACROILIAC JOINT SCREW INTERNAL FIXATION FOR TREATMENT OF PELVIC POSTERIOR RING INJURIES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1338-1343. doi: 10.7507/1002-1892.20160274Copy
Copyright ? the editorial department of Chinese Journal of Reparative and Reconstructive Surgery of West China Medical Publisher. All rights reserved
1.
Giannoudis PV, Tzioupis CC, Pape HC, et al. Percutaneous fixation of the pelvic ring: an update. J Bone Joint Surg (Br), 2007, 89(2): 145-154.
2.
Tile M, Helfet DL, Kellam JF. Comprehensive classification of fractures in the pelvis and acetabulum. Berne: Maurice. Muller Foundation, 1995: 118.
3.
Baker SP, O'Neill B, Haddon W Jr, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma, 1974, 14(3): 187-196.
4.
Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Res, 1996, (329): 129-140.
5.
Majeed SA. Grading the outcome of pelvic fracture. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
6.
Soisson O, Lube J, Germano A, et al. Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction. PLoS One, 2015, 10(3): e0116739.
7.
Yu X, Tang M, Zhou Z, et al. Minimally invasive treatment for pubic ramus fracture combined with a sacroiliac joint complex injury. Int Orthop, 2013, 37(8): 1547-1554.
8.
Matityahu A, Kahler D, Krettek C, et al. Three-dimensional navigation is more accurate than two-dimensional navigation or conventional fluoroscopy for percutaneous sacroiliac screw fixation in the dysmorphic sacrum: a randomized multicenter study. J Orthop Trauma, 2014, 28(12): 707-710.
9.
El-Desouky II, Mohamed MM, Kandil AE. Percutaneous iliosacral screw fixation in vertically unstable pelvic injuries, a refined conventional method. Acta Orthop Belg, 2016, 82(1): 52-59.
Schweitzer D, Zylberberg A, Córdova M, et al. Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures. Injury, 2008, 39(8): 869-874.
Acklin YP, Marco G, Sommer C. Double locking plate fixation of sacral fractures in unstable pelvic ring C-type injuries. Oper Orthop Traumatol, 2015, 27(1): 74-79.
16.
Zwingmann J, Sudkamp NP, Konig B, et al. Intra-and postoperative complications of navigated and conventional techniques in percutaneous iliosacral screw fixation after pelvic fractures: Results from the German Pelvic Trauma Registry. Injury, 2013, 44(12): 1765-1772.
1. Giannoudis PV, Tzioupis CC, Pape HC, et al. Percutaneous fixation of the pelvic ring: an update. J Bone Joint Surg (Br), 2007, 89(2): 145-154.
2. Tile M, Helfet DL, Kellam JF. Comprehensive classification of fractures in the pelvis and acetabulum. Berne: Maurice. Muller Foundation, 1995: 118.
3. Baker SP, O'Neill B, Haddon W Jr, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma, 1974, 14(3): 187-196.
4. Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Res, 1996, (329): 129-140.
5. Majeed SA. Grading the outcome of pelvic fracture. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
6. Soisson O, Lube J, Germano A, et al. Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction. PLoS One, 2015, 10(3): e0116739.
7. Yu X, Tang M, Zhou Z, et al. Minimally invasive treatment for pubic ramus fracture combined with a sacroiliac joint complex injury. Int Orthop, 2013, 37(8): 1547-1554.
8. Matityahu A, Kahler D, Krettek C, et al. Three-dimensional navigation is more accurate than two-dimensional navigation or conventional fluoroscopy for percutaneous sacroiliac screw fixation in the dysmorphic sacrum: a randomized multicenter study. J Orthop Trauma, 2014, 28(12): 707-710.
9. El-Desouky II, Mohamed MM, Kandil AE. Percutaneous iliosacral screw fixation in vertically unstable pelvic injuries, a refined conventional method. Acta Orthop Belg, 2016, 82(1): 52-59.
11. Schweitzer D, Zylberberg A, Córdova M, et al. Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures. Injury, 2008, 39(8): 869-874.
15. Acklin YP, Marco G, Sommer C. Double locking plate fixation of sacral fractures in unstable pelvic ring C-type injuries. Oper Orthop Traumatol, 2015, 27(1): 74-79.
16. Zwingmann J, Sudkamp NP, Konig B, et al. Intra-and postoperative complications of navigated and conventional techniques in percutaneous iliosacral screw fixation after pelvic fractures: Results from the German Pelvic Trauma Registry. Injury, 2013, 44(12): 1765-1772.
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Citation：WANGXiaozhen, WANGGuodong, MENGChengfei, LIUXiming, CAIXianhua. ISO-C3D NAVIGATION FOR PERCUTANEOUS SACROILIAC JOINT SCREW INTERNAL FIXATION FOR TREATMENT OF PELVIC POSTERIOR RING INJURIES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1338-1343. doi: 10.7507/1002-1892.20160274
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