A multicenter retrospective study assessing pelvic unlocking closed reduction device for reducing unstable pelvic posterior ring disruption_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Hua ¹ , ZHANG Qun ¹ ^△ , HAO Ming ¹ ^△ , LI Jiantao ¹ ^△ , QI Hongzhe ² ^△ , YI Chengla ³ ^△ , GUO Xiaodong ⁴ ^△ , FAN Shicai ⁵ ^△ , WANG Jiandong ⁶ ^△ , ZHENG Longpo ⁷ ^△ , FANG Yue ⁸ ^△ , GUO Shuquan ⁹ ^△ , Lü Gang ¹⁰ ^△ , ZHOU Xuefeng ² ^△ , ZHUANG Yan ¹¹ ^△ , SHI Zhanying ¹² ^△ , ZHOU Dapeng ¹³ ^△ ,  TANG Peifu ¹

1. Department of Orthopaedic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P. R. China;
2. Department of Orthopaedic Surgery, Strategic Support Force Medical Center, Beijing, 100101, P. R. China;
3. Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, 430030, P. R. China;
4. Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, 430022, P. R. China;
5. Department of Traumatic Surgery, Center for Orthopaedic Surgery, the Third Hospital Affiliated to Southern Medical University, Guangzhou Guangdong, 510630, P. R. China;
6. Department of Orthopaedic Surgery, Shanghai General Hospital, Shanghai, 200080, P. R. China;
7. Department of Orthopaedic Surgery, the Tenth People’s Hospital of Shanghai, Shanghai, 200072, P. R. China;
8. Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
9. Department of Orthopaedic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China;
10. Department of Orthopaedic Surgery, the Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi Xinjiang, 830099, P. R. China;
11. Department of Orthopaedic Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an Shaanxi, 710054, P. R. China;
12. Department of Orthopaedic Surgery, Liuzhou Workers’ Hospital, Liuzhou Guangxi, 545005, P. R. China;
13. Department of Orthopaedic Surgery, General Hospital of Shenyang Northern Theater, Shenyang Liaoning, 110016, P. R. China;

Corresponding?author：

TANG Peifu, Email: pftang301@126.com

Keywords：

Pelvic unstable posterior ring disruption; minimally invasive internal fixation; pelvic unlocking closed reduction device

DOI：

10.7507/1002-1892.202206060

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Objective To explore the application value and effectiveness of pelvic unlocking closed reduction device for the treatment of unstable pelvic posterior ring disruption. Methods A retrospective analysis of clinical data of 243 cases of unstable pelvic posterior ring disruption treated with pelvic unlocking closed reduction device in 13 orthopaedic trauma centers across the country between December 2018 and June 2020 was performed. There were 139 males and 104 females; the age ranged from 18 to 92 years, with an average age of 48.5 years. The cause of injury included 132 cases of traffic accident injuries, 102 cases of falling from height, and 9 cases of crushing injuries. According to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 5 cases of type 61-B1, 13 cases of type 61-B2, 32 cases of type 61-C1.1, 47 cases of type 61-C1.2, 89 cases of type 61-C1.3, 35 cases of type 61-C2, and 22 cases of type 61-C3. The time from injury to operation was 2-121 days, with a median of 10 days. Preoperative preparation time, installation time of unlocking closed reduction device, fracture reduction time, intraoperative fluoroscopy times, intraoperative blood loss, and surgical complications were recorded, and Matta scoring standard was used to evaluate the quality of fracture reduction. According to Matta evaluation results, the patients were divided into two subgroups: excellent-good group and fair-poor group. The differences in gender, age, time from injury to operation, AO/OTA classification, and perioperative clinical indicators were compared between the two groups, and the effects of baseline data and perioperative indicators on the quality of fracture reduction were studied. Results Pelvic unlocking closed reduction device did not interfere with the display of the pelvic structure and fracture displacement direction during the intraoperative fluoroscopy, effectively correcting the displacement of the pelvic ring. The preoperative preparation time was 17-60 minutes, with an average of 30 minutes; installation time of unlocking closed reduction device was 10-32 minutes, with an average of 21 minutes; intraoperative fracture reduction time was 15-205 minutes, with an average of 49.2 minutes; intraoperative fluoroscopy times were 41-420 times, with an average of 132 times; intraoperative blood loss was 40-1 500 mL, with an average of 71.5 mL. The reduction quality of pelvic fracture was evaluated according to Matta score immediately after operation. The results were excellent in 153 cases, good in 61 cases, fair in 24 cases, and poor in 5 cases. The excellent and good rate was 88.1%. Further subgroup analysis showed that there was no significant difference in other indexes (P>0.05) between the excellent-good group and the fair-poor group except for the time from injury to operation and AO/OTA classification (P<0.05). Among them, the excellent-good reduction rate was 92.2% (119/129) in patients with injury-to-operation time less than 10 days, and the fair-poor reduction rate was 25.7% (9/35) and 40.9% (9/22) in patients with AO/OTA 61-C2 and 61-C3 types, respectively. There was no surgery-related complication due to the application of the pelvic unlocked reduction device, no secondary iliac fractures, vascular, or nerve injuries, and postoperative CT showed that all channel screws were located in the osseous channel. Conclusion The pelvic unlocking reduction device can effectively help to reduce the unstable pelvic posterior ring and maintain reduction, meet the needs of different projection angles of pelvic fracture with intraoperative C-arm fluoroscopy. The system facilitate the operation of pelvic reduction and precise fixation.

Citation： CHEN Hua, ZHANG Qun, HAO Ming, LI Jiantao, QI Hongzhe, YI Chengla, GUO Xiaodong, FAN Shicai, WANG Jiandong, ZHENG Longpo, FANG Yue, GUO Shuquan, Lü Gang, ZHOU Xuefeng, ZHUANG Yan, SHI Zhanying, ZHOU Dapeng, TANG Peifu. A multicenter retrospective study assessing pelvic unlocking closed reduction device for reducing unstable pelvic posterior ring disruption. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(11): 1327-1334. doi: 10.7507/1002-1892.202206060 Copy

1.	Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury, 2004, 35(7): 671-677.
2.	Grotz MR, Allami MK, Harwood P, et al. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury, 2005, 36(1): 1-13.
3.	Mohanty K, Musso D, Powell JN, et al. Emergent management of pelvic ring injuries: an update. Can J Surg, 2005, 48(1): 49-56.
4.	Basta AM, Blackmore CC, Wessells H. Predicting urethral injury from pelvic fracture patterns in male patients with blunt trauma. J Urol, 2007, 177(2): 571-575.
5.	G?nsslen A, Hildebrand F, Heidari N, et al. Pelvic ring injuries in children. Part I:Epidemiology and primary evaluation. A review of the literature. Acta Chir Orthop Traumatol Cech, 2012, 79(6): 493-498.
6.	Pereira GJC, Damasceno ER, Dinhane DI, et al. Epidemiology of pelvic ring fractures and injuries. Rev Bras Ortop, 2017, 52(3): 260-269.
7.	Routt ML, Simonian PT. Closed reduction and percutaneous skeletal fixation of sacral fractures. Clin Orthop Relat Res, 1996, (329): 121-128.
8.	Thaunat M, Laude F, Paillard P, et al. Transcondylar traction as a closed reduction technique in vertically unstable pelvic ring disruption. Int Orthop, 2008, 32(1): 7-12.
9.	陳華, 齊紅哲, 朱正國, 等. 骨盆外架輔助復位聯合通道螺釘固定治療TileC1型骨盆骨折. 中華創傷雜志, 2018, 34(10): 919-924.
10.	Boudissa M, Roudet A, Fumat V, et al. Part 1: Outcome of posterior pelvic ring injuries and associated prognostic factors—A five-year retrospective study of one hundred and sixty five operated cases with closed reduction and percutaneous fixation. Int Orthop, 2020, 44(6): 1209-1215.
11.	王剛, 張月雷, 章樂成, 等. 骨科機器人聯合骨盆解鎖復位架輔助下經皮螺釘固定治療骨盆骨折. 中華創傷骨科雜志, 2020, 22(6): 475-481.
12.	陳華, 白雪東, 易成臘, 等. 中國骨盆骨折微創手術治療指南 (2021). 中華創傷骨科雜志, 2021, 23(1): 4-14.
13.	陳華, 唐佩福. 骨盆髖臼骨折微創治療. 鄭州: 河南科學技術出版社, 2016: 63-74, 119-140.
14.	Chen H, Zhang Q, Wu Y, et al. Achieve closed reduction of irreducible, unilateral vertically displaced pelvic ring disruption with an unlocking closed reduction technique. Orthop Surg, 2021, 13(3): 942-948.
15.	Pape HC, Tornetta P, Tarkin I, et al. Timing of fracture fixation in multitrauma patients: the role of early total care and damage control surgery. J Am Acad Orthop Surg, 2009, 17(9): 541-549.
16.	Fitzgerald CA, Morse BC, Dente CJ. Pelvic ring fractures: has mortality improved following the implementation of damage control resuscitation? Am J Surg, 2014, 208(6): 1083-1090.
17.	胡居正, 石展英, 王仁崇, 等. Starr復位架聯合 “O” 型臂導航系統治療骨盆骨折的近期療效. 中華骨科雜志, 2019, 39(13): 817-825.
18.	唐經勵, 劉搏宇, 胡居正, 等. Starr架輔助復位INFIX與前柱螺釘內固定治療不穩定骨盆骨折臨床比較分析. 創傷外科雜志, 2019, 21(1): 9-13.
19.	李悅, 李輝, 李天宇, 等. 骨盆復位架在骨盆骨折閉合復位和微創固定的初步臨床應用. 創傷外科雜志, 2021, 23(1): 5-9.
20.	楊成亮, 楊曉東, 劉佳, 等. 骨盆解鎖復位架輔助微創治療TileC2、C3型骨盆骨折. 中華骨科雜志, 2021, 41(19): 1380-1386.
21.	楊成志, 黃站珠, 唐經勵, 等. 骨科手術機器人與 “O” 型臂X線導航輔助骨盆骨折經皮內固定術的比較. 中華骨科雜志, 2021, 41(19): 1387-1395.
22.	楊家趙, 謝凱, 李黎, 等. 骨盆支架輔助復位聯合通道螺釘固定治療骨盆骨折. 臨床骨科雜志, 2021, 24(5): 699-703.
23.	楊家趙, 方詩元. 智能監視系統輔助骨盆復位架復位骨盆骨折1例. 臨床骨科雜志, 2021, 24(4): 565.
24.	Luo Y, Chen H, He L, et al. Displaced posterior pelvic ring fractures treated with an unlocking closed reduction technique: Prognostic factors associated with closed reduction failure, reduction quality, and fixation failure. Injury, 2022. doi: 10.1016/j.injury.2022.01.001.
25.	麥奇光, 陳煜輝, 朱振華, 等. 骨盆解鎖復位架輔助復位固定治療陳舊性DenisⅠ、Ⅱ型骶骨骨折合并骶叢損傷. 中華骨科雜志, 2022, 42(10): 652-660.
26.	林森財, 伍洪. 西門子小C形臂原理與維修. 現代科學儀器, 2002, (6): 60-61.
27.	Lefaivre KA, Starr AJ, Barker BP, et al. Early experience with reduction of displaced disruption of the pelvic ring using a pelvic reduction frame. J Bone Joint Surg (Br), 2009, 91(9): 1201-1207.

1. Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury, 2004, 35(7): 671-677.
2. Grotz MR, Allami MK, Harwood P, et al. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury, 2005, 36(1): 1-13.
3. Mohanty K, Musso D, Powell JN, et al. Emergent management of pelvic ring injuries: an update. Can J Surg, 2005, 48(1): 49-56.
4. Basta AM, Blackmore CC, Wessells H. Predicting urethral injury from pelvic fracture patterns in male patients with blunt trauma. J Urol, 2007, 177(2): 571-575.
5. G?nsslen A, Hildebrand F, Heidari N, et al. Pelvic ring injuries in children. Part I:Epidemiology and primary evaluation. A review of the literature. Acta Chir Orthop Traumatol Cech, 2012, 79(6): 493-498.
6. Pereira GJC, Damasceno ER, Dinhane DI, et al. Epidemiology of pelvic ring fractures and injuries. Rev Bras Ortop, 2017, 52(3): 260-269.
7. Routt ML, Simonian PT. Closed reduction and percutaneous skeletal fixation of sacral fractures. Clin Orthop Relat Res, 1996, (329): 121-128.
8. Thaunat M, Laude F, Paillard P, et al. Transcondylar traction as a closed reduction technique in vertically unstable pelvic ring disruption. Int Orthop, 2008, 32(1): 7-12.
9. 陳華, 齊紅哲, 朱正國, 等. 骨盆外架輔助復位聯合通道螺釘固定治療TileC1型骨盆骨折. 中華創傷雜志, 2018, 34(10): 919-924.
10. Boudissa M, Roudet A, Fumat V, et al. Part 1: Outcome of posterior pelvic ring injuries and associated prognostic factors—A five-year retrospective study of one hundred and sixty five operated cases with closed reduction and percutaneous fixation. Int Orthop, 2020, 44(6): 1209-1215.
11. 王剛, 張月雷, 章樂成, 等. 骨科機器人聯合骨盆解鎖復位架輔助下經皮螺釘固定治療骨盆骨折. 中華創傷骨科雜志, 2020, 22(6): 475-481.
12. 陳華, 白雪東, 易成臘, 等. 中國骨盆骨折微創手術治療指南 (2021). 中華創傷骨科雜志, 2021, 23(1): 4-14.
13. 陳華, 唐佩福. 骨盆髖臼骨折微創治療. 鄭州: 河南科學技術出版社, 2016: 63-74, 119-140.
14. Chen H, Zhang Q, Wu Y, et al. Achieve closed reduction of irreducible, unilateral vertically displaced pelvic ring disruption with an unlocking closed reduction technique. Orthop Surg, 2021, 13(3): 942-948.
15. Pape HC, Tornetta P, Tarkin I, et al. Timing of fracture fixation in multitrauma patients: the role of early total care and damage control surgery. J Am Acad Orthop Surg, 2009, 17(9): 541-549.
16. Fitzgerald CA, Morse BC, Dente CJ. Pelvic ring fractures: has mortality improved following the implementation of damage control resuscitation? Am J Surg, 2014, 208(6): 1083-1090.
17. 胡居正, 石展英, 王仁崇, 等. Starr復位架聯合 “O” 型臂導航系統治療骨盆骨折的近期療效. 中華骨科雜志, 2019, 39(13): 817-825.
18. 唐經勵, 劉搏宇, 胡居正, 等. Starr架輔助復位INFIX與前柱螺釘內固定治療不穩定骨盆骨折臨床比較分析. 創傷外科雜志, 2019, 21(1): 9-13.
19. 李悅, 李輝, 李天宇, 等. 骨盆復位架在骨盆骨折閉合復位和微創固定的初步臨床應用. 創傷外科雜志, 2021, 23(1): 5-9.
20. 楊成亮, 楊曉東, 劉佳, 等. 骨盆解鎖復位架輔助微創治療TileC2、C3型骨盆骨折. 中華骨科雜志, 2021, 41(19): 1380-1386.
21. 楊成志, 黃站珠, 唐經勵, 等. 骨科手術機器人與 “O” 型臂X線導航輔助骨盆骨折經皮內固定術的比較. 中華骨科雜志, 2021, 41(19): 1387-1395.
22. 楊家趙, 謝凱, 李黎, 等. 骨盆支架輔助復位聯合通道螺釘固定治療骨盆骨折. 臨床骨科雜志, 2021, 24(5): 699-703.
23. 楊家趙, 方詩元. 智能監視系統輔助骨盆復位架復位骨盆骨折1例. 臨床骨科雜志, 2021, 24(4): 565.
24. Luo Y, Chen H, He L, et al. Displaced posterior pelvic ring fractures treated with an unlocking closed reduction technique: Prognostic factors associated with closed reduction failure, reduction quality, and fixation failure. Injury, 2022. doi: 10.1016/j.injury.2022.01.001.
25. 麥奇光, 陳煜輝, 朱振華, 等. 骨盆解鎖復位架輔助復位固定治療陳舊性DenisⅠ、Ⅱ型骶骨骨折合并骶叢損傷. 中華骨科雜志, 2022, 42(10): 652-660.
26. 林森財, 伍洪. 西門子小C形臂原理與維修. 現代科學儀器, 2002, (6): 60-61.
27. Lefaivre KA, Starr AJ, Barker BP, et al. Early experience with reduction of displaced disruption of the pelvic ring using a pelvic reduction frame. J Bone Joint Surg (Br), 2009, 91(9): 1201-1207.

Chinese Journal of Reparative and Reconstructive Surgery

A multicenter retrospective study assessing pelvic unlocking closed reduction device for reducing unstable pelvic posterior ring disruption

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