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.
ObjectiveTo investigate the impact of the Salter innominate osteotomy on the acetabular morphology and direction and the relationship between them in children with developmental dislocation of the hip (DDH) by three-dimensional CT.
MethodsBetween January 2013 and January 2015, 51 patients with unilateral DDH were treated. All patients were females with an average age of 2 years and 5 months (range, one year and 6 months to 5 years). All the patients underwent open reduction of the hip, Salter innominate osteotomy, proximal femoral osteotomy, and hip cast immobilization for treatment. The data of three-dimensional CT before surgery and at 1 week after surgery were measured and collected as follows:the anterior acetabular index (AAI), posterior acetabular index (PAI), axial acetabular index (AxAI), acetabular anteversion angle (AAA) of the acetabulum, and the distances of the forward, outward, and lateral rotation of the distal osteotomy fragments. The differences of AAI, PAI, AxAI, AAA between before and after surgeries were compared and the difference values of the data with significant difference results were calculated. The relationship between the difference values and the distances of three different rotation directions before and after surgeries were tested by Spearman correlation analysis.
ResultsThere were significant differences in the AAI, PAI, and AAA between before and after surgery (P<0.05), but no significant difference was found in the AxAI between before and after surgery (t=0.878, P=0.384). The difference values of AAI, PAI, and AAA were (4.518±4.601), (4.219±6.660), and (3.919±4.389)° respectively. The distances of the outward, lateral, and forward rotation of the distal osteotomy fragments after surgery were (0.420±0.339), (2.440±0.230), and (0.421±0.311) cm. There was a significant correlation between the three different rotation directions and AAI difference (P<0.05), especialy the outward rotation (r=0.981). There was a correlation between the outward, forward rotation and PAI, AAI differences (P<0.05), and no significant correlation between the lateral rotation and PAI, AAA was found (P>0.05). There was a significant correlation between the forward rotation and AAA difference (r=0.841).
ConclusionSalter innominate osteotomy can increase the curvature of the anterior wall of the acetabulum in DDH, but reduce the curvature of the rear wall. At the same time, it can also change the direction of the acetabulum, significantly decrease the acetabular anteversion, but it can not change the depth of the acetabulum. The main factors of the curvature change after Salter innominate osteotomy of DDH is attributable to outward rotation, followed by forward rotation, and the main factor of the acetabular direction change is attributable to forward rotation.
Objective To investigate the clinical effect of orthopedic robot-assisted sacroiliac joint screws in the treatment of posterior pelvic ring fractures. Methods Patients who underwent sacroiliac joint screw fixation in People’s Hospital of Deyang City between January 2018 and August 2021 were included, and the patients were divided intoa robotic group and a manual group by randomization. The robot group used robot-assisted insertion of sacroiliac joint screws, and the manual group used manual insertion of sacroiliac joint screws. The general condition, time of sacroiliac joint screw placement, intraoperative fluoroscopy times, guide needle drilling times, surgical blood loss, and Majeed pelvic function score were compared between the two groups. Results A total of 42 patients were included, and there was no significant difference in gender, age, body mass index , injury type or injury cause between the two groups (P>0.05). Finally, 21 screws were placed in 19 patients in the robotic group and 23 screws in 23 patients in the manual group. The wounds of the two groups were completely healed after operation, and there was no wound infection, iatrogenic vascular and nerve injury, and no loosening of internal fixation. There was no significant difference in screw placement time, blood loss or Majeed score between the two groups (P>0.05). The number of fluoroscopy (14.53±4.54 vs. 19.87±5.48) and drilling times (1.00±0.00 vs. 7.24±3.77) in the robotic group were less than those in the manual group, and the differences were statistically significant (P<0.05). Conclusion Orthopedic surgical robots have the advantages of minimally invasive, less fluoroscopy, and accurate screw placement in sacroiliac joint screw placement, and have good clinical results in the treatment of pelvic fractures.
ObjectiveTo analyze the biomechanical properties of the rod-screw prosthesis based on a pelvic three-dimensional finite element model including muscle and ligament, and evaluate the effectiveness of zoneⅠ+Ⅱ+Ⅲ reconstruction of hemipelvis with rod-screw prosthesis in combination with clinical applications. Methods A total of 21 patients who underwent hemipelvic tumor resection (zoneⅠ+Ⅱ+Ⅲ) and rod-screw prosthesis reconstruction between January 2015 and December 2020 were selected as the research subjects. Among them, there were 11 males and 10 females; the age ranged from 16 to 64 years, with an average age of 39.2 years. There were 9 cases of chondrosarcoma, 7 cases of osteosarcoma, 3 cases of Ewing sarcoma, and 2 cases of undifferentiated pleomorphic sarcoma. According to the Musculoskeletal Tumor Society Score (MSTS) staging, there were 19 cases of stage ⅡB and 2 cases of stage Ⅲ. Preoperative Harris Hip Score (HHS) and MSTS score were 54.4±3.1 and 14.1±2.0, respectively. Intraoperative 15 cases underwent extensive resection, 5 cases underwent marginal resection, and 1 case underwent intralesional resection. The CT image of 1 patient after reconstruction was used to establish a three-dimensional solid model of the pelvis via Mimics23Suite and 3-matic softwares. At the same time, a mirror operation was used to obtain a normal pelvis model, then the two solid models were imported into the finite element analysis software Workbench 2020R1 to establish three-dimensional finite element models, and the biomechanical properties of the standing position were analyzed. The operation time, intraoperative blood loss, and operation-related complications were recorded, and the postoperative evaluation was carried out with HHS and MSTS scores. Finally, the local recurrence and metastasis were reviewed. ResultsFinite element analysis showed that the peak stress of the reconstructed pelvis appeared at the fixed S1, 2 rod-screw connections; the peak stress without muscles was higher than that after muscle construction, but much smaller than the yield strength of titanium alloy. The operation time was 250-370 minutes, with an average of 297 minutes; the amount of intraoperative blood loss was 3 200-5 500 mL, with an average of 4 009 mL. All patients were followed up 8-72 months, with an average of 42 months. There were 7 cases of pulmonary metastasis, of which 2 cases were preoperative metastasis; 5 cases died, 16 cases survived, and the 5-year survival rate was 72.1%. There were 3 cases of local recurrence, all of whom did not achieve extensive resection during operation. The function of the affected limbs significantly improved, and the walking function was restored. The HHS and MSTS scores were 75.2±3.0 and 20.4±2.0 at last follow-up, respectively, and the differences were significant when compared with those before operation (t=22.205, P<0.001; t=11.915, P<0.001). During follow-up, 2 cases of delayed incision healing, 2 cases of deep infection, 1 case of screw loosening, and 1 case of prosthesis dislocation occurred, and no other complication such as prosthesis or screw fracture occurred. Conclusion The stress and deformation distribution of the reconstructed pelvis are basically the same as normal pelvis. The rod-screw prosthesis is an effective reconstruction method for pelvic malignant tumors.
Objective To review the clinical characteristics of patients with traumatic spinopelvic dissociation (SPD) and explore the diagnostic and therapeutic methods. Methods A clinical data of 22 patients with SPD who underwent surgical treatment between March 2019 and August 2024 was retrospectively analyzed. There were 13 males and 9 females, with an average age of 35.5 years (range, 14-61 years). The causes of injury included falling from height in 16 cases, traffic accidents in 5 cases, and compression injury in 1 case. Sacral fractures were classified based on morphology into “U” type (9 cases), “H” type (7 cases), “T” type (4 cases), and “λ” type (2 cases). According to the Roy-Camille classification, there were 4 cases of type Ⅰ, 12 cases of type Ⅱ, 2 cases of type Ⅲ, and 4 cases of type Ⅳ. The Cobb angle was (35.7± 22.0)°. Sixteen patients were accompanied by lumbosacral trunk and cauda equina nerve injury, which was classified as grade Ⅱ in 5 cases, grade Ⅲ in 5 cases, and grade Ⅳ in 6 cases according to the Gibbons grading. The time from injury to operation was 2-17 days (mean, 5.7 days). Based on the type of sacral fracture and sacral nerve injury, 6 cases were treated with closed reduction and minimally invasive percutaneous sacroiliac screw fixation, 16 cases were treated with open reduction and lumbar iliac fixation (8 cases)/triangular fixation (8 cases). Among them, 11 patients with severe fracture displacement and kyphotic deformity leading to sacral canal stenosis or bony impingement within the sacral foramen underwent laminectomy and sacral nerve decompression. X-ray films and CT were reviewed during followed-up. The Matta score was used to evaluate the quality of fracture reduction. At last follow-up, the Majeed score was used to assess the functional recovery, and the Gibbons grading was used to evaluate the nerve function. Results All operations were successfully completed. All patients were followed up 8-64 months (mean, 20.4 months). Two patients developed deep vein thrombosis of the lower limbs, 2 had incision infections, and 1 developed a sacral pressure ulcer; no other complications occurred. Radiological examination showed that the Cobb angle was (12.0±6.8)°, which was significantly different from the preoperative one (t=6.000, P<0.001). The Cobb angle in 16 patients who underwent open reduction was (14.9±5.5)°, which was significantly different from the preoperative one [(46.8±13.9)° ] (t=8.684, P<0.001). According to the Matta scoring criteria, the quality of fracture reduction was rated as excellent in 8 cases, good in 7 cases, fair in 5 cases, and poor in 2 cases, with an excellent and good rate of 68.2%. Bone callus formation was observed at the fracture site in all patients at 12 weeks after operation, and bony union achieved in all cases at last follow-up, with a healing time ranging from 12 to 36 weeks (mean, 17.6 weeks). At last follow-up, the Majeed score was rated as excellent in 7 cases, good in 10 cases, fair in 4 cases, and poor in 1 case, with an excellent and good rate of 77.3%. One patient experienced a unilateral iliac screw breakage at 12 months after operation, but the fracture had already healed, and there was no loss of reduction. Among the 16 patients with preoperative sacral nerve injury, 11 cases showed improvement in nerve function (6 cases) or recovery (5 cases). Conclusion SPD with low incidence, multiple associated injuries, and high incidence of sacral nerve injury, requires timely decompression of the sacral canal for symptomatic sacral nerve compression, fractures reduction, deformities correction, and stable fixation.
Objective To investigate the relationship between the Clinical Frailty Scale (CFS) and prognosis in elderly patients with pelvic fractures who are treated conservatively. Methods Patients aged ≥65 years admitted to Chengdu Pidu District People’s Hospital between January 2015 and January 2023 with low-energy pelvic-ring fractures (Tile type A/B) who received non-operative management were retrospectively collected. The patients were stratified by CFS score on admission into robust (CFS 1-3), vulnerable (CFS 4), and frail (CFS 5-9) groups. Baseline characteristics (age, sex, smoking history, alcohol use, and so on) and outcomes (complications, discharge destination, and in-hospital mortality) were compared among groups. Binary logistic regression was used to assess the association between CFS and outcomes. Results A total of 197 patients were enrolled: 78 robust, 59 vulnerable, and 60 frail. Significant differences were observed among the robust, vulnerable, and frail groups in age [(68.72±2.53), (71.47±3.53), and (73.25±2.33) years, respectively; P<0.05], incidence of complications (28.2%, 33.9%, and 56.7%, respectively; P<0.05), and incidence of adverse discharge destinations (15.4%, 25.4%, and 38.3%, respectively; P<0.05). Logistic regression analysis revealed that frailty (CFS 5-9 vs. 1-3) was an independent predictor of any complications [odds ratio (OR)=3.342, 95% confidence interval (CI) (1.390, 8.037), P=0.007] and adverse discharge destination [OR=4.871, 95%CI (1.762, 13.469), P=0.002]. Conclusion CFS-assessed frailty correlates with the adverse discharge destination and any complication in elderly patients undergoing conservative treatment for pelvic fractures.
Objective To investigate the early effectiveness of transiliac-transsacral screws internal fixation assisted by augmented reality navigation system HoloSight (hereinafter referred to as “computer navigation system”) in the treatment of posterior pelvic ring injuries. MethodsA retrospective analysis was made in the 41 patients with posterior pelvic ring injuries who had been treated surgically with transiliac-transsacral screws between June 2022 and June 2023. The patients were divided into navigation group (18 cases, using computer navigation system to assist screw implantation) and freehand group (23 cases, using C-arm X-ray fluoroscopy to guide screw implantation) according to the different methods of transiliac-transsacral screws placement. There was no significant difference in gender, age, body mass index, causes of injuries, Tile classification of pelvic fracture, days from injury to operation, usage of unlocking closed reduction technique between the two groups (P>0.05). The time of screw implantation, the fluoroscopy times, the guide wire adjustment times of each screw, and the incidence of complications were recorded and compared between the two groups. The position of the transiliac-transsacral screw was scanned by CT within 2 days after operation, and the position of the screw was classified according to Gras standard. ResultsThe operation was successfully completed in both groups. The time of screw implantation, the fluoroscopy times, and the guide wire adjustment times of each screw in the navigation group were significantly less than those in the freehand group (P<0.05). There were 2 cases of incision infection in the freehand group, and the incision healed by first intention after active dressing change; there was no screw-related complication in the navigation group during operation and early period after operation; the difference in incidence of complications between the two groups (8.7% vs. 0) was not significant (P=0.495). According to the Gras standard, the screw position of the navigation group was significantly better than that of the freehand group (P<0.05). ConclusionCompared with the traditional freehand method, the computer navigation system assisted transiliac-transsacral screws internal fixation in the treatment of posterior pelvic ring injuries has advantages of improving the accuracy of screw implantation and reducing radiation damage and the time of screw implantation.
ObjectiveTo summarize the research progress of surgical treatment for primary sacrum tumor.
MethodThe domestic and foreign related literature about surgical treatment of primary sacrum tumor, and many aspects of its surgical procedures, intraoperative hemostasis, pelvic reconstruction, protection of sacral nerve, complications, and prognosis was summarized and analyzed.
ResultsThe operation is the major therapy for primary sacrum tumor. However, surgical procedures, protection of sacral nerve, and the way of intraoperative hemostasis remain controversial. Meanwhile, the complexity of pelvic reconstruction, the diversity of complications, and prognosis related with many factors bring difficulties and challenges to the surgical treatment.
ConclusionsIt is urgent need to develop an effective unified standard to conduct diagnosis and treatment of primary sacrum tumor.
