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.
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.
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.
【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 investigate the effectiveness of channel screw combined with skin-stretching technique in treatment of pelvic fracture with severe Morel-Lavallée lesion.MethodsBetween January 2017 and May 2020, 11 patients with pelvic fractures complicated with severe Morel-Lavallée lesions were treated with channel screw combined with skin-stretching technique. There were 8 males and 3 females, with an average age of 39.2 years (range, 28-58 years). Causes of injury included traffic accident in 9 cases and falling from hight in 2 cases. The time from injury to hospital admission ranged from 1 to 6 days (mean, 3.7 days). According to the Tile classification, the pelvic fractures were rated as type C1 in 7 cases, type C2 in 3 cases, and type C3 in 1 case. The sites of Morel-Lavallée lesions were buttocks in 8 cases, hips in 2 cases, and thigh in 1 case. There was 1 case of rectal injury, 1 case of splenic rupture, 3 cases of craniocerebral injury, 2 cases of chest injury, 4 cases of spinal fracture, and 6 cases of sacral nerve injury. X-ray films were performed to observe reduction and healing of fracture. The quality of fracture reduction was evaluated by Matta standard at 1 week after operation. Wound healing and complications were observed. Majeed scoring was used to evaluate hip function and Gibbons sacral nerve injury grading was used to evaluate neurological function recovery.ResultsThe patients underwent 4-7 operations, with an average of 5.8 operations. The time of first operation (pelvic fracture fixation, debridement, and skin distractor installation) was 115-275 minutes, with an average of 186.5 minutes. The amount of intraoperative blood loss was 30-80 mL, with an average of 45.5 mL. All patients were followed up 6-12 months, with an average of 8.3 months. The quality of fracture reduction according to the Matta standard was excellent in 7 cases, good in 2 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. All fractures healed at 3-6 months after operation, with an average of 4.5 months. At last follow-up, the hip functions were excellent in 7 cases and good in 4 cases according to Majeed scoring, with an excellent and good rate of 100%. Among the 6 patients complicated with sacral nerve injury, the Gibbons sacral nerve injury grading reached gradeⅠ for 4 cases, gradeⅡ for 1 case, and grade Ⅲ for 1 case. The wounds of 9 cases were sutured directly after skin-stretching treatment for 25-32 days, with an average of 28 days. The dermal edge necrosis occurred in 1 case, and the defect was repaired by free skin grafting. The skin superficial dry necrosis of the wound occurred in 1 case, and healed by dressing change.ConclusionIn the treatment of pelvic fracture complicated with severe Morel-Lavallée lesion, the channel screw and skin-stretching technique showed their own advantages, which can obtain early fracture fixation and good wound healing.
Objective To evaluate the security and effectiveness of minimal invasive fixation with fluoroscopybased navigation in the management of pelvic fractures. Methods From April 2007 to June 2008, 22 patients with pelvic fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system after closed reduction. There were 13 males and 9 females, aged 21-65 years old. Fractures were caused by traffic accident in 17 cases, andfall ing from height in 5 cases. According to AO classification, there were 2 cases of A2.2 type, 2 cases of A2.3 type, 7 cases of B1.2 type, 3 cases of B2.2 type, 1 case of B3.3 type, 2 cases of C1.2 type, 3 cases of C1.3 type, and 2 cases of C2.3 type. The interval from injury to hospital ization was 4 hours to 3 days (mean 1.2 days). After 3-13 days of skeletal traction through tibial tubercle, the operation was performed. Results Totally 42 screws were inserted. The average time for operation was 20.4 minutes per screw. Forty-one screws were inserted correctly with a successful insertion rate of 97.6%, only 1 hollow screw was reinserted for deviation. No incision problem and implant failure occurred. All 22 patients were followed up 7 to 21 months with an average of 14.5 months. At last follow-up, fracture union was achieved in all patients with satisfactory screw fixation. According to Majeed functional scoring, the results were excellent in 18 cases and good in 4 cases, with an excellent and good rate of 100%. Conclusion The minimal invasive fixation with fluoroscopy-based navigation makes the surgery for the pelvic fracture more precise and time-saving, and improves cl inical results without an increasing rate of compl ications.
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.
Objective To investigate the surgical treatments of Morel-Lavallée lesion with perineal lacerations. Methods From March 2003 to June 2009, 18 cases of Morel-Lavallée lesion with perineal lacerations were treated. There were 16 males and 2 females with a median age of 28.5 years (range, 3-54 years). The time between the injury and hospital ization ranged from 3 hours to 7 days. The lesions were in the greater trochanter (2 cases), the gluteal (2 cases), the lumbar flank (1 case), the lumbar sacrum (3 cases), the pelvic girdle (7 cases), and the hip (3 cases). All the cases were compl icated with perineal lacerations, which included male genital ia defect (2 cases), mangled genital ia (2 cases), and genital ia injuries with anal injuries (14 cases). The main treatments included repeated debridement, external fixation of fractures, vacuum seal ing drainage, skin grafting, reconstruction of genital ia, and anoplasty. Results Three cases died after operation. Two cases died of multiple system organ failure, 1 case died of septic shock. Three cases were amputated and the causes were mangled extremities (2 cases) and osteofascial compartment syndrome (1 case). In 15 survivors, the average time of operations was 3.6 times (range, 3-8 times) and the average hospital ization days was 43.3 days (range, 32-108 days). After a follow-up of 6 months to 2 years, all perineal wounds healed. Anals recovered the normal defecation while one with ostomy was waiting for the secondly resetting of the bowels. Conclusion The treatments of Morel-Lavallée lesion with perineal lacerations were significantly different from simple close Morel-Lavallée lesion. With high mortal ity and disabil ity, Morel-Lavallée lesion with perineal lacerations require more challenging treatment protocols among which the most important is the soft tissue management and nutrition. The satisfactory outcomes come from joint efforts of multiple departments.
ObjectiveTo evaluate the effectiveness of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in pubic branch fractures.MethodsThe clinical data of 42 patients with pubic branch fractures treated by hollow screw fixation between March 2008 and March 2019 were analyzed retrospectively. According to the operation method, they were divided into the traditional operation group (20 cases in group A, fixed with traditional retrograde pubic screws) and the modified operation group (22 cases in group B, fixed with percutaneous retrograde pubic screws assisted by hollow pedicle opener). There was no significant difference (P>0.05) between the two groups in terms of gender, age, cause of injury, fracture classification, comorbidity, and time from injury to operation. The operation time, blood loss, incision length, screw length, and complications were recorded and compared between the two groups. The fracture reduction was evaluated according to Matta standard on the next day after operation, and the function was evaluated by Majeed score at 12 months after operation.ResultsThe operation was successfully completed in both groups. The operation time, blood loss, and incision length of group B were significantly less than those of group A (P<0.05); there was no significant difference in screw length between the two groups (t=0.793, P=0.437). All patients were followed up 8-24 months, with an average of 16.8 months. There was no complication in the two groups, such as injury of blood vessels and nerves, fracture of internal fixation, screw entering into joint cavity, and nonunion of fracture. There was no significant difference in the fracture healing time between the two groups (t=?1.068, P=0.299). There were 2 cases of incision infection, 1 case of incision fat liquefaction, 2 cases of lower extremity deep vein thrombosis in group A, the incidence of complications was 25.0%; there was only 1 case of lower extremity deep vein thrombosis in group B, the incidence of complication was 4.5%, which was lower than that in group A, but the difference was not significant (χ2=2.104, P=0.147). In group A, 1 case was found to be dislocated, but in group B, there was no dislocated fracture. There was no significant difference between the two groups in the evaluation of Matta imaging on the next day after operation and the evaluation of Majeed function at 12 months after operation (P>0.05).ConclusionPercutaneous retrograde pubic screw implantation assisted by hollow pedicle opener is effect for the pubic branch fractures with the advantage of smaller incision, shorter operation time, and less bleeding compared with traditional methods.
