ABSTRACT
Objective:The effect of three-dimensional(3D)printed bone-attached guide plate assisted cannulated screw fixation of pelvic fracture is reliable,but extensive soft tissue dissection is still required when installing the guide plate.This study aims to compare the efficacy of posterior pelvic ring fracture fixation with iliosacral screw insertion between the assistance of modified percutaneous patient specific 3D printed guide template and conventional fluoroscopy. Methods:From May,2019 and September 2021,28 patients sustained posterior pelvic ring fractures were randomized into 2 groups:A guide template group,in which the iliosacral screw was inserted for fixation of the posterior pelvic ring fracture with the assistance of modified percutaneous patient specific 3D printed guide template,and a fluoroscopy group,in which the iliosacral screw was inserted under the guidance of conventional fluoroscopy.The operation time,fluoroscopic frequency,intraoperative blood loss,and incision length were recorded for each screw insertion.Fracture reduction was evaluated according to the Matta criteria.The screw position was evaluated according to the modified Gras classification,and the functional outcome was evaluated according to Majeed score.The parameters of both groups were compared,and statistical analysis was performed. Results:All the 28 patients were followed up for 12-24 months.Of them,15 iliosacral screws were inserted in 14 patients in the guide template group,and 14 iliosacral screws were inserted in 14 patients in the fluoroscopy group.The operation time,fluoroscopic frequency,screw deviation,incision length,and blood loss in the guide template group were 20-30(25.8±2.8)min,9-15(12.2±1.9),2-4(2.6±0.7)mm,4-5(4.6±0.5)cm,and 5-10(7.8±1.7)mL,respectively,whereas those in the fluoroscopy group were 30-60(48.1±7.5)min,40-96(64.7±16.3),3-6(4.2±0.9)mm,0.8-1.2(1.0±0.1)cm,and 2-5(3.1±1.3)mL,respectively,and there were statistical significance(all P<0.001).Fracture reduction was evaluated according to the Matta criteria,and all the patients reached excellence and good(P=0.584)in the 2 groups.According to modified Gras classification,there were 12 Grade Ⅰ screws,3 Grade Ⅱ screws,and 0 Grade Ⅲ screws in the guide template group,and 10 Grade Ⅰ screws,3 Grade Ⅱ screws,and 1 Grade Ⅲ screw in the fluoroscopy group,with no statistical significance(P=0.334).The functional outcome was evaluated according to Majeed score at the last follow-up,without significant difference between the guide template group and the fluoroscopy group(P=0.908). Conclusion:Compared with the conventional fluoroscopy,it would cost less operation time,less fluoroscopic frequency and increase more accurate screw insertion to fixate the posterior pelvic ring fracture with the assistance of modified percutaneous patient specific 3D printed guide template.
ABSTRACT
Objective:To observe the relationship between carotid intima-media thickness (CIMT) and hemoglobin A1c (HbA1c) control in type 2 diabetes mellitus (T2DM) patients.Methods:328 cases with T2DM were selected from the endocrinology department of our hospital.All patients underwent assessment,biochemical test and CIMT measurement.According to the value of CIMT,patients were divided into normal CIMT group (＜0.9 mm) and abnormal CIMT group (＞0.9 mm).A multi-factor Logistic regression was performed to analyze the risk factors associated with the abnormal CIMT.Results:(1) Among the 328 T2DM patients,154 cases had normal CIMT and 174 cases had abnormal CIMT.(2) Pearson correlation analysis indicated that the cholesterol and HbA1c levels were positively correlated with CIMT (P＜ 0.05).(3) Univariate analysis showed that the incidence of CIMT was associated with age (t=4.132,P=0.041),systolic blood pressure (t=8.456,P＜0.01),HbA1c≥ 9.0％ (x2=9.912,P＜0.01),cholesterol 0=5.549,P=0.018),triglyceride (t=6.592,P=0.008),UA(t=9.618,P＜0.01),fasting plasma glucose (t=4.592,P=0.037).(4) Multi-factor Logistic regression indicated that age,systolic blood pressure,cholesterol and HbA1c≥ 9.0％ were the independent risk factors for the onset of CIMT (P ＜0.05).Conclusions:The level of HbA1c in T2DM patients was associated with CIMT;And HbA1c≥ 9％ was the independent risk factors for the increase of CIMT.