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Objective@#To compare the clinical efficacy of the preserving insertion point of the rectus abdominis-Pfannenstiel approach with traditional Pfannenstiel approach in the treatment of pelvic anterior ring injuries.@*Methods@#A retrospective analysis was performed on 43 cases with pelvic anterior ring injuries treated from September 2008 to February 2016. Among them, 20 cases were treated with the preserving insertion point of the rectus abdominis-Pfannenstiel approach (modified approach group) including 14 males and 6 females, aged 18-58 years, with an average age of 36.9 years. According to Tile classification of pelvic fractures, there were 8 cases of B1 type, 4 cases of B2 type, 2 cases of B3 type, 4 cases of C1 type and 2 cases of C2 type. And 23 cases were treated with traditional Pfannenstiel approach (traditional approach group, 16 cases of males and 7 cases of females, aged 19-59 years, with an average age of 36.8 years). Tile classification of pelvic fractures: 9 cases of B1, 4 cases of B2, 3 cases of B3, 4 cases of C1 and 3 cases of C2). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative reduction, postoperative functional and complications were compared between the two groups.@*Results@#43 patients were followed up for 12-40 months, with an average of 20.5 months. All fractures healed in 8-20 weeks, with an average time of 10 weeks. Duration of anterior approach: 119.0±18.3 min in the modified approach group and 93.7±17.8 min in the traditional approach group (t=4.597, P< 0.05). Intraoperative blood loss: 206.0±38.2 ml in the modified approach group and 252.4±46.1 ml in the traditional approach group (t=-3.560, P< 0.05). Postoperative hospital stay: 14.5±3.0 d in the modified approach group, and 20.0±4.4 d in the traditional approach group (t=-4.775, P< 0.05). Postoperative reduction was evaluated according to the Matta reduction criteria, among which 15 cases were excellent and 5 cases were good in the modified approach group; 17 cases were excellent and 6 cases were good in the traditional approach group. According to the Majeed score, the postoperative function of pelvic fracture was excellent in 10 cases, good in 7 cases, and acceptable in 3 cases, with an excellent and good rate of 85.0% (17/20). There were 11 excellent cases, 8 good cases and 4 fair cases in the traditional approach group, with an excellent and good rate of 82.6% (19/23). There was no statistically significant difference between the two groups (χ2=0.04, P >0.05). Complications: 2 cases of internal fixation loosening and 2 cases of coital pain occurred in the modified approach group after surgery, with a complication rate of 20.0% (4/20). Postoperatively, 1 case of superficial infection, 1 case of pulmonary infection, 1 case of internal fixation loosening, 1 case of screw broken and 4 cases of coital pain occurred in the traditional approach group, with a complication rate of 34.8% (8/23).@*Conclusion@#Both approaches can achieve satisfactory results in the treatment of anterior pelvic ring injury. The preserving insertion point of the rectus abdominis-Pfannenstiel approach for the treatment of anterior pelvic ring injuries has the advantages of less bleeding, faster recovery and shorter hospitalization time.
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Objective To explore the incidence and clinical significance of corona mortis vessels.Methods From December 2015 to December 2017,48 patients with pelvic acetabular fractures were treated with the Stoppa approach,including 36 males and 12 females,aged 30 to 67 years,with an average age of 47.2±8.2 years.There were 52 sides of hemipelvis in the all including 44 cases of unilateral pelvic acetabular fractures and 4 cases of bilateral pelvic acetabular fractures.In the 48 patients,there were 6 pelvic fractures,40 acetabular fractures and 2 pelvic combined with acetabular fractures.According to Judet-Letournel classification:there were 6 cases of anterior column fracture,4 cases of anterior column with anterior wall fracture,2 cases of anterior column with posterior transverse fracture,4 cases of transverse fracture,6 cases of "T" shape fracture and 20 cases of double column fracture.According to Tile classification,there were 2 cases of B1 type,2 cases of B3 type,2 cases of C1 type,and 2 cases of C2 type.The time from injury to surgery was 5 to 16 days,with an average of 8.3±2.8 days.All patients were treated with the Stoppa approach for reduction and fixation.The incidence,number and type of corona mortis vessels across the superior pubic branch,and the diameter and the distance between the vessels and the pubic symphysiswere detected and recorded.Results In the 52 hemi pelvis,there were 46 sides with an anastomotic blood vessel,and no anastomotic blood vessel was found in 6 sides,with the incidence of corona mortis vessels of 88.5％ (46/52).Among them,36 cases were venous type,with the incidence of 78.3％ (36/46);8 cases were arterial type,with the incidence of 17.4％ (8/46);2 cases were mixed type,with the incidence of 4.3％(2/46);corona mortis venous blood vessel diameter was 1.8-3.7 mm,with an average of 2.9±0.5 mm;arterial blood vessel diameter was 2.4-3.0 mm,with an average of 2.7±0.3 mm;the distance between the vessels and the pubic symphysis was 48-71 mm,with an average of 56.9±5.8 mm.Conclusion The corona mortis vessels are common,with the incidence through Stoppa approach about 88.5％.In the clinical treatment of pelvic acetabular fractures,we should pay attention to careful separation of pubic branches exposed by the Stoppa approach,especially when using ilioinguinal approach to avoid corona mortis vessels injury and haemorrhage.
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Objective To compare the clinical efficacy of the preserving insertion point of the rectus abdominis?Pfannen?stiel approach with traditional Pfannenstiel approach in the treatment of pelvic anterior ring injuries. Methods A retrospective analysis was performed on 43 cases with pelvic anterior ring injuries treated from September 2008 to February 2016. Among them, 20 cases were treated with the preserving insertion point of the rectus abdominis?Pfannenstiel approach (modified approach group) including 14 males and 6 females, aged 18-58 years, with an average age of 36.9 years. According to Tile classification of pelvic fractures, there were 8 cases of B1 type, 4 cases of B2 type, 2 cases of B3 type, 4 cases of C1 type and 2 cases of C2 type. And 23 cases were treated with traditional Pfannenstiel approach (traditional approach group, 16 cases of males and 7 cases of females, aged 19-59 years, with an average age of 36.8 years). Tile classification of pelvic fractures: 9 cases of B1, 4 cases of B2, 3 cases of B3, 4 cases of C1 and 3 cases of C2). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative reduc?tion, postoperative functional and complications were compared between the two groups. Results 43 patients were followed up for 12-40 months, with an average of 20.5 months. All fractures healed in 8-20 weeks, with an average time of 10 weeks. Duration of anterior approach: 119.0±18.3 min in the modified approach group and 93.7±17.8 min in the traditional approach group (t=4.597, P<0.05). Intraoperative blood loss: 206.0±38.2 ml in the modified approach group and 252.4±46.1 ml in the traditional ap? proach group (t=-3.560, P<0.05). Postoperative hospital stay: 14.5±3.0 d in the modified approach group, and 20.0±4.4 d in the traditional approach group (t=-4.775, P<0.05). Postoperative reduction was evaluated according to the Matta reduction criteria, among which 15 cases were excellent and 5 cases were good in the modified approach group; 17 cases were excellent and 6 cases were good in the traditional approach group. According to the Majeed score, the postoperative function of pelvic fracture was excel?lent in 10 cases, good in 7 cases, and acceptable in 3 cases, with an excellent and good rate of 85.0% (17/20). There were 11 excel?lent cases, 8 good cases and 4 fair cases in the traditional approach group, with an excellent and good rate of 82.6% (19/23). There was no statistically significant difference between the two groups (χ2=0.04,P >0.05). Complications: 2 cases of internal fixation loosening and 2 cases of coital pain occurred in the modified approach group after surgery, with a complication rate of 20.0% (4/20). Postoperatively, 1 case of superficial infection, 1 case of pulmonary infection, 1 case of internal fixation loosening, 1 case of screw broken and 4 cases of coital pain occurred in the traditional approach group, with a complication rate of 34.8% (8/23). Conclu?sion Both approaches can achieve satisfactory results in the treatment of anterior pelvic ring injury. The preserving insertion point of the rectus abdominis?Pfannenstiel approach for the treatment of anterior pelvic ring injuries has the advantages of less bleeding, faster recovery and shorter hospitalization time.
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Objective To explore the application value of external fixator in obsolete hip dislocation.Methods Retrospective analysis of 9 cases of obsolete hip dislocation treated with external fixator from January 2010 to January 2017.There were 6 males and 3 females,with an average of 32.0±8.3 years old (range 19-47).The time from injury to operation was 3-9 months,with an average of 6.2± 1.9 months.The patient's limb shortening length,traction time,traction length,operation time,surgical bleeding volume,preoperative and last follow-up VAS score,Epstein score,D'Aubigne functional score were recorded.Results The length of the limb shortened 5-11cm,with an average of 6.7±2.0 cm.The preoperative traction time ranged 20-45 d,with an average of 26.9±8.2 d.The length of traction ranged 5-12 cm,with an average of 7.1±2.2 cm.The second reconstruction operation time was 2.0-4.0 hours,with an average of 2.8±0.7 h.The bleeding volume was 800-2 000ml,with an average of 1 216.7±422.8 ml.The Epstein score at the last follow-up was excellent in 4 cases,good in 4 cases and improved in 1 case.The preoperative VAS score and the final follow-up VAS score were 0.9±0.8 points and 4.6±0.9 points respectively.There was a significant difference between preoperative and postoperative VAS scores (t=8.981,P=0.000).The D'Aubigne functional scores of preoperative and final follow-up were 5.2±1.0 points and 13.1±2.0 points respectively and the difference was statistically significant (t=-12.044,P=0.000).Conclusion The external fixation in the treatment of obsolete dislocation of the hip is helpful and accepted in patients with femoral head dislocation.It is easy to carry and tract for patients and convenient for functional exercise.The external fixation makes operation simple and flexible;the traction force is strong and the effect of the femoral head reduction is obvious,the operation method is simplified and the quality of the reduction is improved.
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Objective To report the effects of surgical treatment of old die-punch fractures of the distal radius.Methods A retrospective study of case series was made of the 21 old die-punch fractures of the distal radius which had been surgically treated from January 2012 to January 2017 at Department of Orthopaedics,Shandong Provincial Hospital.There were 13 males and 8 females,aged from 34 to 63 years (average,46.9 years).According to the preoperative definite diagnoses by the X-ray and CT images,there were 14 metacarpal compression fractures and 7 dorsal compression fractures.The palmar approach was used in 13 cases,the dorsal approach in 7 and the combined approach in one.Autogenous iliac bone grafting was performed for all the cases.Their preoperative and postoperative Cooney scoring and visual analogue scale (VAS) of the wrist,and postoperative complications as well,were observed and recorded.Results This cohort was followed up for 8 to 14 months (average,9.2 months).All their postoperative wounds healed by the first intention.Their Cooney functional scores of the wrist were,respectively,58.5 ± 4.2 and 84.0 ± 3.1 points preoperatively and at the final follow-up,and their corresponding VAS scores 7.6 ± 0.9 and 3.4 ± 1.3 points,showing significant differences between preoperation and the final follow-up (P ＜ 0.05).Carpal arthritis was observed in one case.Conclusion For old die-punch fractures of the distal radius,surgical treatment can obviously reduce pain,improve function of the wrist and enhance the quality of life of the patients.
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Objective To evaluate clinical outcomes of the Kocher-Langenbeck (K-L) approach combined with partial proximal Watson-Jones incision for the treatment of acetabular fractures involving the weight-bearing area.Methods From January 2012 to January 2017,20 patients were treated by the K-L approach combined with partial proximal Watson-Jones incision for acetabular fracture involving the weight-bearing acetabular dome.They were 13 males and 7 females,with an average age of 40.7 years (range,from 22 to 67 years).According to the Letournel-Judet classification,there were 8 posterior wall fractures,one transverse fracture,one T-shaped fracture,one transverse and posterior wall fracture,3 posterior column and posterior wall fractures,and 6 double-column fractures.All patients received open reduction and internal fixation with plates and screws.The outcomes of reduction were evaluated at follow-ups according to the Matta criteria.The hip function was evaluated according to the modified Merle d'Aubigne-Postel criteria and the abductor strength by the American Medical Research Council criteria at final follow-ups.Results All the 20 patients were followed up for an average of 8.2 months (range,from 7 to 21 months).They all obtained bony union after 10 to 18 weeks (average,11.4 weeks).No fracture displacement,internal fixation loosening or deep infection occurred.According to the Matta criteria,anatomic reduction was achieved in 13 cases,satisfactory reduction in 6 cases,and unsatisfactory in one (a satisfactory rate of 95％).The modified Merle d'Aubigne-Postel scoring for the hip function at the final follow-ups yielded 9 excellent cases,7 good cases,3 fair cases and one poor case (an excellent to good rate of 80％).Ectopic ossification of Brooker grade Ⅰ occurred in one case.The abductor strength was rated as grade Ⅳ in 3 cases and as grade Ⅴ in 17.Conclusions In the treatment of acetabular fractures involving the acetabular dome,the K-L approach combined with partial proximal Watson-Jones incision can increase the operation view of the weight-bearing area,enhance the anatomic matching of femoral head and acetabular roof,and reduce the difficulties in reduction and fixation.
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Objective To investigate the application of 3D printing technique in the treatment of obsolete pelvic and acetabular fractures.Methods The clinical data of 23 patients with obsolete pelvic and acetabular fractures were retrospectively analyzed who had been surgically treated in our hospital from January 2006 through January 2016.3D printing technique was used in surgical planning in 11 of them,including 8 males and 3 females,with an average age of 33.8 ±4.9 years (3D group).The other 12 patients received conventional surgery without using 3D printing technique.They were 9 males and 3 females,with an average age of 34.8 ± 8.3 years (conventional group).The primary pelvic fractures in both groups were all type C according to the Tile classification system.The patients complicated with acetabular fracture in the 3D group and the conventional group were 10 and 11 cases respectively.The operative time,blood loss,blood transfusion.intraoperative fluoroscopy,visual analogue score (VAS) and Majeed score were compared between the 2 groups.Results The 2 groups were compatible in terms of preoperative general data (P ＞ 0.05).For the 3D group and the conventional group,operative time was 166.4± 24.2 min versus 222.5 ± 49.0 min.blood loss 2,063.6 ± 484.3 mL versus 2,700.0 ± 597.0 mL,blood transfusion 13.2 ± 3.2 U versus 17.6 ± 4.5 U,and intraoperative fluoroscopy 7.4 ± 1.3 times versus 11.7 ± 3.6 times.There were significant differences between the 2 groups in the above indexes (P ＜ 0.05).The 3D group and the conventional group obtained an average follow-up of 18.4 months and 21.7 months,respectively.The postoperative VAS scores were respectively 1.8 ±-0.9 points and 3.4 ± 1.0 points for the 2 groups,showing a significant between-group difference (P ＜0.05).The Majeed scores at the last follow-ups were respectively 85.7 ± 4.2 points and 84.9 ± 3.1 points for the 2 groups,showing no significant between-group difference (P ＞ 0.05).There were no such complications in the 3D group as iatrogenic nerve injury,vascular injury,nonunion or internal fixation failure.One patient in the conventional group suffered transient iatrogenic injury to the sciatic nerve.Conclusions 3D printing technique can provide helpful guidance for diagnosis and fracture classification preoperatively.It improves the patient's perioperative safety by benefiting intraoperative reduction,shortening operative time,and reducing intraoperative blood loss and intraoperative fluoroscopy.