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Objective:To investigate the clinical effect of "ladder reduction method" in the treatment of iliac fracture combined anterior dislocation of sacroiliac joint.Methods:The retrospective analysis was performed on 10 cases of iliac fracture combined anterior sacroiliac joint dislocation admitted to the Affiliated Hospital of Yunnan University from February 2010 to January 2022, among which 5 cases were males and 5 cases were females, aged ranging from 22 to 52 years, with an average age of 38.8 years. All patients were injured in car accidents including 5 cases of C1.2, 3 cases of C2, and 2 cases of C3 fractures according to Tile classification. All patients were treated with the "ladder reduction method" with plate and screw fixation. In the first step, 1-2 Schanz pins were inserted into the iliac crest to control the ilium, and the Schanz pins were appropriately pulled laterally; in the second step, the periosteal stripper was used to pry the reduction between the sacrum and ilium; in the third step, for the patients who still could not be reduced, a 2.5 mm diameter Kirschner wire was placed on the sacrum close to the iliac crest, and a periosteal stripper was inserted between the sacrum and iliac crest, with its tip against the Kirkner wire, and the iliac crest as the fulcrum for pry pulling to separate the two. In the fourth step, the pry was maintained, and then another 2.5 mm diameter Kirschner wire was placed on the sacrum close to the internal margin of the iliac bone. The periosteal stripper was continued to pry between the sacrum and the iliac bone, and the operation was repeated. At the same time, the anterior dislocation of the sacroiliac joint was reduced with traction of the lower limb. Postoperatively, the quality of reduction was evaluated by the Matta score, and the degree of functional recovery after pelvic fracture was evaluated by the Majeed score.Results:Four patients completed the reduction through the first and second steps, and 6 cases of refractory sacroiliac joint anterior dislocation were successfully reduced through the first to fourth steps. The fracture reduction time of 6 patients with refractory anterior sacroiliac joint dislocation was 39.67±3.09 min (range, 35-44 min), with intraoperative blood loss of 300.00±141.42 ml (range, 150-600 ml); in the other 4 cases, the fracture reduction time was 36.75±4.38 min (range, 30-42 min), and the intraoperative blood loss was 225.00±44.30 ml (range, 200-300 ml). All 10 patients were followed up for 12.9±3.7 months (range, 9-20 months). The anterior and posterior pelvic ring fractures were healed in all patients, and the fracture healing time was 12.77±1.62 weeks (range, 10.71-15.28 weeks). At the last follow-up, Matta evaluation was excellent in 5 cases, good in 1 case, and excellent in the other 4 cases. The Majeed scores of 6 cases were 86.50±6.08 points (range, 74-92 points), of which 5 cases were excellent and 1 case was good. The other 4 cases were 81.5±9.39 scores (range, 71-94), of which 2 were excellent and 2 were good.Conclusion:The "ladder reduction method" is a safe, effective and easy-to-operate method for the treatment of iliac fracture combined anterior dislocation of the sacroiliac joint, especially for refractory anterior dislocation of the sacroiliac joint, which can still obtain satisfactory curative effects.
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Objective To compare the clinical effects of combined anterolateral and posterolateral approach,lateral incision via double intermuscular spatia approach,and posterolateral transfibular approach in the treatment of fractures of anterolateral and posterolateral columns of tibial plateau.Methods A retrospective analysis was done of the 18 patients with fracture of anterolateral and posterolateral columns of tibial plateau who had been treated at our hospital from January 2012 to January 2015.They were 10 men and 8 women,aged from 28 to 58 years (mean,35.5 years).They were divided into 3 equal groups.Group A was treated with combined anterolateral and posterolateral approach,group B with lateral incision via double intermuscular spatia approach and group C with posterolateral transfibular approach.Operation time,surgical blood loss and complications were recorded.At the final follow-ups,Rasmussen score was used to evaluate the fracture reduction and Hospital for Special Surgery (HSS) knee score to assess functions of the involved knees.Results The 18 patients were followed up for 10 to 18 months (average,13.3 months).No such early complications as incision infection or deep vein thrombosis occurred.The operation time (89.5 min and 79.3 min,respectively) and surgical blood loss (151.7 mL and 207.8 mL,respectively) for groups A and B were obviously less than those for group C (102.5 min;260.2 mL);the incision length for group A (10.5 cm) was shorter than that for group B (17.4 cm) and for group C (16.3 cm);group C had more cases of excellent reduction (6) than groups A and B (4 for both).There were no obvious differenc es between groups A,B and C in the Rasmussen score (16.8,17.0 and 16.3) or HSS score (86.3,86.0 and 85.7).One case of delayed incision healing due to partial necrosis occurred in group B.At the final follow-ups in group C,the varus stress test showed 2 cases of laxation of degree Ⅱ and 2 cases of laxation of degree Ⅰ.Conclusions In the treatment of fractures of anterolateral and posterolateral columns of tibial plateau,all the 3 approaches can lead to good exposure,fine reduction,rigid fixation and satisfactory outcomes.Although the combined anterolateral and posterolateral approach and lateral incision via double intermuscular spatia approach can lead to similar exposure ranges and fixation effects,the latter is easier in operation while the former exposes the anterior and posterior spatia more fully,allowing the anterior and posterior plates to be better positioned.The posterolateral transfibular approach can lead to the largest exposure range and more precise reduction,but it has risks of damage to the lateral ligamentous structure,greater invasion,postoperative lateral instability and injury to the common peroneal nerve.
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Objective To measure the size and area of the vestibule of normal inner ear to provide basic data for further study of the vestibule-related diseases.Methods Two hundred forty patients (480 ears) who underwent temporal bone 64 slices CT scans were enrolled in this study from April 2011 to July 2012.These patients were divided into 4 groups,including Child group (＜ 18 years),Youth group (18-44 years),Adult group (45-59 years),and Elder group (≥ 60 years).The size and area of the vestibules were measured on the multiplanar reformatted images in post-processing workstation.Results There were no statistically significant differences in the size and area of vestibules in sides,genders and among the different groups (P ＞ 0.05),while there were statistically significant differences of those in different positions (P ＜ 0.05).Conclusion The measurements in different planes were as follow:1) In axial plane,the length of vestibule and its 95％ confidence interval were (5.89 ± 0.34),5.22-6.56 mm,respectively; the width (2.47 ± 0.36),1.76-3.18 mm; the area(13.97 ± 1.71) 10.62-17.32 mm2 2) in coronal plane,the length of vestibule and its 95％ confidence interval were (5.10 ± 0.32),4.47-5.73 mm,respectively; the width (2.42 ± 0.21),2.01-2.83 mm; the area (11.30 ± 1.33),8.69-13.91 mm2 ;3)in sagittal plane,the length of vestibule and its 95 ％ confidence interval were(5.27 ± 0.33),(4..62-5.92) mm,respectively; the width (3.72 ± O.35),(3.03--4.41) mm; the area (13.77 ± 1.55),(10.73-16.81)mm2.The volume CT combined with post-processing technology can accurately measure the size and area of the vestibules.The data can provide quantitative basis for diagnosis of the vestibule-related diseases.
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Objective To study the normal microanatomy and HRCT findings in nasal bone part which is easy to be confused with the bone fracture, thus increasing the diagnostic accuracy of nasal bone fracture. Methods CT findings were compared between two groups 60 volunteers as normal group and 30 cases with nasal bone fracture as trauma group, which were all performed with HRCT in transverse and coronal scans to find the differences. Results Three experienced radiologists observed the films of the normal group in blind. 54 cases were diagnosed normal, 3 were suspected to have fracture, and 3 misdiagnosed as fracture. (1) There were some normal nasal structures which were susceptible to be confused with fracture, such as bone suture, internasal aperture, intersuture bone, and normal variations. (2) On transverse and coronal scan, nasal-maxillary suture demonstrated various characteristics, including 57 cases and 3 cases of inflated type, 39 and 5 of occluded type, 31 and 6 of intersuture bone, 16 and 34 of thin bony shapes, respectively. (3) Sometimes the extremity of outside was too depressed or flat which was related with the development, and it included 12 cases in left and 13 in right of inner alcula type, 4 in left and 4 in right of outer raised shape on coronal images, which were easily confused with fragment of fracture. But the conformation and structure were intact on transversal images, thus fracture could be excluded. Conclusion The understanding of morphological structure and characterized imaging findings can reduce the incidence of clinical misdiagnosis. Nasal bone fracture is not rare in facial trauma, and the following points should be paid attention to: 1.Normal nasal structures and variations of the nasal bone. 2.The scanning methods with HRCT. 3.Combination of the transversal and coronal scan can reinforce and testify with each other.