ABSTRACT
Objective:To investigate the clinical efficacy of using INFIX combined with hollow nail in the treatment of anterior pelvic ring injury with symphyseolysis.Methods:Data of 12 patients with anterior pelvic ring injury and symphyseolysis who were treated from January 2016 to December 2018 were retrospectively analyzed. They were 8 males and 4 females with an average age of 39.5 years (range, 23-64 years). There were 4 cases of traffic injury, 3 cases of falling injury and 5 cases of crush injury; all the cases were combined with front and rear crush injury. According to Tile classification for pelvic fractures, there were 6 cases of type B1 , 3 cases of type B3, 1 case of type C1 and 2 cases of type C2. Six cases of B1 and 3 cases of B3 patients used percutaneous inter fixation with sacroiliac joint cannulated screw in posterior ring; 1 case of C1 and 2 cases of C2 used spinal-pelvic fixation. Every patients' operating time of INFIX combined with the pubic symphysis hollow nail , amount of hemorrhage, length of incisions and number of X-ray projections were recorded. Pelvic X-ray and CT scan were taken postoperatively to observe the reduction and screw position. Postoperative reduction quality was assessed using Matta radiological criteria and Majeed criteria was used at the final follow-up to evaluate the pelvic function.Results:The average operating time for 12 patients was 42 min (range, 35-56 min) ; the average amount of hemorrhage was 28 ml (range, 15-40 ml); the average length of incision at INFIX nail placement on both sides were 2.7 cm (range, 2.2-3.5 cm); the average length of incisions at the pubic symphysis hollow nail placement was 0.8 cm (range, 0.6-1.2 cm) and the average number of X-ray projections was 38 times (range, 26-55 times). Postoperative X-ray and CT scan showed that all the hollow screws are located accurately and firmly, and pubic symphysis had good reduction and no infection occurred in the surgical incision at the screw placement site. Postoperative reduction quality was evaluated according to Matta radiological criteria, and there were excellent in 10 and good in 2, giving an excellent to good rate of 100% (12/12). The average follow-up time for the 12 patients was 12 months (range, 6-15 months). At the final follow-up, all patients showed fine fracture union and no looseness of pubic symphysis occurred according to imaging test. According to the Majeed criteria, the pelvic function was excellent in 8 cases, good in 3 cases and fair in 1 case, giving a good to excellent rate of 91.7% (11/12). One case developed symptoms of femoral nerve compression after surgery and returned to normal after removal of the INFIX. Another case had damage to the lateral femoral cutaneous nerve and the symptoms disappeared after three months.Conclusion:Using INFIX combined with hollow nail in the treatment of symphyseolysis can lead to more minimally invasive with excellent postoperative efficacy and markedly reduced the morbidity of complication.
ABSTRACT
Objective To evaluate the clinical efficacy of our self-made minimally invasive pelvic channel instrument in the treatment of pelvic ring fracture-dislocation.Methods A retrospective study was conducted of the 35 patients who had been treated for pelvic ring fracture-dislocation from December 2015 to November 2017 and fully followed up at Department I of Orthopaedis,Beijing Chaoyang Emergency Rescue Center.They were 25 males and 10 females,aged from 20 to 73 years (average,41.3 years).According to the Tile classification for pelvic fractures,there were 26 cases of type B (type B1 in 8,type B2 in 12 and type B3 in 6) and 9 cases of type C(type C1 in 5,type C2 in 3 and type C3 in 1).Infix or anterior plate combined with percutaneous internal fixation with sacroiliac cannulated screws was used in 11 patients,sacroiliac triangle fixation combined with percutaneous internal fixation with anterior ring cannulated screws in 5 ones,and internal fixation with cannulated screws for anterior and posterior rings in 19 ones.All the channels were established using our self-made minimally invasive pelvic channel instrument for internal fixation with cannulated screws.The time for each screw placement and the number of X-ray projection were recorded.Postoperative reduction,pelvic function at the final follows-ups and complications were recorded.Results A total of 84 cannulated screws were inserted in the 35 patients.The time for each cannulated screw placement ranged from 5 to 13 minutes (average,8.1 minutes);the number of X-ray projection for each screw placement ranged from 7 to 15 times (average,10.3 times).Postoperative CT showed that all the cannulated screws were located in the preset channels.According to the Matta radiological criteria,postoperative reduction quality was excellent in 29,good in 4 and fair in 2,giving a good to excellent rate of 94.3％.The follow-up time for the 35 patients ranged from 6 to 15 months (average,12.3 months).At the final follow-ups,all the patients showed fine fracture union.There was no loosening or breakage of screws in all but one patient in whom one sacroiliac screw became loose 3 months after surgery.By the Majeed criteria,the pelvic function was excellent in 27 cases,good in 5,fair in 3 and poor in one,giving a good to excellent rate of 91.4％.Conclusion Our self-made minimally invasive pelvic channel instrument can be used to establish pelvic channels,leading to more accurate placement,shorter operative time and less X-ray projection.