ABSTRACT
ABSTRACT Objective The use of open reduction and internal fixation (ORIF) for unstable pelvic injuries is associated with extensive blood loss, iatrogenic neurovascular injury, and infection. Moreover, the placement of sacroiliac (SI) screws is a blinded procedure, guided primarily by palpation and two-dimensional radiological screening, which demands expertise. The complex three-dimensional anatomy of SI joint and its proximity to neurovascular structure require a safe and precise technique. Computed tomography (CT)-guided SI joint stabilization allows an accurate intra-operative assessment of screw placement. This study demonstrated a technique of CT-guided closed reduction and screw fixation of the SI joint in unstable pelvic fractures. Methods This was a retrospective non-randomized cohort study conducted at a tertiary care hospital. Six patients with unstable pelvic fractures were operated; the anterior rim was stabilized first by ORIF with plate on the superior and anterior aspects of the pubic symphysis. Subsequently, the posterior stabilization was made percutaneously under CT guidance with a 7-mm cannulated cancellous screw. Results The mean operative time was 48 min (35-90 min), the mean effective radiation dose was 9.32 (4.97-13.27), and the mean follow-up was 26 months (6-72 months). All patients had satisfactory healing, with near-anatomic reduction and no complications, except in one case where the plate broke at 61 months post surgery, but no intervention was required. The mean VAS score at the final follow-up was 1.8, and all patients returned to their original occupation without any limitations. Conclusion CT-guided SI joint stabilization offers many advantages, including safe and accurate screw placement, reduced operating time, decreased blood loss, early definitive fixation, immediate mobilization, and fewer infections and wound complications.
RESUMO Objetivo O uso de redução aberta e fixação interna (RAFI) em lesões pélvicas instáveis está associado a hemorragia ampla, lesão neurovascular iatrogênica e infecção. Além disso, os parafusos sacroilíacos (SI) são colocados às cegas − o procedimento é guiado principalmente pela palpação e triagem radiológica bidimensional, o que exige especialização. A complexa anatomia tridimensional da articulação SI e sua proximidade com a estrutura neurovascular requerem o uso de uma técnica segura e precisa. A estabilização da articulação SI guiada por tomografia computadorizada (TC) permite uma avaliação intraoperatória precisa do posicionamento do parafuso. Este estudo demonstrou uma técnica, guiada por TC, de redução fechada e fixação da articulação SI com parafusos em fraturas pélvicas instáveis. Métodos Estudo de coorte retrospectivo, não randomizado, feito em um hospital terciário. Seis pacientes com fraturas pélvicas instáveis foram operados. A borda anterior foi estabilizada primeiro por RAFI com placa nos aspectos superior e anterior da sínfise púbica. Então, a estabilização posterior foi feita de forma percutânea, guiada por TC, com um parafuso esponjoso canulado de 7 mm. Resultados O tempo médio de cirurgia foi de 48 min (35-90 min); a dose média efetiva de radiação foi de 9,32 (4,97-13,27) e o seguimento médio foi de 26 meses (6-72 meses). Todos os pacientes apresentaram cura satisfatória, com redução quase anatômica e sem complicações, exceto em um caso em que a placa quebrou 61 meses após a cirurgia, sem a necessidade de intervenção. O escore EVA médio no seguimento final foi de 1,8 e todos os pacientes retornaram às suas ocupações originais sem quaisquer limitações. Conclusão A estabilização da articulação SI guiada por TC apresenta muitas vantagens, inclusive um posicionamento seguro e preciso do parafuso, redução do tempo de cirurgia, diminuição da perda de sangue, fixação definitiva precoce, mobilização imediata e redução no número de infecções e complicações da ferida cirúrgica.
Subject(s)
Humans , Male , Female , Pelvic Bones , Bone Screws , External Fixators , Fractures, Bone , Fracture Fixation, InternalABSTRACT
Background Although pulmonary abnormalities have been recognized in patients with inflammatory bowel diseases (IBD), their prevalence and clinical significance are not known. Aim To study the prevalence and clinical significance of pulmonary abnormalities in patients with IBD. Methods Ninety-five non-consecutive patients with IBD (12 Crohn’s disease, 83 ulcerative colitis; mean age 41.9 [SD 13] years; 47 women) were prospectively studied from January 2007 to March 2010. Pulmonary function tests (PFT) and high-resolution CT (HRCT) chest were performed in them. PFT were compared to those in 270 healthy (control) subjects matched for age, sex and smoking status. Results Twenty-seven (28.5%) patients and 11 (4%) control subjects had abnormal PFT (p<0.0001). Small airway obstruction was seen in 18 patients, restrictive defect in six and mixed defect in three. Twenty-one (22%) patients had abnormal HRCT findings – bronchiectasis and nodules (nine patients each, including one with nodules who later developed active tuberculosis after infliximab therapy), parenchymal bands (8), mediastinal lymphadenopathy (five, including two with tuberculosis on histology and culture), emphysema (5), brochiolitis (2), pleural effusion or thickening (2), pericardial effusion (2), patchy consolidation (1), ground-glass opacities (1) and lung metastasis (1). Three patients had symptoms (one asthma, two cough). Conclusion PFT and HRCT chest showed abnormality in about one-quarter of patients with IBD. A majority of patients with these abnormalities were asymptomatic.