Progress in Biomechanics of Pelvic Fractures / 医用生物力学

In recent years, with the increase of traffic accidents and the further development of aging, the incidence of pelvic fracture is gradually increasing. Based on the in-depth study about biomechanics of pelvic fracture fixation, the surgical treatment has been widely carried out. The purpose of surgical treatment is to effectively reduce and fix the fracture, correct deformity, restore integrity and stability of the pelvis, and minimize the complications caused by internal and external fixation. How to improve stability of the pelvis while ensuring therapeutic effect is a problem that every doctor will face in clinic. This paper summarizes the biomechanical research progress of pelvic fracture in recent years from the aspects of anatomy, normal biomechanics, classification and biomechanics of pelvic fracture fixation, so as to provide some references for reasonable treatment of pelvic fracture.

The effect of preperitoneal pelvic packing for hemodynamically unstable patients with pelvic fractures / 中华创伤杂志(英文版)

PURPOSE@#Hemodynamically unstable patients with pelvic fractures still represent a challenge to trauma surgeons and have a very high mortality. This study was designed to explore the effect of the interventions of direct preperitoneal pelvic packing for the hemodynamically unstable pelvic fractures.@*METHODS@#This retrospective study enrolled 67 cases of severe pelvic fractures with unstable hemodynamics from October 2011 to December 2019. All patients presented in our emergency center and received preperitoneal pelvic packing were included in this study. The indication was persistent systolic blood pressure ≤90 mmHg during initial resuscitation and after transfusion of two units of red blood cells. Patients with hemodynamic stability who need no preperitoneal pelvic packing to control bleeding were excluded. Their demographic characteristics, clinical features, laboratory results, therapeutic interventions, adverse events, and prognostic outcomes were collected from digital information system of electronic medical records. Statistics were described as mean ± standard deviation or medium and analyzed using pair sample t-test or Mann-Whitney U-test.@*RESULTS@#The patients' average age was 41.6 years, ranging from 10 to 88 years. Among them, 45 cases were male (67.2%) and 22 cases were female (32.8%). Significant difference was found regarding the systolic blood pressure (mmHg) in the emergency department (78.4 ± 13.9) and after preperitoneal pelvic packing in the surgery intensive care unit (100.1 ± 17.6) (p < 0.05). Simultaneously, the arterial base deficit (mmol/L) were significantly lower in the surgery intensive care unit (median -6, interquartile range -8 to -2) than in the emergency department (median -10, interquartile range -14 to -8) (p < 0.05). After preperitoneal pelvic packing, 15 patients (22.4%) underwent pelvic angiography for persistent hypotension or suspected ongoing haemorrhage. The overall mortality rate was 29.5% (20 of 67).@*CONCLUSIONS@#Preperitoneal pelvic packing, as a useful surgical technique, is less invasive and can be very efficient in early intra-pelvic bleed control.

Epidemiology of pelvic fractures in adults: Our experience at a tertiary hospital / 中华创伤杂志(英文版)

PURPOSE@#Pelvic fractures are severe injuries and are often associated with multiple system injuries, exacerbating the overall outcome. In India, the incidence of pelvic fractures is on a rise due to suboptimal roads and traffics but related literature regarding the overall epidemiology of these injuries is scarce and scanty. Our aim was to study the epidemiology of patients admitted with pelvic fractures at a level 1 trauma centre in India.@*METHODS@#A 16-month (between September 2015 and December 2016) prospective observational study was carried out on trauma patients with pelvic fractures at a level 1 trauma centre of a tertiary care hospital. Demography of patients, mechanism of injuries and complications were recorded prospectively.@*RESULTS@#We observed 75 patients who presented with pelvic fractures, where 56 were males and 19 were females. Mean age of the study population was 37.57 years. Road traffic accidents were the most common mode of injuries. Lateral compression injuries were the most common pattern. Associated injuries frequently encountered were lower extremities and acetabulum fractures, blunt abdominal trauma, urogenital injuries and head injuries. Out of the 75 patients, 52 were treated surgically and 23 were managed by conservative methods. Associated injuries of the extremities, head, abdomen and urogenital system indicated a longer hospital stay.@*CONCLUSION@#Pelvic fractures, although belong to a relatively rare trauma subset, cause a high morbidity and mortality with considerable burden on the economy. Proper road safety training and driving etiquettes along with its strict implementation in true sense and spirit are the need of the hour.

Analysis of early treatment of multiple injuries combined with severe pelvic fracture / 中华创伤杂志(英文版)

PURPOSE@#To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures.@*METHODS@#A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200-10,000 mL, with an average volume of 2850 mL. Postoperative follow-up ranged from 6 months to 1.5 years.@*RESULTS@#The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral artery thrombosis), and 18 cases of consumptive coagulopathy.@*CONCLUSION@#The early treatment of multiple injuries combined with severe pelvic fractures should focus on pelvic hemostasis. Massive bleeding-induced hemorrhagic shock is one of the main causes of poor prognosis. The technique of internal iliac artery devasculization including ligation and embolization can be used as an effective measure to stop or reduce bleeding. Consumptive coagulopathy is difficult to deal with, which should be detected and treated as soon as possible after surgical measures have been performed. The effect of using recombinant factor VII in treating consumptive coagulopathy is satisfactory.

Application of self-made pelvic bag in treatment for patients with unstable pelvic fracture / 现代临床护理

Objective To explore the effect of the self-made pelvic bag on patients with unstable pelvic fracture.Methods Toally 24 patients with unstable pelvic fracture from January 2013 to June 2014 were set as control group and used conventional nursing.Toally 30 patients from July 2014 to December 2015 were set as observation group.The self-made pelvic bag was used in the observation group for pelvic fixation and suspension traction.The degree of pain was compared between the pre-and post-use of the bag.Result The pains after using pelvic bag in the observation group were significantly lower than that of the control group (P＜0.001).Conclusions The self-made pelvic bag can be effective for the pelvic fixation and suspension for the patients with pelvic traction.At the same time it can relieve the pain.

The application of percutaneous cannulated screw fixation in patients with unstable pelvic fractures / 中国基层医药

Objective To study the application of percutaneous cannulated screw fixation in patients with unstable pelvic fractures.Methods According to the digital table,98 patients were randomly divided into the two groups,the control group were operated through plate fixation,and the observation group were operated through percutaneous cannulated screw fixation.Results After the surgery,the excellent rates were 89.8％ in the control group and 98.0％ in the observation group,which was significantly higher than that of the control group (x2 =4.68,P ＜ 0.05).The operative time,blood loss,wound length were (121.6 ± 26.4) min,(416.3 ± 39.2) mL,(134.5 ± 21.3) cm in the control group and (81.3 ± 19.2)min,(63.5 ± 12.8)mL,(15.8 ± 2.1)cm in the observation group.The operative time,blood loss,wound length were significantly lower than those of the control group (t =2.961,6.312,8.061,P ＜ 0.05,P ＜ 0.01).Callus occurrence,fracture healing time were (14.2 ± 2.7) weeks,(10.1±2.9) weeks in the control group and (9.1 ± 1.4) weeks,(6.5 ± 1.5) weeks in the observation group.Callus occurrence,fracture healing time in the observation group were less than that of the control group (t =3.061,2.772,P ＜ 0.05).The control group had postoperative complications occurred in 10 patients,with an incidence of 20.4％,and the observation group had three cases of complications,the rate was 6.1％,the complications incidence of the observation group was significantly less than the control group (x2 =6.14,P ＜ 0.05).Conclusion Percutaneous cannulated screw fixation had significant effectiveness for patient with unstable pelvic fractures and fewer complications.

The application of computer aided rapid prototyping technology in diagnosis and treatment of complicated pelvic fractures / 实用医学杂志

Objective To evaluate the value of computer aided rapid prototyping technology in diagnosis and treatment of complicated pelvic fractures. Methods Twenty-two patients of complicated pelvic fractures were examined by thin-slice CT to gain two-dimensional data of the pelvis. Three-dimensional reconstructions of anatomical models were accomplished by computer aided technology. By rapid prototyping technology , the pelvic models were rendered , by which diagnosis and typing of pelvic fractures were finalized for operation project , mimic operation and guiding the operation. Results Three-dimensional reconstruction images and rapid prototyping pelvic models were extremely similar to what doctors saw in the operations. Preoperative mimic operation shortened the time of operation and reduced the volume of bleeding in the operation. All 22 cases were available for review in follow-up period of 6 ~ 24 months. Patients could sit up in 2 ~ 4 weeks after surgery , and walk with a crutch 6 weeks later. Pelvic fractures reductions were good in 22 cases. According to the Majeed's functional criteria , 16 patients were judged excellent and 3 patients were good. The excellent and good rate was 86.4%. Conclusions Computer aided rapid prototyping technology can overall, direct-viewing, and exactly display the three-dimensional shape of pelvis and spatial relation of anatomic structures. It is important for definite clinic diagnosis , typing and treatment.

Effect evaluation of clinical nursing intervention for patients with pelvic fractures / 中国实用护理杂志

Objective To investigate the effect and nursing experience of iliacus groin approaches and internal fixation treatment for patients with pelvic fractures. Methods Twenty- six patients with unstable pelvic fracture were obtained iliac groin approaches and internal fixation treatment, the changing symptoms in patients were monitored frequently, and all patients were performed general nursing. Results All patients were followed up for 0.5 to 5.0 years, without obvious complications, the results of surgical treatment included optimal 16 cases, good 7 cases, mean 3 cases. Conclusions Iliacus groin approaches and internal fixation with reconstruction plate treatment on pelvic fractures was proved to be reset accurate, reliable and strong, with better effects. Effective nursing measures can save life of patients with pelvic fractures, speed up rehabilitation of physiological function, improve life quality of the patients.

Treatment of complex posterior urethral strictures with urethroplasty via transpubic approach after pelvic fracture / 中华创伤杂志

Objective To evaluate the efficacy and safety of urethroplasty via transpubie ap-proach in treatment of complex posterior urethral strictures after pelyic fracture. Methods Urethroplas-ty via transpubic approach was done on 26 patients (21 males and 5 females, at mean age of 26 years) with complex posterior urethral strictures. Posterior urethral stricture was 2.5-4.0 cm long in 23 patiens and > 4.0 em in three. There were five patients with urethratresia. The perioporative complications and operative effect were evaluated after the broken ends of the urethra was thoroughly resected and treated with end-to-end anastomosis. Results A follow-up for 1-7 years ( mean 4 years) showed successful op-eration in 22 patients (85%), with normal urination and without complications like osteitis pubis, pelvic disassociation, pelvic instability or urinary incontinence. But obstructed urination was found in one (4%) and failed operation in three (11%). Conclusions Urethroplasty via transpubic approach takes advantages of precise and thorough scar excision, less complications and long term curative effect and is clinically feasible and safe for patients with complex posterior urethral stricture.

Evaluation of effect of early limited fluid resuscitation in treatment of severe pelvic fracture accompanied with traumatic hemorrhagic shock / 中华创伤杂志

Objective To evaluate the effect of early limited fluid resuscitation in treatment of severe pelvic fracture accompanied with traumatic hemorrhagic shock. Methods A retrospective study was done on 96 patients with severe pelvic fractures accompanied with traumatic hemorrhagic shock admitted into hospital from January 2002 to December 2006. Of all, 55 patients ( routine resuscitation group)were dealt with routine fluid resuscitation and 41 (limited resuscitation group) with limited fluid resuscitation. The injury severity, degree of shock, start time of resuscitation, transfusion volume were statistically analyzed and compared in two groups. Results Routine resuscitation group received transfusion volume of (3 432 ± 1 156) ml, with cure rate of 64% and mortality rate of 36% ; while limited resuscitation group received transfusion volume of (2 685 ± 524) ml, with cure rate of 83% and mortality rate of 17%. There was statistical difference between both groups ( P ＜ 0.05 ). Conclusion Limited fluid resuscitation can improve cure rate of severe pelvic fracture accompanied with traumatic hemorrhagic shock.

Meta analysis of the rate of urethral stricture after treatments of posterior urethral injuries / 中华泌尿外科杂志

0bjective To determine the effect of 2 therapies(early realignment versus delayed open urethroplasty)for posterior urethral injuries associated with pelvic fractures. Methods A sys-tematic review of all the relevant clinical trials was performed.Trials were identified from specialized trials register of Cochrane UGDP Group,the Coehrane library,additional electronic search(mainly MEDLINE、EMBSAE、CBM)and manual searching.Clinical trials comparing early realignment and delayed open urethroplasty of posterior urethral disruption associated with pelvic fractures were includ-ed.Statistics analysis was managed by using Review Manager 4.2. Results Ten clinical trials inclu-ding 470 patients were included.Meta-analysis indicated that odds ratio(OR)of the rate of urethral stricture was 0.27[95%confidence interval(95%CI)0.08,0.86,P=0.03].The OR of the percent-age of strictures needing urethroplasty was 0.25,95%CI 0.08,0.74,P=0.01. Conclusions Early realignment may provide better outcomes than delayed open urethroplasty after posterior urethral dis-ruption.It can decrease urethral stricture formation and the percentage of strictures needing urethro-plasty.But the results might be influenced by the bias of grouping,especially the severity of injuries.

Damage control for a pelvic fracture following an earthquake: one case report / 中华创伤骨科杂志

Objective To discuss the effect of damage control applied for an earthquake pelvic fracture. Methods One case of pelvic fracture in the 5.12 Wenchuan earthquake was treated by damage control in May, 2008. The patient was managed with anti-shock measures and temporal fixation of fracture in the first stage and minimally invasive surgery under fluoro-navigation system in the second stage. Results After two-stage damage control, the patient obtained stable vital signs, satisfactory reduction and internal fixation with no complications. Conclusion Damage control strategy for the earthquake pelvic fractures can improve the survival of patients and decrease their complications.

Treatment of unstable pelvic fractures with complex fixation / 中国矫形外科杂志

[Objective]To evaluate the outcomes of treatment of unstable pelvic fractures with complex fixation.[Method]Twenty-eight cases of patients with unstable pelvic fracture from January 2000 to June 2007 were treated and followed-up.Eighteen cases were male,10 cases were female,aged from 22 to 68 years old,with the average of 38-years-old.The types of fracture were classified by Tile classification:Type B2 9 cases,Type B3 8 cases,Type C1 6 cases,Type C2 2cases,Type C3 3 cases.The 28 cases had different complicated injury,all the patients were treated with complex fixation.[Result]After being evaluated by the Matta scale and the functional outcome,the outcomes of reduction were excellent in 18 cases,good in 7,fair in 2 and poor in 1,with an excellent and good rate of 85%.[Conclusion]External fixation can win the time for the rescue,choose internal fixation after stable condition,the complex fixation technology is a good way to treat unstable pelvic fractures.

Imageologic foundation of ultraselection arterial embolism for pelvic fracture with hemorrhage / 中国矫形外科杂志

[Objective]To study the imageologic characteristic of pelvic arterial anastomosis and the method of ultraselection arterial embolism for pelvic fracture with hemorrhage.[Method]From 1999.1-2005.6,60 patients were undergone pelvic arteriography.The patient ages ranged from 21 to 52 years of age(mean,34.5),and 42 were male,18 were female.Measure the types and number of pelvic arterial anastomosis.[Result]The types and number of pelvic arterial anastomosis were observed by pelvic arteriography as follows: the lumbar artery with iliolumbal artery 100%;the iliolumbal artery with deep iliac circumflex artery 83.33%;the obturator artery with inferior epigastric artery(or external iliac artery) 36.67%;the lateral sacral artery with coccygeal artery 100%;the inferior gluteal artery with internal pudendal artery 26.67%;the inferior gluteal artery with deep femoral artery 56.67%;the superior gluteal artery with inferior gluteal artery 61.67%.[Conclusion]For pelvic fracture whith hemorrahge,the best treatment of the pelvic arterial disruption is embolization of injured arteries and their anastomosis.

Therapeutic Effect of Open Reduction and Internal Fixation Combined with Three-stage Syndrome Differentiation and Treatment for Unstable Fractures of Pelvic Ring: A Report of 19 Cases / 广州中医药大学学报

Objective To investigate the anatomical features of different types of unstable fractures of pelvic ring,and to observe the therapeutic effect of open reduction and internal fixation combined with three-stage syndrome differentiation and treatment.Methods Nineteen patients with pelvic fracture were classified according to Tile's classification for pelvic fracture.Of 19 patients,12 were classified into type B(6 being type B1,3 type B2,and 3 type B3),and 7 into type C(3 being type C1,2 type C2,and 2 type C3).All of the patients received pelvic reconstruction through open reduction and internal fixation with titanium plate.After treatment,three-stage syndrome differentiation and treatment were carried out: Taohe Chengqi Decoction was used in the early stage of fractures,Xugu Huoxue Decoction in the middle stage and Yangjin Jiangu Decoction in the late stage.Meanwhile,traumatic ointment was applied on the affected region after the union of operation wound.Results After operation,the follow-up was carried out in all of the patients for 12 ～ 36 months,averaged 18 months.The results of follow-up showed that the fractures and dislocation of all the patients were healed within 3 ～ 6 months,and the patients obtained the normal life and walking function.The results of Majeed's classification showed that 17 were effective,2 ineffective and the effective rate was 89.47%.Conclusion According to the classification of pelvic fractures,it is a better method for pelvic fractures by pelvic reconstruction through different methods of open reduction and internal fixation with titanium plate,and then by three-stage syndrome differentiation and treatment.

Mine Car Pelvic Fracture / 中华创伤杂志

In a coal mine, about 50% of pelvic fractures are caused by a mine car. During the years of 1987～1991, our hospital treated 162 cases of pelvic fractures. In order to study the characteristics of tub (mine car) pelvic fractures, we divided these victims into four groups according to the cause of trauma, (1) stricken and pressed by tub, (2) bumped by heavy objects, (3) MVA and (4)falling from height. With respect to the anatomic classification, mechanism classification, injury severity and associated trauma of the 4 groups, more simple pelvic fracture in tub pelvic fractures, less associated trauma (P