Résumé
Objective To investigate the clinical results of minimally invasive fixation of the sacroiliac triangle for vertically unstable pelvic posterior ring injury. Methods A retrospective study was conducted of 20 patients who had been treated for vertically unstable pelvic posterior ring from January 2014 to August 2016. They were 12 males and 8 females, aged from 20 to 58 years ( average, 35 years ) . According to Tile classification for pelvic fractures, there were 4 cases of type C1. 1, 6 cases of type C1. 2, 7 cases of type C1. 3 and 3 cases of type C2. Their posterior rings were treated by fixation through posterior paraspinal approach with S1-iliac pedicle screws plus percutaneous sacroiliac screws, and their anterior rings by closed reduction and internal fixation with cannulated screws, Infix or plate following open reduction. The incision length, operation time and intraoperative blood loss were recorded. Postoperative reduction quality was assessed by Matta radio-logical criteria and pelvic function by Majeed criteria at the final follow-ups. Results Altogether 20 fixation systems of S1-iliac pedicle screws and 37 sacroiliac joint screws were inserted in this series. The length of incision ranged from 5. 5 to 7. 6 cm ( average, 6. 2 cm ) , the operation time from 89 to 130 minutes ( average, 98 minutes) and the intraoperative blood loss from 110 to 320 mL (average, 195 mL). According to Matta ra-diological criteria, reduction was excellent in 13, good in 5 and fair in 2 cases, with an excellent and good rate of 90％. The follow-up time for the 20 patients ranged from 6 to 15 months ( average, 9 months ) . The healing time ranged from 10 to 14 weeks ( average, 12. 5 weeks ) . At the final follow-ups, X-ray and CT three-dimensional reconstruction showed fine fracture union. By the Majeed criteria, the pelvic function was excellent in 11 cases, good in 5, fair in 3, and poor in one, with an excellent and good rate of 80％. No loosening, breakage or pull-out of pedicle screws or sacroiliac screws happened. Conclusion Minimally invasive fixation of the sacroiliac triangle for vertically unstable pelvic posterior ring injury can lead to precise placement, quick recovery, small incision and good functional outcome.
Résumé
BACKGROUND:Bone cement solidification can improve the stability, strength and mechanical support of fractured vertebrae. However, there are few studies on the effect of bone cement dispersion within the fracture line on percutaneous vertebroplasty. OBJECTIVE:To analyze the effect of bone cement dispersion within the fracture line of thoracolumbar osteoporotic vertebral compression fractures on percutaneous vertebroplasty. METHODS:Totaly 90 patients with thoracolumbar osteoporotic vertebral compression fractures were enroled, 53-80 years old, including 42 males and 48 females. Al these patients underwent percutaneous vertebroplasty with bone cement injection, and divided into two groups according to bone cement dispersion conditions: study group with good bone cement dispersion (n=60) and control group with poor bone cement dispersion (n=30). Visual analogue scale scores, Oswestry dysfunction index, Cobb's angle and adverse reactions were recordedbefore and after treatment. RESULTS AND CONCLUSION:There were no differences in the visual analogue scale score and Oswestry dysfunction index between the two groups before treatment (P > 0.05). The visual analogue scale scores were significantly lower in the study group than the control group at 3 days after treatment and at the last folow-up (P < 0.05); the Oswestry dysfunction index and Cobb's angle were also lower in the study group than the control group at 3 days after treatment (P < 0.05). However, no difference was found in the Oswestry dysfunction index, Cobb's angle and bone cement leakage between the two groups at the last folow-up. These findings indicate that the percutaneous vertebroplasty show better effects on pain relief in patients with good bone cement dispersion that those with poor bone cement dispersion, and the vertebral stability is better as wel as the short-term effect is more obvious.