The application of pelvic unlocking reduction frame for the treatment of old Denis I or II sacral fractures combined with sacral plexus nerve injury / 中华骨科杂志

ABSTRACT

Objective:To investigate the clinical effect assistant with pelvic unlocking reduction frame for the treatment of old Denis I or II sacral fractures combined with sacral plexus nerve injury.Methods:From January 2013 to October 2020, 37 patients diagnosed with old sacral fractures with sacral plexus nerve injury which Gibbons classification was grade III were divided into the use group and the non-use group according to whether assisted with pelvic unlocking reduction frame. Eighteen patients (11 males, 7 females, mean age 38±6.4, range from 13-56) were selected into the use group and nineteen patients (14 males, 5 females, mean age 42±10.7, range 19-59) were selected into the non-use group. The three-dimensional (3D) pelvic model (1∶1) was printed before operation. The operation time, intraoperative bleeding, Matta score, visual analogue scale (VAS), Majeed score and gibbons sacral nerve injury grade of the two groups were compared. The healing time and complications of each group was recorded.Results:The average operation time of the use group and the non-use group was 121.0±16.2 min and 182.6±16.2 min, respectively, with significant difference ( t=11.54, P<0.001). The mean operative bleeding was 686±382 ml of the use group and 963±348 ml of the non-use group ( t=2.38, P=0.003). The quality of fracture reduction was evaluated according to Matta scoring standard: the excellent and good rate of the use group was 94% (17/18), and that of the non-use group was 68% (13/19) ( P=0.039). The curative effect was evaluated according to the Majeed score: the use group was 88.72±7.03 points, and that of the non-use group was 72.00±9.75 points ( t=5.96, P<0.001) at 1 year post-operative. One year after operation, the VAS scale of the use group was 0.83±0.71 points, and that of the non-use group was 1.00±0.82 points ( t=0.66, P=0.512). According to Gibbons classification, 15 patients were grade I, 1 patient was grade II and 2 patients were grade III in the use group and 11 patients were grade I, 3 patients were grade II and 5 patients were grade III in the non-use group one year after operation ( Z=-1.04, P=0.401). One patient in the use group presented rupture of plate without symptoms. In the non-use group, 1 case with internal iliac vein rupture which treated with gelatin sponge and no obvious bleeding after operation. 4 cases with unequal length of lower limbs, walking claudication. The complication rate of the use group was 6% (1/18), and that of the non-use group was 26% (5/19) ( P=0.042) . Conclusion:The lateral rectus abdominis approach combined with pelvic unlocking reduction frame can reduce the operation time and bleeding, improve the fracture reduction in the treatment of old Denis type I and II sacral fractures with sacral plexus injury.