Posterior percutaneous fixation of lumbo-ilium with rod/screw system for sacral fractures of Denis type Ⅱ / 中华创伤骨科杂志

ABSTRACT

Objective To investigate the clinical efficacy of anterior pelvic plating plus percutaneous lumbo-iliac rod/screw fixation in the treatment of pelvic fractures which are vertically and rotationally unstable and combined with unilateral sacral fracture of Denis type Ⅱ.Methods From January 2008 to November 2012,19 patients were treated for compound injury to the anterior and posterior pelvic rings complicated with sacral fracture of unilateral Denis type Ⅱ using anterior pelvic plating plus posterior percutaneous fixation of lumbo-ilium with screws.Their improvement in neurological function,reduction outcome and clinical effectiveness were evaluated by comparing preoperation and 2 years postoperation in terms of visual analogue scale (VAS),Japanese Orthopaedic Association (JOA) score for lower back pain,MOS Item Short-form health survey (SF-36 comprehensive scale),modified Roland-Morris Disability questionnaire (RDQ),Oswestry disability index (ODI),Gibbons overall scale,Majeed total score,sacral kyphosis abnormity,bias of sagittal/coronal vertical axis (SVA/CVA),pelvic incidence,pelvic tilt,lumbar lordosis,vertical displace,and leg length discrepancy.Results The differences respectively reached statistical significance for the aforementioned clinical and imaging parameters between preoperation and 2 years postoperation (P ＜ 0.05).By Majeed scoring,13 cases were rated as excellent,4 as good and 2 as fair.By Tometta/Matto scoring postoperatively,the fracture reduction was rated as excellent in 12 cases,as good in 6 and as fair in one.The complications of incision infection or necrosis,secondary neurovascular damage,implant failure or mal-union was not observed.Perfect nerve functional recovery and sufficient imaging reduction were achieved in all but one patient who had to receive decompression and release for sacral canals or foramens.According to Mohammad criteria,15 patients were engaged in the jobs with the same intensity and property as their pre-injury ones.Conclusions The simultaneous hybrid performance of anterior reconstruction plating combined with unilateral lumbar/sacral pedicle and iliac screwing may be a safe,reliable and satisfactory treatment for pelvic fractures of AO/Tile C1 type which involve unilateral sacral Denis type Ⅱ.