ABSTRACT
Objective:
To investigate the
efficacy of intelligent visualization system (HoloSight Intelligent Visualization System) assisted reduction and screw fixation in the
treatment of
elderly pelvic fragility fracture.
Methods:
From January 2016 to December 2022, clinical data of 18
elderly patients aged over 75 years with pelvic fragility fractures surgically treated by our team were retrospectively analyzed. Among them, 11 cases were treated with closed reduction and
hand-inserted percutaneous screw fixation to fix the posterior pelvic ring (
control group), and 7 cases were treated with the assistance of the HoloSight intelligent visualization system for reduction and minimally invasive fixation (experimental group). In the
control group, there were 3
males and 8
females with an age range of 75-94 years (mean age, 82±12 years). The pelvic fractures were classified as FFP type IIIa in 5 cases, IIIb in 2 cases, IIIc in 3 cases, and IV in 1 case. In the experimental group, there were 1
male and 6
females with an age range of 76-100 years (mean age. 83±14 years). The pelvic fractures were classified as FFP type IIIa in 4 cases, IIIc in 2 cases, and IV in 1 case. The
surgical time,
blood loss, effective intraoperative
fluoroscopy times,
fracture reduction quality (according to Matta
standards), visual analogue scale (VAS),
limb function
rehabilitation (Majeed score) and
postoperative complications were recorded and evaluated in both groups.
Results:
All
patients underwent
surgery successfully and were followed up for 6 months to 3 years(12 months on average), all pelvic fractures healed. Among the 7 cases of experimental group, a total of 13 screws were placed, and the
adjustment times of guide pin for each screw were 3±1 times (range, 1-5 times), while 18 screws of the
control group with the
adjustment times of 7±2 times (range, 4-10 times), statistical difference was present ( t=6.99, P<0.001). The
surgical time in experimental group (63±12 min) was shorter than that in
control group 88±23 min, while effective intraoperative
fluoroscopy times in experimental group (9±3 times) was less than that in
control group (35±7 times), the difference were both statistically significant ( t=2.69, P=0.016; t=9.22, P<0.001). The intraoperative
blood loss was 38±12 ml in the experimental group and 55±26 ml in
control group, with no significant difference ( t=1.61, P=0.127). According to Matta's reduction criteria after
surgery, the results of experimental group were excellent in 4 cases, good in 2, and fair in 1, while the result of
control group were excellent in 5 cases, good in 3, fair in 2, and poor in 1. At the last follow-up, among the
patients in experimental group, the Majeed score was 84±11, excellent in 3 cases, good in 2, and fair in 2. In
control group, the score was 79±17, with excellent in 5 cases, good in 3, fair in 3. No statistical difference was observed in two groups ( t=0.69, P=0.501). The VAS was 6.4±2.6 preoperatively and 2.4±0.8 postoperatively in the experimental group, while in the
control group was 6.9±3.1 preoperatively and 2.7±1.3 postoperatively, the data suggested an improvement in both groups ( t=3.89, P=0.002; t=4.14, P<0.001), while no statistical significant was observed in two groups at last follow-up ( t=0.55, P=0.593). Two cases of experimental group had loosening or withdrawal of the fixation screws in 9 and 12 months, but the fractures healed. Four cases of
control group loose fixation screws in 4, 6, 9, and 12 months, two cases underwent
revision surgery and other two cases healed.
Conclusion:
Intelligent visualization system assisted reduction and screw fixation in the
treatment of
elderly pelvic fragility fractures have the advantages of good reduction, accurate
nail placement, less
bleeding, less effective
fluoroscopy, which improves the
safety of
surgery.
