The effect of a specific reduction sequence in the treatment of Tile C pelvis fracture with acetabular fracture / 中华骨科杂志

Objective:To explore the clinical effect of open reduction in the treatment of Tile C pelvic fracture combined with acetabular fracture in a specific sequence.Methods:Retrospectively analyzed the clinical data of 53 patients with Tile C type pelvic fracture combined with acetabular fracture from January 2014 to January 2019, and were divided into specific sequence group and non-specific sequence group according to the sequence of intraoperative reduction. A total of 29 cases were observed in the specific sequence group, including 20 males and 9 females; aged 43.8±14.8 years old (18-71 years), and the fractures were reduced in the sequence of "inside and out, then up and down" during the operation. There were 24 cases in the non-specific sequence group, including 14 males and 10 females; aged 44.4±14.7 years old (18-69 years), and fracture reduction was not performed in this sequence during the operation. According to the type of pelvic and acetabular fracture injury, we choose the appropriate position and surgical approach. After open reduction, the fracture was fixed with internal plants. The intraoperative blood loss, operation time, visual analogue scale (VAS) score were compared between the two groups. The quality of fracture reduction was evaluated by Matta score, pelvic fracture function recovery was evaluated by Majeed score, and acetabular fracture was evaluated by hip joint modified Merle d'Aubigné-Postel score.Results:There was no statistically significant difference in general data between the two groups before operation ( P>0.05), which was comparable. The intraoperative blood loss of the specific sequence group and the non-specific sequence group were 1 031.1±513.7 and 1 406.3±738.1 ml, and the operation time was 3.5±1.0 and 4.8±1.4 h; The differences between the two groups were statistically significant ( P<0.05). 53 patients were followed up for 14.8±1.6 months (12-18 months) after operation. The average postoperative VAS scores of specific sequence group and non-specific sequence group were 1.3±1.1 and 1.5±1.3 respectively, and there was no statistically significant difference. The effectiveness of the pelvic fracture Matta score standard was evaluated in the specific sequence group: excellent in 22 cases, good in 5 cases, fair in 2 cases, excellent and good rate was 93.1%; non-specific sequence group excellent in 10 cases, good in 6 cases, fair in 5 cases, poor in 3 cases, excellent and good rate was 66.7%, the difference was statistically significant ( P<0.05). Matta score of acetabular fracture: 21 cases were excellent in specific sequence group, 5 cases were good, 3 cases were poor, excellent and good rate was 89.7%; 9 cases were excellent in non-specific sequence group, 8 cases were good, 7 cases were poor, excellent and good rate was 70.8 %, the difference is statistically significant ( P<0.05). The results of the last follow-up pelvic fractures were evaluated by Majeed score: 20 cases were excellent in the specific sequence group, 7 were good, 2 were fair, excellent and good rate was 93.1%; 10 were excellent in the non-specific sequence group, 5 were good, 5 were fair, and 4 were poor, excellent and good rate was 62.5%, the difference was statistically significant ( P<0.05). At the last follow-up, the modified Merle d'Aubigné-Postel score was used to evaluate the efficacy: 20 cases were excellent in the specific sequence group, 5 were good, 4 were fair, the excellent and good rate was 86.2%; In the non-specific sequence group, 9 cases were excellent, 7 cases were good, 4 cases were fair, and 4 cases were poor, excellent and good rate was 66.7%, the difference was statistically significant ( P<0.05). During the follow-up period, none of the patients in the two groups developed fracture nonunion, heterotopic ossification, iatrogenic neurovascular injury, and femoral head necrosis. Trauma arthritis occurred in 4 patients in the non-specific sequence group. Conclusion:"Inside and out, then up and down" sequential reduction of Tile C pelvis combined with acetabular fracture can significantly shorten the operation time and reduce the amount of intraoperative blood loss. The surgical procedure is reasonable, which helps to improve the quality of fracture reduction and promote the functional recovery of patients.

Intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.

BACKGROUND: Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture. METHODS: A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and the sural nerve was identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the small saphenous vein (SSV). RESULTS: All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78 ± 1.40 weeks and 17.28 ± 2.34 weeks, respectively. The Mean American Orthopaedic Foot & Ankle Society (AOFAS) scores improved from 59.17 ± 5.31 preoperatively to 98.92 ± 1.63 at the time of 12 months follow-up. There was a statistically significant difference (P < 0.001). No patient complained of a negative effect on their life. CONCLUSIONS: The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time, and less complications, especially sural nerve injury. It is an efficient, reliable, and safe method for acute Achilles tendon (AT) rupture.

The incidence and clinical significance of corona mortis vessel / 中华骨科杂志

Objective To explore the incidence and clinical significance of corona mortis vessels.Methods From December 2015 to December 2017,48 patients with pelvic acetabular fractures were treated with the Stoppa approach,including 36 males and 12 females,aged 30 to 67 years,with an average age of 47.2±8.2 years.There were 52 sides of hemipelvis in the all including 44 cases of unilateral pelvic acetabular fractures and 4 cases of bilateral pelvic acetabular fractures.In the 48 patients,there were 6 pelvic fractures,40 acetabular fractures and 2 pelvic combined with acetabular fractures.According to Judet-Letournel classification:there were 6 cases of anterior column fracture,4 cases of anterior column with anterior wall fracture,2 cases of anterior column with posterior transverse fracture,4 cases of transverse fracture,6 cases of "T" shape fracture and 20 cases of double column fracture.According to Tile classification,there were 2 cases of B1 type,2 cases of B3 type,2 cases of C1 type,and 2 cases of C2 type.The time from injury to surgery was 5 to 16 days,with an average of 8.3±2.8 days.All patients were treated with the Stoppa approach for reduction and fixation.The incidence,number and type of corona mortis vessels across the superior pubic branch,and the diameter and the distance between the vessels and the pubic symphysiswere detected and recorded.Results In the 52 hemi pelvis,there were 46 sides with an anastomotic blood vessel,and no anastomotic blood vessel was found in 6 sides,with the incidence of corona mortis vessels of 88.5％ (46/52).Among them,36 cases were venous type,with the incidence of 78.3％ (36/46);8 cases were arterial type,with the incidence of 17.4％ (8/46);2 cases were mixed type,with the incidence of 4.3％(2/46);corona mortis venous blood vessel diameter was 1.8-3.7 mm,with an average of 2.9±0.5 mm;arterial blood vessel diameter was 2.4-3.0 mm,with an average of 2.7±0.3 mm;the distance between the vessels and the pubic symphysis was 48-71 mm,with an average of 56.9±5.8 mm.Conclusion The corona mortis vessels are common,with the incidence through Stoppa approach about 88.5％.In the clinical treatment of pelvic acetabular fractures,we should pay attention to careful separation of pubic branches exposed by the Stoppa approach,especially when using ilioinguinal approach to avoid corona mortis vessels injury and haemorrhage.

Tibiocalcaneal arthrodesis via bone transport technique for traumatic talus infection or defect / 中华创伤杂志

Objective To investigate the clinical efficacy of tibiocalcaneal arthrodesis using bone transport technique in the treatment of traumatic talus infection or loss. Methods A retrospective case series study was conducted to analyze the clinical data of 15 patients with talus infection or loss admitted to the provincial hospital affiliated to Shandong University from June 2011 to October 2017. There were 13 males and two females, aged from 19 to 47 years, with an average age of 27 years. Thirteen patients had talus infection and two patients had talus loss. All patients underwent tibiocalcaneal fusion with external fixator using bone transport technique, including four patients treated with annular external fixator and 11 with unilateral external fixator. Six patients with severe infection underwent debridement at stage I and osteotomy at stage II, and the other nine underwent debridement and osteotomy at the same time. The length of new bone, the fixation time of external fixator and complications were recorded. The American Orthopedic Foot and Ankle Society ( AOFAS ) score was used to evaluate the efficacy. Results All patients were followed up for 18-35 months, with an average of 26 months. The length of new bone in proximal tibial osteotomy area was 5-16 cm, with an average of 9 cm. The external fixators were removed after bone healing at docking site and maturation of new bone. The fixation time of external fixator ranged from 13 to 27 months, with an average of 18 months. No complications such as needle breakage, recurrence of infection and calcaneal varus occurred, and the length of both lower limbs was equal. AOFAS score was increased from preoperative (42. 0 ± 3. 6)points (31-55 points) to (76. 0 ± 4. 2)points (69-86 points ) at the last follow-up. Conclusion Tibiocalcaneal arthrodesis using bone transport technique is proved to be effective in treating traumatic talus infection or loss, which can repair the bone defect after debridement, improve the ankle-hindfoot function and improve the quality of life.

Pre-reduction effect of external fixator in treatment of obsolete dislocation of hip joint / 中华骨科杂志

Objective To explore the application value of external fixator in obsolete hip dislocation.Methods Retrospective analysis of 9 cases of obsolete hip dislocation treated with external fixator from January 2010 to January 2017.There were 6 males and 3 females,with an average of 32.0±8.3 years old (range 19-47).The time from injury to operation was 3-9 months,with an average of 6.2± 1.9 months.The patient's limb shortening length,traction time,traction length,operation time,surgical bleeding volume,preoperative and last follow-up VAS score,Epstein score,D'Aubigne functional score were recorded.Results The length of the limb shortened 5-11cm,with an average of 6.7±2.0 cm.The preoperative traction time ranged 20-45 d,with an average of 26.9±8.2 d.The length of traction ranged 5-12 cm,with an average of 7.1±2.2 cm.The second reconstruction operation time was 2.0-4.0 hours,with an average of 2.8±0.7 h.The bleeding volume was 800-2 000ml,with an average of 1 216.7±422.8 ml.The Epstein score at the last follow-up was excellent in 4 cases,good in 4 cases and improved in 1 case.The preoperative VAS score and the final follow-up VAS score were 0.9±0.8 points and 4.6±0.9 points respectively.There was a significant difference between preoperative and postoperative VAS scores (t=8.981,P=0.000).The D'Aubigne functional scores of preoperative and final follow-up were 5.2±1.0 points and 13.1±2.0 points respectively and the difference was statistically significant (t=-12.044,P=0.000).Conclusion The external fixation in the treatment of obsolete dislocation of the hip is helpful and accepted in patients with femoral head dislocation.It is easy to carry and tract for patients and convenient for functional exercise.The external fixation makes operation simple and flexible;the traction force is strong and the effect of the femoral head reduction is obvious,the operation method is simplified and the quality of the reduction is improved.

Surgical treatment of old die-punch fractures of distal radius / 中华创伤骨科杂志

Objective To report the effects of surgical treatment of old die-punch fractures of the distal radius.Methods A retrospective study of case series was made of the 21 old die-punch fractures of the distal radius which had been surgically treated from January 2012 to January 2017 at Department of Orthopaedics,Shandong Provincial Hospital.There were 13 males and 8 females,aged from 34 to 63 years (average,46.9 years).According to the preoperative definite diagnoses by the X-ray and CT images,there were 14 metacarpal compression fractures and 7 dorsal compression fractures.The palmar approach was used in 13 cases,the dorsal approach in 7 and the combined approach in one.Autogenous iliac bone grafting was performed for all the cases.Their preoperative and postoperative Cooney scoring and visual analogue scale (VAS) of the wrist,and postoperative complications as well,were observed and recorded.Results This cohort was followed up for 8 to 14 months (average,9.2 months).All their postoperative wounds healed by the first intention.Their Cooney functional scores of the wrist were,respectively,58.5 ± 4.2 and 84.0 ± 3.1 points preoperatively and at the final follow-up,and their corresponding VAS scores 7.6 ± 0.9 and 3.4 ± 1.3 points,showing significant differences between preoperation and the final follow-up (P ＜ 0.05).Carpal arthritis was observed in one case.Conclusion For old die-punch fractures of the distal radius,surgical treatment can obviously reduce pain,improve function of the wrist and enhance the quality of life of the patients.

Early usage of extraperitoneal pelvic packing plus temporary occlusion of abdominal aorta for treatment of pelvic fractures with hemodynamic instability / 中华创伤杂志

Objective To investigate the clinical outcomes of extraperitoneal pelvic packing combined with temporary occlusion of abdominal aorta in treatment of pelvic fractures with hemodynamic instability.Methods A retrospective case series study was made on 14 patients with pelvic fractures with hemodynamic instability managed by extraperitoneal pelvic packing plus temporary occlusion of abdominal aorta between December 2006 and December 2013.There were ten males and four females,with mean age of 38.2 years old (range,18-63 years).The fractures were classified according to the Tile classification,including two patients with type B1,two with type B2.2,one with type C1.1,two with type C1.2,two with type C1.3,three with type C2,and two with type C3.In addition,10 patients were with closed pelvic fractures and four with open pelvic fractures.All patients were diagnosed as hypovolemic shock once they were admitted.Every patient was given anti-shock treatment,temporary occlusion of abdominal aorta,and extraperitoneal pelvic packing instantly,in order to control hemorrhage of pelvic fracture after they were admitted.The operation time,red blood cell transfusion volume,preoperative and postoperative blood pressures,heart rates as well as other relevant parameters concerning death and survival were recorded and compared.Postoperative infection and wound healing status were recorded as well.Results The operation time was 50-70 minutes (mean,61 minutes).After surgery,the length of ICU stay was (10.9 ± 9.8) days and hospital stay was (23.1 ± 14.9) days.Red blood cell transfusion volume before and after surgery was (17.7 ± 2.2)U and (8.4± 1.7)U,respectively (P ＜ 0.05).The parameters of systolic pressures varied from preoperative (63.6 ± 2.1) mmHg to postoperative (90.9 ± 1.1) mmHg,and the parameters of heart rates declined from preoperative (106.2 ± 5.9) beats/min to postoperative (94.0 ± 6.2) beats/min,(P ＜ 0.05).Ten patients were available for follow-up of 8-24 months (mean,11.5 months).There were four deaths (29％) postoperatively,among which three were died from multisystem and organ failure,and one from severe brain injury.There were statistically significant differences between the survivors and the deaths in terms of time from injury to operation,average systolic pressures,and average heart rates (P ＜ 0.05).None had complications and wound was well healed.Conclusion For pelvic fractures with hemodynamic instability,extraperitoneal pelvic packing plus temporary occlusion of abdominal aorta has advantages of short manipulation time and effective outcomes,which can control the hemorrhage of pelvic fracture and ameliorate the hemodynamic status.

3D printing used in treatment of complex acetabular fractures / 中华创伤骨科杂志

Objective To evaluate 3D printing used in the treatment of complex acetabular fractures.Methods Between January 2009 and December 2013,121 patients with complex acetabular fracture were treated at our department.3D printing was used in surgical planning in 53 of them,including 36 males and 17 females with an average age of 41.2 ± 10.4 years (3D group).The other 68 patients received conventional surgery without use of 3D printing,including 42 males and 26 females with an average age of 42.6 ± 8.9 years (conventional group).By the Judet-Letournel classification system,there were respectively 7 and 9 T-type fractures,4 and 6 posterior column with posterior wall fractures,21 and 28 transverse and posterior wall fractures,5 and 6 anterior with the second half transverse fractures,and 16 and 19 double column fractures.Surgical time,blood loss,transfusion,fluoroscopy times and complications were recorded in the 2 groups.At the final follow-ups,the clinical results were assessed by Merle D'Aubigné & Postel scoring and the radiographic results were assessed by Matta records.The 2 groups were similar in preoperative demographic data (P ＞ 0.05).Results In the 3D and conventional groups,respectively,surgical time was 3.5 ±O.9 hours versus 4.5 ± 1.1 hours,blood loss was 1,200.2 ±232.8 mL versus 1,550.4 ±211.6 mL,transfusion was 8.9 ± 3.8 U versus 12.3 ± 2.9 U,and fluoroscopy times were 8.7 ± 2.1 versus 11.9 ± 2.4.The differences between the 2 groups were statistically significant (P ＜ 0.05).The 3D and conventional groups were respectively followed up for 20.3 and 37.8 months on average.All the acetabular fractures healed.The time from surgery to full-weight-bearing walking averaged 3.5 months.Iatrogenic ischiadic nerve injury occurred in 5 and 7 cases and superficial infection in 3 and 5 cases in the 3D and conventional groups,respectively.No iatrogenic vascular injury,nonunion,or implant failure occurred in the 2 groups.By the Merle D' Aubigné & Postel records,the excellent and good rate was 64.2％ (34/53) in the 3D group versus 64.7％ (44/68) in the conventional group.By the Matta records,the excellent and good rate was 73.6％ (39/53) in the 3D group versus 75.0％ (51/68) in the conventional group.The differences were not statistically significant (P ＞ 0.05).Conclusion Since 3D printing can contribute to better preoperative plan,it helps to lead to more accurate operation,shorter surgical time,and enhanced perioperative safety.

Treatment of comminuted posterior acetabular wall fractures with structural autologous iliac bone graft combined with mini screws / 中华创伤骨科杂志

Objective To evaluate the short and mid-term effects of fixing comminuted posterior acetabular wall fractures with structural autologous iliac bone graft combined with mini screws.Methods From January 2010 to January 2014,29 patients with comminuted posterior acetabular wall fracture were treated by structural autologous iliac bone graf combined with mini screws.They were 21 males and 8 females,with a mean age of 44.2 years (range,from 22 to 58 years).The mean time form injury to operation was 7.8 days (range,from 1 to 25 days).The operations were performed through the Kocher-Langenbeck approach,with the patients in the lying position on the uninjured side.The fragments were reduced and fixed by mini screws and the ischemic ones were removed.Structural autologous iliac bone graft was used to reconstruct the posterior wall of acetabulum before a reconstruction plate was applied to compress and maintain it.The functional outcomes were evaluated by the modified Merle d'Aubigne and Postel clinical grading system at the last follow-ups.The radiographs were graded according to the Matta criteria.Results By the Matta criteria,10 cases achieved excellent reduction,16 good reduction,and 3 poor reduction,giving a good to excellent rate of 89.7％.Of this series,29 patients were followed up for 31.5 months on average (range,from 12 to 48 months).By the modified Merle d'Aubigne and Postel criteria,the functional recovery was rated as excellent in 16 cases,good in 9,fair in 3 and poor in one,giving a good to excellent rate of 86.2％.Two cases developed femoral head necrosis according to the magnetic resonance imaging 18 months postoperation.Three patients developed traumatic arthritis two years postoperation.Five patients developed heterotopic ossification postoperation,with no obvious clinical symptoms.Two patient with injury to the sciatic nerve recovered 4 months postoperation.Conclusions Structural autologous iliac graft combined with mini screws can reconstruct the integrity and stability of the fractured acetabular posterior wall,avoiding osteonecrosis of the acetabulum.This surgical technique is effective and safe in treatment of comminuted fracture of the acetabular posterior wall.

Treatment of open tibial plateau fractures with Hybrid external fixation / 中华创伤骨科杂志

Objective To evaluate the clinical results of minimally invasive surgery for open tibial plateau fractures using minimally open reduction and Hybrid external fixation.Methods From January 2011 through January 2015,9 complicated open tibial plateau fractures were treated with Hybrid external fixation.They were 6 males and 3 females,with an average age of 33.8 years (range,from 18 to 53 years).According to the Schatzker classification,there were 5 cases of type Ⅴ and 4 ones of type Ⅵ.According to the Gustilo classification,there were 5 cases of type Ⅱ,3 ones of type Ⅲ A and one of type Ⅲ B.All the patients were treated with Hybrid external fixation with or without minimally open reduction.Results The average operation time was 185.6 minutes (from 140 to 240 minutes).The average time for hospital stay was 18.4 days (from 10 to 45 days).The patients were followed up for an average of 15.6 months (from 6 to 36 months).All the 9 fractures got united after an average time of 4.3 months (from 3 to 7 months).The external fixation was removed after confirmation of fracture union.According to Merchant scores,the clinical results were evaluated as excellent in 4 cases,as good in 3,as fair in one and as poor in one.The knee joint was stable in each case.Pin tract infection was observed in one and wire loosening in one.Conclusion Hybrid external fixation with or without minimally open reduction is a safe and feasible surgical method which avoids massive soft tissue dissection for complicated open tibial plateau fractures.

The application of computer aided technology in the treatment of pelvic malunion / 中华骨科杂志

Objective To introduce the application of computer aided technology in the treatment of pelvic malunion and observe the effect of this technique on the operation.Methods Data of 9 consecutive patients with pelvic malunion who were enrolled in our hospital from January 2009 to December 2012 were retrospectively observed.There were 4 patients who had undergone surgery with computer aided technology,including 3 men and 1 woman with an average age of 34 years (computer aided technology,CAT) group.According to the Tile classification,4 cases were all type C.There were 1 case with open pelvic fractures,2 associated with the craniocerebral injury,2 associated with the thoracic injury and 2 associated with the abdomen trauma.There were 5 patients who had undergone surgery without computer aided technology,including 3 men and 2 women with an average age of 32.6 years (conventional group).According to the Tile classification,4 cases were all type C.There were 1 case with open pelvic fractures,2 associated with the craniocerebral injury,3 associated with the thoracic injury and 1 associated with the abdomen trauma.The Majeed score,the visual analogue score (VAS),operation time,blood loss,blood transfusion,intraoperative fluoroscopy,degree of improvement in lower limb length,iatrogenic injury and the complication were all recorded respectively.Results For the CAT group,the operation time was 195-230 min,the blood loss was 800-1 6 00 ml,the blood transfusion was 6-16 U,intraoperative fluoroscopy was 6-11 times and the degree of improvement in lower limb length was 2-3 cm.The Majeed score in the final follow-up was 78-90 points,including 3 excellent cases and 1 good.The VAS after surgery was 0-4 points.For the conventional group,the operation time was 210-330 min,the blood loss was 600-4 500 ml,the blood transfusion was 6-28 U,intraoperative fluoroscopy was 7-18 times and the degree of improvement in lower limb length was 1-3 cm.The Majeed score in the final follow-up was 79-89 points,including 3 excellent cases and 2 good.The VAS after surgery was 1-4 points.Conclusion Surgeons can make full preoperative planning by the computer aided technology before the operation.This technology which reduces the operation time can make the operation more accurately,effectively and safely.

Comparison of the efficiency of the pelvic packing and the angioembolization for controlling pelvic fracture hemorrhoea / 中华骨科杂志

Objective To compare the efficiency of the pelvic packing and the angioembolization for controlling pelvic fracture hemorrhoea.Methods Data of 43 consecutive patients with pelvic fracture hemorrhoea who were enrolled in our hospital from April 2004 to April 2012 were retrospectively analyzed.There were 26 patients who had undergone pelvic packing,including 15 men and 11 women with an average age of 41.6 years (packing group).The causes of the fractures included road accident injury (12 cases),falling injury (8 cases) and the bruise injury caused by heavy object (6 cases).According to the Tile classification,there were 16 cases of type B and 10 cases of type C.There were 4 cases with open pelvic fractures and 5 associated with the abdomen trauma.There were 17 patients who had undergone angioembolization,including 10 men and 7 women,with an average age of 39.2 years (angio group).The causes included road accident injury (9 cases),falling injury (5 cases) and the bruise injury caused by heavy object (3 cases).There were 2 cases of type A,11 cases of type B and 4 cases of type C.The ISS,operation time,blood transfusion and the complication were all recorded respectively.Results For the packing group,the average ISS was 52.4± 15.3,and the operation time was 42.0±2.1 min.The blood transfusion was 15.0±4.7 U before the surgery and 6.0±1.6 U in the first 24 h after the surgery.The mean ICU stay was (8.0±3.6)d.And for the angio group,the average ISS was 40.6±12.4,and the operation time was 86.0±3.6 min.The blood transfusion before the surgery was 13.0±5.4 U vs.10.0±2.1 U in the first 24 h after the surgery,and the ICU stay was 11.0± 1.8 d.2 cases in the packing group underwent repacking and 6 cases in the angio group had received second angioembolization.Five cases died in the packing group but no one died of the hemorrhoea while 4 cases died in the angio group with one died of the hemorrhoea.There were 3 cases in the packing group suffering the deep infection while 1 suffered the superficial infection in the angio group.Conclusion The efficiency of the pelvic packing is higher than the angioembolization because of its shorter operation time and ICU stay,more effective blood control,less blood transfusion after surgery,and lower postoperative mortality.It is very suitable for the application at the local hospital and the national conditions nowadays.

Comparison of conventional X-ray fluoroscopy and ISO-C3D navigation for placement of sacroiliac screws in treatment of posterior pelvic ring fractures / 中华创伤杂志

Objective To compare the effect of ISO-C3D navigation and conventional C-arm fluoroscopy in iliosacral screws insertion for treatment of posterior pelvic ring injuries.Methods Sixty-five patients with posterior pelvic ring injuries managed by minimally invasive percutaneous iliosacral screws from June 2006 to January 2012 were reviewed.There were 37 males and 28 females,at age range of 18-63 years (mean 35.9 years).Pelvic fracture classification based on Tile system was type B1 in 10 cases,type B2 in 15,type B3 in nine,type C1 in 18 and type C2 in 13.Patients were divided into ISO-C3D navigation group (Group A,n =35) and C-arm fluoroscopy group (Group B,n =30) according to the difference in intraoperative fluoroscopy methods.Intraoperative fluoroscopy time,time cost in inserting a screw,patient satisfaction rate for bone reduction,bone union time and excellent-good rate of postoperative function were recorded.Results Eighty cannulated screws were inserted for the 65 patients.Average fluoroscopy time and time cost in inserting a screw were shorter in Group A than in Group B (P ＜0.01),but there was no statistical difference between the two gronps in patient satisfaction rate for bone reduction.No patient presented with infection,vascular nerve injury or other complications.Follow-up was 6-24 months (mean 12.7 months) for all the patients.Functional recovery showed no statistical difference between the two groups at postoperative 6 months.All fractures were healed and no delayed union or nonunion happened.Conclusion As compared with conventional C-arm fluoroscopy,computer-navigated surgery can reduce fluoroscopy time and improve screw insertion accuracy.

Sacroiliac anterior papilionaceous plate in the treatment of sacroiliac joint disruption: clinical application and short-term outcome / 中华骨科杂志

Objective To compare the effect of sacroiliac anterior papilionaceous plate (SAPP) and the traditional reconstruction plate for the treatment of sacroiliac joint disruption.Methods 11 consecutive patients with sacroiliac joint disruption associated with pelvic fracture enrolled in our hospital.Detailed physical examination,X-rays,CT and FAST were performed before surgery.11 patients underwent SAPP fixation.Of the 11 patients,there were 5 males and 6 females.Their average age was 39.6 years.12 patients enrolled in last year as control group underwent reconstruction plate.There were 7 males and 5 females in this group.Their average age was 39.1 years.Operation time,blood loss,placing time of SAPP were recorded.X-ray films were performed after surgery to evaluate reduction condition by Matta criteria.X-ray films and Majeed outcome were performed in follow up.Results According to Tile classification,there were 13 Type B and 10 Type C.For SAPP group,operation time was (100.9±32.1) min,blood loss (998.8±365.7)ml,Placing time of SAPP was (6.6±3.2) min.For control group,operation time was (110.8±29.6) min,blood loss was (136.0±279.3) ml,placing time of reconstruction plate was (15.4±1.1) min.According to Matta criteria,8 cases were rated as excellent,11 as good,3 as fair,and 1 as poor.Lumbosacral nerve injury occurred in 1 case,lateral femoral cutaneous nerve injury in 7,and massive blood loss in 2 cases.No posterior infection occurred.Compared with control group,SAPP group experienced shorter placing time,and less blood loss in type B pelvic fracture.Conclusion As a new instrument,SAPP could be well applied in the treatment of sacroiliac disruption.Compared with reconstructed plate,SAPP obviously shortens placing time and facilitated placing procedure,and does not increase blood loss,neurological risk and infection rate and does not need different incision and reduction method.

Minimally invasive percutaneous fixation based on ISO-C3D computerized navigational system for fracture of the acetabulum / 中国组织工程研究

BACKGROUND:Percutaneous hol ow screw under X-Ray fluoroscopy has been shown to treat fracture of acetabulum of the pelvis, but the time of internal fixation was long, and the amount of radiation exposure to the patients and physicians was large. OBJECTIVE:To test the application of the ISO-C3D METHODS:Thirty-one patients with fracture of the acetabulum were treated with percutaneous hol ow screw under a fluoroscopy-based ISO-C computerized navigational system for fracture of acetabulum. 3D computerized navigational system. The interval from injury to operation was 4 to 13 days. Al patients were fol owed up for one year. RESULTS AND CONCLUSION:The average bleeding volume during operation was only 18 mL, except that the bleeding volume of only one patient, who suffered from the sacroiliacjoint injury and received open reduction and internal fixation, was up to 300 mL. The total number of screws used in the operation was 42, among which 24 were screws for acetabular anterior column fracture and 18 for posterior column fracture. Al screws were implanted once precisely. The average time of internal fixation was 59 minutes, and the mean time for fluoroscopy was 39 seconds. The 31 patients were pain-free one week after the operation and no complication (infection, vascular nerve injury or implant breakage) was noted post-operatively. When the fol ow-up ended, radiography revealed fracture union with satisfactory screw fixation (no screw breakage or loosening). According to Matta functional scoring, results were excellent in 23 cases, good in 8 cases, with an excellent and good rate of 100%. According to Majeed functional scoring, the results were excellent in 22 cases, good in 6 cases and average in 3 cases, with an excellent and good rate of 90%. These results indicated that ISO-C3D computerized navigational system can supply stable internal fixation without an increase of complication.