RESUMO
Objective@#To investigate the anatomical features of the safe zone for sacral lateral mass screw placement and find the safe trajectory, so as to provide reference for clinical application.@*Methods@#The three-dimensional computed tomography scan materials of sacrococcygeal vertebrae in 60 patients admitted to the Liaocheng People's Hospital of Shandong Province were analyzed by Mimics software to establish three-dimensional models. There were 33 males and 27 females, aged 25-78 years, with an average age of 45.7 years. After the safe zone was separated from sacral lateral mass model, a maximum cylinder was placed into the safe zone according to its anatomical feature. The cylinder was established as safe trajectory. Anatomical data were measured, including the length and diameter of screw trajectory, the distance between the entry point and the middle jaw, and adjacent upper and lower foramen, as well as the intersection angle between the screw direction and sagittal plane, between the screw direction and the adjacent upper end plate.@*Results@#The restriction factor of screw size on S1, S2 lateral mass was transverse diameter, while the restriction factor on S3, S4 was the distance between adjacent intervertebral foramen. The maximal length of screw from S1 to S4 was 30 mm, 35 mm, 30 mm, 14 mm respectively, while the maximal diameter was 12 mm, 9 mm, 5 mm, 5 mm respectively. The best entry point of S1 mass screw was lateral to the zygopophysis. The best entry point of S2-S4 mass screw was located at the midpoint of a line connecting the lateral edge of adjacent posterior sacral foramen approximately about 2 cm from median sacral crest. The leaning angles of screw was increased successively, and the sagittal plane was slightly inclined. There were significant differences between male and female groups in the leaning angle in S2 [male: (35.8±1.2)°, female: (37.9±3.7)°] and the distance between entry point and median sacral crest [male: (20.5±1.0)mm, female: (19.1±1.4)mm](P<0.05), while there was no significant difference in other parameters (P>0.05).@*Conclusions@#Cylindrical bony channel which is feasible for screw placement can be found in the lateral mass of sacrum. Individualized measurement can provide reference for application of lateral mass screw.
RESUMO
Objective To investigate the anatomical features of the safe zone for sacral lateral mass screw placement and find the safe trajectory,so as to provide reference for clinical application.Methods The three-dimensional computed tomography scan materials of sacrococcygeal vertebrae in 60 patients admitted to the Liaocheng People's Hospital of Shandong Province were analyzed by Mimics software to establish three-dimensional models.There were 33 males and 27 females,aged 25-78 years,with an average age of 45.7 years.After the safe zone was separated from sacral lateral mass model,a maximum cylinder was placed into the safe zone according to its anatomical feature.The cylinder was established as safe trajectory.Anatomical data were measured,including the length and diameter of screw trajectory,the distance between the entry point and the middle jaw,and adjacent upper and lower foramen,as well as the intersection angle between the screw direction and sagittal plane,between the screw direction and the adjacent upper end plate.Results The restriction factor of screw size on S1,S2 lateral mass was transverse diameter,while the restriction factor on S3,S4 was the distance between adjacent intervertebral foramen.The maximal length of screw from S1 to S4 was 30 mm,35 mm,30 mm,14 mm respectively,while the maximal diameter was 12 mm,9 mm,5 mm,5 mm respectively.The best entry point of S1 mass screw was lateral to the zygopophysis.The best entry point of S2-S4 mass screw was located at the midpoint of a line connecting the lateral edge of adjacent posterior sacral foramen approximately about 2 cm from median sacral crest.The leaning angles of screw was increased successively,and the sagittal plane was slightly inclined.There were significant differences between male and female groups in the leaning angle in S2 [male:(35.8 ± 1.2) °,female:(37.9 ± 3.7) °] and the distance between entry point and median sacral crest [male:(20.5 ± 1.0) mm,female:(19.1 ± 1.4) mm] (P ＜ 0.05),while there was no significant difference in other parameters (P ＞ 0.05).Conclusions Cylindrical bony channel which is feasible for screw placement can be found in the lateral mass of sacrum.Individualized measurement can provide reference for application of lateral mass screw.
RESUMO
Objective To investigate the transiliac-transsacral screw insertion pathway (TSIP) so as to provide an anatomical basis for clinical surgical practice.Methods CT scanning data of normal pelvis in 90 Chinese adults were selected by random number table.There were 45 males and 45 females,aged from 21 to 82 years (mean,53.88 years).After computed tomography scan,pelvic data of the 90 subjects were entered into Mimics software 16.0 for three-dimensional reconstruction.The outer frames of sacrum and ilium at sagittal plane were depicted.Maximum inscribed circle method was applied to determine the screw insertion pathways which traversed 1st (S1) and 2nd (S2) sacral segments,respectively.The diameters and lengths of screw pathways,the distances from screw insertion points to both anterior superior iliac spine and posterior superior iliac spine,as well as the angles between pathways and anatomic surface were measured.Results Most subjects had the condition of a trans-S1 TSIP (male 78％,female 76％),and all the tested pelvis had the condition of trans-S2 TSIP.There was no statistically significant difference between the left and right side parameters in male group,and so was in female group (P ＞0.05).TSIP radius:there was no statistically significant difference among male S1 [(5.52 ± 1.91)mm],male S2 [(5.35 ± 1.05)mm],and female S1 [(5.49± 1.34)mm] (P＞0.05),but each of them was greater than female S2 [(4.79 ± 1.40) mm] (P ＜ 0.05).TSIP length:male S1 [(158.25 ±9.84) mm] was larger than male S2 [(138.94 ± 9.75) mm],and female S1 [(154.91 ± 9.40) mm] was larger than female S2 [(141.01 ±8.60)mm].The screw insertion point was located at the outer ilium side.The distances from S1 to anterior superior iliac spine and to posterior superior iliac spine were (96.49 ±6.91)mm and (68.22 ±6.35)mm in males but (100.48 ±8.15)mm and (61.57 ±6.84) mm in females.The distances from S2 to anterior superior iliac spine and to posterior superior iliac spine were (114.43 ±8.77)mm and (49.62 ±8.54)mm in males but (114.75 ± 10.19)mm and (44.52 ±8.36)mm in females.Compared with those with a condition of TSIP in S1,a pelvis without a condition of an S1 TSIP had larger S2 TSIP radius.The S2 TSIP radius in one with such condition in male was (5.10 ±0.84)mm and that in one without such condition in male was (6.22 ± 1.27) mm.The corresponding female data was (4.37 ± 0.92)mm and (6.11 ± 1.84)mm (P ＜ 0.05).Both S1 and S2 TSIP were almost vertical to sagittal plane and parallel to coronal plane.Conclusions Anatomically,a S1 or S2 transiliactranssacral screw is available in most Chinese adults for sacroiliac joint fixation on both sides.Mimics software can be helpful to ensure the pathway of screw fixation,which provides reference for transiliactranssacral screw fixation technique.
RESUMO
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.
RESUMO
Objective To investigate the effect and mechanism of mitomycin C in reducing hypertrophic scar in rat traumatic osteomyelitis model.Methods A total of 120 Wistar rats were divided into control group (Group A,n =40),traumatic osteomyelitis group (Group B,n =40),traumatic osteomyelitis treated with Mitomycin C group (Group C,n =40),according to the random number table.The model of traumatic osteomyelitis was produced by Staphylococcus aureus.Muscle tissues around the focus were harvested at 15 d and 30 d postinjury.HE staining was used to observe the changes of muscle tissue structure.Immunohistochemistry was used to detect expression of transforming growth factor (TGF)-β1.Masson staining was used for collagen deposition evaluation.Western blot was used for detection of levels of TGF-β1 and collagen Ⅰ.Results HE staining revealed consistent alignment of fibers within the muscle in Group A.Fibrosis with the muscle was observed in both Group B and C,but the degree of muscle fiber disorder was decreased in Group C compared to Group B.Either 15 d or β0 d after injury,expressions intensity of TGF-β1,collagen fraction volume,and activation levels of TGF-β1 as well as collagen Ⅰ were higher in Group B and C than Group A,and all parameters were decreased in Group C compared to Group B (all P ＜ 0.05).Conclusion Mitomycin C can reduce hypertrophic scar formation in traumatic osteomyelitis model,and the potential mechanism relates to downregulated TGF-β1 and collagen Ⅰ.
RESUMO
Objective To establish a reliable unstable pelvic fracture model with sacral plexus stretch injury in goats and to detect electrophysiological signals when pelvis is shifted in different orientations and distance.Methods Twenty-four goats were divided into three groups of 8 animals each:pelvic longitudinal displacement was induced in group A,pelvic lateral displacement in group B,and pelvic dorsal displacement in group C.Animal left L6 and S1 nerve root and initial segment of sciatic nerve were exposed to connect stimulating and receiving electrodes respectively.Left pelvis was shifted at the speed of 0.25 mm/s to produce the model of unstable pelvic fracture with sacral plexus stretch injury.Electrophysiological signals of L6 and S1 were recorded when the placement of pelvis was 0,0.5 and 1.0 cm respectively.Results With pelvic displacement,the threshold potential,maximum stimulus potential and incubation period were gradually increased,but the peak-to-peak value became smaller gradually.When the pelvis displaced 0.5 cm at different orientations,group A showed improved threshold potential and incubation period (P ＜0.05),decreased peak-to-peak value (P ＜0.05),and no significant change in maximum stimulus potential(P ＞0.05);group B only showed lowered peak-to-peak value with no significant variations in other electrophysiological signals (P ＜ 0.05);group C had no significant variations in all electrophysiological signals (P ＞ 0.05).When the pelvis displaced 1.0 cm at different orientations,groups A and B showed improved threshold potential,maximum stimulus potential and incubation period (P ＜ 0.05) and lowered peak to peak value (P ＜ 0.05);group C showed higher incubation period with no significant variations in other electrophysiological signals(P ＜0.05).Between groups,the amplitude of variation in electrophysiological signals was the most in group A and the least in group C.Conclusion After unstable pelvis fracture in goats,sacral plexus stretch injury is the most serious in longitudinal displacement of the pelvis.
RESUMO
Objective With the isocentric C-arm (Iso-C) three-dimensional computerized navigation system,cadaveric pelvic specimens were used to imitate double screw fixation of the symphysis pubic.Practicability and safety of the screw trajectory were examined postoperatively by local cadaveric dissections and imaging tests.Methods Pelvic specimens were harvested from 8 male and 7 female adult cadavers.Double screw placement in symphysis pubic was performed using the Iso-C three-dimensional navigation and entry point and safety trajectory was achieved.With the detailed local dissection postoperatively,distances from screw entry and exit points to unilateral structures (spermatic cord,femoral artery and vein,femoral nerve,obturator artery and vein,obtrurator nerve,and so on) were measured respectively.After complete removal of surrounding soft tissues of the specimen with only bony structure kept,the entry angle and length were calculated.Accuracy of double screw fixation of symphysis pubic was further checked using X-ray and CT.Results Entry point of the first screw was at the junction of unilateral pubic tubercle and transitional site of superior pubic ramus.Mean angle of the first screw with the horizontal plane was (7.7 ± 1.9) ° in men and (8.1 ± 1.7) ° in women.Mean angle between the first screw and coronal plane was (7.8 ± 1.8)° in men and (7.7 ±2.0)° in women.Entry point of the second screw was in the same place in the contralateral pubic tubercle.Mean angle between the second screw and horizontal plane was (30.6 ± 4.0) ° in men and (30.8 ± 3.4) ° in women.Mean angle between the second screw and coronal plane was (9.1 ± 3.0)°in men and (9.2 ± 3.3)°in women.Conclusions With the three-dimensional computerized navigation system,the bony channels of double screws implanted in the symphysis pubic are achieved and reliable.Percutaneous double screw fixation is feasible to treat the pubic symphysis diastasis.
RESUMO
Objective To perform anatomic study on percutaneous cannulated-screw fixation of symphysis pubis diastasis in human cadaveric pelvic specimens so as to provide a basis for clinical practice of the technique.Methods Fifteen adult pelvic cadaveric specimens were dissected to expose pubic symphysis,peripheral major vascular nerve,spermatic cord and round ligament of the uterus.Thickness of pubic symphysis and distance between the outer edge of pubic tubercle and spermatic funicle or round ligament of uterus were measured respectively.Distances were measured respectively from entry and exit points to the above-mentioned structures in the direction of guide pin.Entry depth and angles of guide pin with the coronal plane and cross section of the human body were measured.Surgery was simulated to prove the surgery effect through post-surgery filming and CT.Results Thickness of symphysis pubis was gradually reduced from up to down.Pubic tubercle part was the most thick and it could accommodate a 7.3 mm cannulated-screw.Entry and exit points of cannulated-screw were in certain distances with the important nervusvascularis and spematicfunicle (or round ligament of uterus) in the periphery,which were invulnerable to damages in the process of surgery.Proper lengths of cannulated screws were (73.6 ± 1.3) mm for males and (72.4 ± 1.7)mm for females (t =3.146,P ＜ 0.05).Screw thread was completely embedded in pubic tubercle.Angles of guide pin with coronal plane and cross section of human body were (7.3 ± 1.1) °and (6.4 ± 1.0) ° for males (6.9 ± 1.5) ° and (6.1 ± 0.6) ° for females.Radiography and CT findings confirmed that all pin tracks were in the bone substances with angle and length of screws staying within the scope of experiment.Conclusion Percutaneous cannulated screw fixation is reliable and safe for symphysis pubis diastasis.
RESUMO
<p><b>BACKGROUND</b>Pelvic fractures are uncommon in elderly patients and so are infrequently addressed in the literature. The purpose of this study was to investigate the management and outcome of pelvic fractures in elderly patients.</p><p><b>METHODS</b>We retrospectively reviewed the records of pelvic fractures in elderly patients (age ≥55 years) who were treated in our department from September 1997 to May 2010.</p><p><b>RESULTS</b>A total of 40 elderly patients with pelvic fractures were identified. Their mean age was 65.8 years (range 55-87 years). About 68% (n = 27) were men. The average Injury Severity Score (ISS) was 17.8 (range 6-45). Twelve (30%) patients required blood transfusion (mean 10 units) during the first 24 hours. The fractures were most frequently due to falling from a standing position (48%). Almost half (48%) were grade I breaks. Associated injuries were present in 70% (n = 28) of patients, and 65% (n = 26) had medical co-morbidities. Altogether, 29 patients (73%) underwent non-surgical management of their pelvic fracture. The average hospital stay was 25 days. There were five in-hospital deaths and one death 10 months after discharge. High ISSs (>25) were associated with increased in-hospital mortality (P = 0.018). At the final assessment (mean follow-up 15 months), 52% of the surviving patients had experienced decreased self-sufficiency.</p><p><b>CONCLUSIONS</b>Pelvic fractures in elderly patients result in high morbidity and mortality rates. A high ISS (>25) can be used to identify a patient at high risk. We recommend aggressive resuscitation and intensive care for that patient. For patients with an unstable pelvic or displaced acetabular fracture (≥2 mm) who can endure surgery, open reduction and internal fixation can provide adequate fixation for early weight-bearing and restoration of the bone stock.</p>
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transfusão de Sangue , Fixação Interna de Fraturas , Fraturas Ósseas , Cirurgia Geral , Terapêutica , Mortalidade Hospitalar , Ossos Pélvicos , Ferimentos e Lesões , Estudos RetrospectivosRESUMO
Objective Toobservetheeffectofperioperativeuseoflowmolecularheparin(LMH)forpreventinglowerlimbdeep vein thrombosis(DVT ) in elderly hip peripheral fracture .Methods 105 cases of elderly hip peripheral fracture from July 2007 to July 2011 were divided into the LMH group(65 cases) and the conventional treatment group(40 cases) .The two groups were per-formed the physical therapy for preventing lower limb DVT .The LM H group was added with LM H for preventing DVT .The sta-tuses of DVT occurrence and the coagulation related indicators were compared between the two groups .Results In the LM H group ,the thrombus events happened in 4 cases ,accounting for 6 .15% .In the conventional treatment group ,thrombosis occurred in 13 cases ,accounting for 32 .5% .The difference between the two groups had statistical significance (P<0 .05) .Hemoglobin on post-operative 1 ,10 d was obviously improved ,the difference had statistical significance(P<0 .05) .Conclusion Using LMH has rela-tively ideal effect for preventing lower limb DVT in elderly hip peripheral fracture .
RESUMO
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.
RESUMO
BACKGROUND:Under physiological conditions, nerve roots can move along with the movement of limbs and spine. However, the mechanisms of nerve root stretch injury under physiological conditions and the neurological dysfunction after injury are unclear. OBJECTIVE:To review the reason of nerve root stretch injury, and to analyze the mechanism of nerve function from biomechanics, pathology and neurophysiology. METHODS:A computer-based online search of PubMed database was undertaken by the first author to identify the articles related to the research of nerve root injury and nerve stretch injury between 1990 and 2012, with the key words of“nerve root, nerve, stretch injury”. A total of 391 articles were screened out. The articles on the anatomy and biomechanics research of nerve root were included, as wel as the pathology and neurophysiology research after nerve root stretch injury. Final y, 44 articles were included for review. RESULTS AND CONCLUSION:Nerve root can be stretched along with limbs and spine movement. However, diseases or trauma may cause pathological nerve root stretch, and thus leading neurological dysfunction. The nerve root is often influenced stretch because of its anatomical and tissue structure. Mechanical injury mechanism of stretch composes of peripheral (peripheral nerve conduction stress) and central mechanism (displacement of spinal cord content). Pathological studies found that the local fibrosis is caused by the extracted serum protein that difficult to remove after injury, and this is because of the shortage of lymphatic system in nerve roots. Fibrosis can cause nerve root ischemia, affect the nerve function, and change the biomechanical properties of nerve root. Nerve root injury can cause primary and secondary injury of internal axons, and this is the main reason for neurological dysfunction after injury.
RESUMO
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.
RESUMO
Objective To investigate feasibility and effect of external fixator plus steel plate in treatment of open tibiofibular fractures combined with tibial defect.Methods The study involved 21 patients with open fractures of tibia and fibula (15 patients with type Gastilo ⅢA,five with type Gastilo ⅢB and one with type Gastilo ⅢC) with concurrent tibial defect of 2-6 cm.External fixator plus fibular steel plate was performed at the first stage,followed by iliac bone grafting for bone defect at the second stage.Results All patients showed successful reconstruction of the tibial defects with length difference between affected and healthy extremities less than 2 cm in follow-up for (14.0 ± 10.5) months (range,8-24 months).Meanwhile,no talipes equinovarus existed.Conclusions External fixator plus steel plate is an effective method for treating open tibiofibular fractures combined with tibial defect.The length and function of the extremities of patients with open tibiofibular fractures combined with tibial defect of less than 6 cm can be successfully restored.
RESUMO
Objective To explore the efficacy of temporary occlusion of abdominal aorta in the treatment of massive bleeding after pelvic fracture.Methods From May 2003 to May 2010,temporary occlusion of abdominal aorta was performed for 23 patients with massive bleeding after pelvic fracture.There are 15 male and 8 female patients with a mean age of 32 years (range,17-62 years).The mechanisms of injury included traffic accidents in 17 cases,falls in 4,engine injury in 1 and crash injury in 1 case.According to AO classification,4 cases were of type B2,4 of type B3,2 of type B3,1 of type C1,4 of type C2,and 12 of type C3.After aorta occlusion,the internal iliac vessel was ligated and the bleeding sites were tamponed.The fractures of pelvis were reduced.External fixation was used in 17 cases and screws and plates were used to fixation in 6 cases.Results All cases were rescued successfully.The average volume of blood transfusion was 4000 ml (range,1500-8500 ml).Intraoperative self-blood transfusion was performed in 14 patients.The average volume of self-blood transfusion was 1500 ml (range,700-5000 ml).Twenty-one patients were followed;the duration of follow-up was 26 months (range,5-36 months).The functional results were excellent in 11 cases,good in 4,fair in 3 and poor in 2 according to Majeed scores system.Complications included 2 cases of infection,1 of lower limb deep venous thrombosis,1 of malreduction of sacroiliac joint,and 1 of malunion of pelvic fracture.No complication was found due to the aorta occlusion or the internal iliac vessel ligation.Conclusion Temporary occlusion of abdominal aorta was an efficient and quick method in the treatment of massive bleeding after pelvic fracture.
RESUMO
Objective To explore the feasibility of Ilizarov technique in managing large tibia defects combined with soft tissue defects.Methods A total of 24 patients with large tibial defects combined with soft tissue defects caused by compound open tibial fractures were fixed with Ilizarov technique from September 2003 to September 2010.All patients belonged to open tibial fractures,including 20 patients with Gustilo type Ⅲ B and four with Gustilo type Ⅲ C.After debridement,the soft tissue defect areas was 10 cm ×6 cm and the bone defect was(8 ±4)cm.Fifteen patients with tibial defects ＜5 cm were treated with one stage debridement,fibula resection and tibial defect end compression.The other nine patients with tibial defect ＞ 5 cm were managed by one stage debridement,bone transport and bone lengthening.Then,15 patients were treated with one stage debridement,wound closure or wound reduction,bone grafting treatment and second stage cleansing of the incarcerated skin and fracture end.Results All patients were followed up for average 14 months(10-24 months),which showed reconstruction of the bone defects,restoration of the limb length,fracture healing and less than 2 cm difference between health limb and contralateral limb.One patient experienced common peroneal nerve palsy after operation,but recovered three months later.Of all,19 patients recovered without extra surgery,three restored with skin graft and two received skin flap.Conclusion Ilizarov technique is an effective option for treating the tibial defects combined with soft tissue defects at one stage.
RESUMO
Objective To simulate the process of lag screw insertion on intact pelvises under guidance of conventional fluoroscopes or 2D and Iso-C3D computer-assisted navigations and evaluate the accuracy and practicability of the computer-assisted navigation. Methods Six dried intact adult pelvic specimens were selected and divided into three groups randomly. A total of 54 hollow screws were placed in bilateral pedicles of S1 and S2, anterior column of bilateral acetabulum, anterior column of bilateral acetabulum and pubic symphysis of intact adult dried pelvic specimens of three groups under guidance of conventional fluoroscopy, 2D and Iso-C3Dcomputer assisted navigations, respectively. The accuracy of the screw positions, the average operating time of each screw insertion and the average time of radiation exposure during the insertion of each screw were compared among three groups. Results There were significant differences in the accuracy of the screw positions, the average operating time and the average time of radiation exposure among three groups (P＜0.01). The navigation with Iso-C3D appeared to provide the highest accuracy and the shortest operating time of all guidance techniques. The mean operating time and the average time of radiation exposure of the conventional fluoroscope were the longest among three groups. The average time of radiation exposure of the 2D computer-assisted navigation was the shortest.Conclusions Iso-C3D computer-assisted navigation is the most accurate and expeditious means of all guidance techniques. The time of radiation exposure can be significantly reduced by both 2D and Iso-C3D computer-assisted navigations.
RESUMO
Objective To discuss the timing and methods of operative treatment of acetabular fractures of AO Type C (double- column fractures). Methods From February, 1999 to January, 2004, we treated operatively 46 cases of AO Type C acetabular fractures, including 23 cases of C- 1 type, 14 cases of C- 2 type, and 9 cases of C- 3 type. 15 cases were treated through ilioinguinal approach, 10 cases through improved Kocher- Langenbeck approach, and 21 cases through combined anterior and posterior approaches. There were 3 groups of patients according to the time from injury to operation: 15 cases got operation within 1st week after injury (Group A); 23 cases within 2nd week (Group B); 8 cases within/after 3rd week (Group C). All of them were checked with radiography and 3D CT scan before and after operation. Results 34 cases( 73.9% ) obtained anatomical reduction, 8 cases( 17.4% ) got imperfect reduction, and 4 cases( 8.7% ) had unsatisfactory reduction. All the patients were followed up for 1 year to 4 years, averaging 31 months. According to D' Aubigne and Postel Hip Score, joint function was rated as excellent in 32 cases( 69.6% ) , good in 5 cases( 10.9% ) , fair in 5 cases ( 10.9% ) and poor in 4 cases ( 8.7% ) . As far as reduction was concerned, there was a significant difference (P0.05). As far as joint function was concerned, there was a significant amelioration in Groups A and B compared with Group C (P0.05) between group A and Group B. Conclusions Good knowledge of AO classification of acetabular fractures combined with particular radiological data can result in correct diagnosis of Type C acetabular fractures. Operations should be carried out within 2 weeks after injury and efforts should be made to ensure anatomical reduction. To achieve good clinical results in treatment of Type C acetabular fractures, suitable approaches and correct reduction and internal methods are essential
