| Objective By using two kinds of internal fixation for treatment of unstable pelvic fracture, we compared the clinic efficacy, and tried to provide ethical evidence for the clinic application of percutaneous hollow screw fixation. Methods:1. From December 2006 to December 2010, 57 cases of unstable pelvic fractures (Tile type-B and type-C) were divided into two groups.30 cases were treated with the percutaneous hollow screws fixation (group A),27 cases treated through the surgery with open reduction and plate-screw fixation were selected as Group B. 2. According to the Tile classification system, Group A included between 21 cases of Tile type-B and 9 cases of Tile type-C, Tile type-B contained 15 male and 6 female patients with an average age of 35(range from 18 to 58) years. Tile type-C contained 6 male and 3 female patients with an average of 31 (range from 21 to 47) years. Make sure that pelvic fractures got a better reduction by bone traction or closed reduction was conducted with fluoroscopic C-arm before surgery. First the patients were positioned supine on radiolucent bed. Once a reduction was obtained, percutaneous internal fixation of anterior pelvic ring was conducted with a 6.5- millimeter hollow screw. After fixation of anterior pelvic ring was done, the patients were positioned prostrate. The posterior sacroiliac joint was fixed with one 6.5-millimeter or 7.3-millimeter hollow screw through percutaneous approach.3. According to the Tile classification system, Group B included between 19 cases of Tile type-B and 8 cases of Tile type-C. Tile type-B contained 13 male and 6 female patients with an average age of 36(range from 19 to 51) years. Tile type-C contained 6 male and 2 female patients with an average of 34(range from 17 to 56) years. All patients were temporary treated with bone traction before operation, and were treated with open reduction and internal fixation through anterior approach after stabilization of body condition.4. It was necessary to record the surgical time and the blood loss, X-ray was reviewed periodically after surgery. Fractures reduction was evaluated according to Matta scores and to use Majeed functional scores to evaluate the efficacy of treatment.5. The results of the surgical time and the blood loss were analyzed by t test, the results of the Matta scores and the Majeed functional scores were treated through chi-square. Results: 1.All patients of group A were followed up for 6 to 18 months (average 14 months), hospitalized time was 11 to 30d, average 19.3d. Blood loss was about 20ml to 70ml, average 35ml. The surgical time was 40-125 min, average 65 min. According to the Matta scores, the results were excellent in 11 cases, good in 15 cases, moderate in 4 cases, poor in 1 case, the excellent and good rate of fractures reduction was 86.7 percents. According to the Majeed functional scores, the results were excellent in 15 cases, good in 12 cases, moderate in 3 cases, poor in 0 case, the excellent and good rate was 90 percents.2. All patients of Group B were followed up for 4 to 18 months(average 12 months), hospitalized time was 18 to 34d,average 24.2d. Blood loss was about 400ml to 1200ml, average 675ml. The surgical time was 70-160 min, average 97 min. According to the Matta scores, the results were excellent in 18 cases, good in 6 cases, moderate in 3 cases, poor in 0 cases, the excellent and good rate of fractures reduction was 88.9 percents. According to the Majeed functional scores, the results were excellent in 14 cases, good in 10 cases, moderate in 2 cases, poor in 1 case, the excellent and good rate was 88.9 percents.3.A11 fractures healing well in the period from 3 to 6 months. The results of the surgical time and the blood loss indicated statistically significant differences were observed between group A and B. the group A was superior to the group B (p<0.05), there was no statistically significant differences in between Matta scores and Majeed functional scores after 6 months. (p>0.05)Conclusions:1. Two kinds of internal fixation for treatment of unstable pelvic fracture that can be reduction through closed ways, there were an approximate efficacy.2. For the unstable pelvic fracture that can be reduction through closed ways, we adopted preferentially percutaneous hollow screw fixation.3. The cases that can not be reduction through closed ways we should still adopt plate fixation... |
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