Analysis Of The Effect Of Minimally Invasive Anterior Pedicle Screw Fixation Combined With Posterior Pedicle Screw Fixation In The Treatment Of Unstable Pelvic Fractures

Objective : Most patients with unstable pelvic fractures are complex and severe,challenging injuries that require effective treatment.The purpose of this study was to evaluate the efficacy of minimally invasive anterior pedicle screw and posterior pedicle screw internal fixation in the treatment of unstable pelvic fractures.Methods : The clinical data of patients with unstable pelvic fractures treated with minimally invasive anterior pedicle screw fixation or no posterior pedicle screw fixation between January 2013 and December 2016 in our department were retrospectively analyzed.Reduction quality(imaging efficacy)was assessed using Tornetta and Matta criteria,and clinical functional efficacy was assessed using Majeed score.Further evaluation included duration of surgery,intraoperative blood loss and incidence of postoperative complications.Results:29 patients(15 males and 14 females)were evaluated,with an average age of35.5 years(11-63 years)and an average follow-up time of 15.2 months(6-30months).According to Tile classification,16 cases had fracture of type B(B1 = 7,B2 =5,B3 = 4)and 10 cases had fracture of type C(C1 = 9,C2 = 4).The average operative time of minimally invasive anterior pedicle screw pelvic internal fixation was 24.2 min(19-30 min),and the average intraoperative blood loss was 19.5 ml(15-29 ml),n=16.The average operative time of posterior pedicle screw pelvic internal fixation was58 min(43-70 min),and the average intraoperative blood loss was 148 ml(110-169 ml),n = 13.The reduction quality was excellent in 15 cases,good in 9 cases and fair in 5cases.In the follow-up of the clinical functional efficacy of 6 months after surgery,16 cases were excellent,8 were good,4 were fair and 1 was poor.Two patients with unilateral thigh paresthesia improved after the removal of the internal fixation device.No complications such as ectopic ossification,deep venous thrombosis or deep wound infection were observed in all patients,and no loosening or fracture of internal fixation was found.Conclusions: Minimally invasive anterior pedicle screwpelvic internal fixation is a safe,minimally invasive surgical technique that can be effectively combined with posterior pedicle screw pelvic internal fixation for the ultimate treatment of vertical and/or rotational unstable pelvic fractures,especially in patients with complex conditions at high risk of mortality.