| Objective In this study,the applied anatomical parameters of pubic screw nail in the Dynamic Anterior Plate-screw System for Quadrilateral area were measured by digital method to provide a basis for clinical safety screw placement.Furthermore,the application effect of three-dimensional digital planning in the Dynamic Anterior Plate-screw System for Quadrilateral area for the treatment of complex acetabular fractures involving the square area was initially explored,providing a new idea for improving the Dynamic Anterior Plate-screw System for Quadrilateral area independently developed by our department.Finally,Finally,the clinical effects were compared to determine the effect of Taohe Chengqi Decoction on abdominal flatulence and dysdefecation in patients with acetabular fracture.Methods Part Ⅰ: The data of 20 normal adults with complete pelvis thin slice CT scan were collected respectively from the Northern theater Command general hospital of the Chinese People’s Liberation Army,Central Theater Command general hospital of the Chinese People’s Liberation Army,Sanshui District People’s Hospital in Foshan City and the First Affiliated Hospital of Xinjiang Medical University.Among them,there were 10 male and 10 female patients(20 sides of each pelvis)were be saved in DICOM format and then imported into the computer-aided surgery software of MICs to reconstruct the three-dimensional model of pelvis through the function of threshold segmentation region growth.The scheme of setting screws in the pubic region was determined with the Dynamic Anterior Plate-screw System for Quadrilateral area as the reference template.The virtual screws were replaced by the virtual cylinder of Mimics software,and the length of the screws was measured after adjusting the position of the screws.The angle between the screws and the inner and lower surface of the pubic and The angle between screw and sagittal plane of pelvis were measured by the line and surface angle function of 3-matic research 12.0 software.PartⅡ: By formulating inclusion and exclusion criteria,medical records of 26 patients with complex quadrangular acetabular fractures were collected,including 21 males and 5 females aged from 20 to 69 years old,from the department of orthopedics of the Central Theater Command general hospital of the Chinese People’s Liberation Army during May 2016 to June 2019.Patient data were divided into two groups based on whether to use three-dimensional digital planning: 12 patients in the three-dimensional digital planning group,10 males and 2 females;age years(44.50±12.60);14 patients in the conventional nail placement group,11 males and 3 females;the age years(51.00±11.57).The patient data of the three-dimensiona digital planning group were subjected to three-dimensional digital planning according to the method of anatomical measurement.Mimics computer-assisted surgery software was used to reconstruct the three-dimensional model of the pelvis through functions such as threshold segmentation and regional growth.Dynamic Anterior Plate-screw System for Quadrilateral area is a reference virtual screw of the pubic branch.The nail insertion point and direction are designed.The length of the virtual screw and the angle between the virtual screw and the inner and lower surface of the pubic branch are measured.Systematic pubic branch screws provide reference data.Patients in the conventional nail placement group underwent routine examinations before surgery,and the doctors placed the screws with their bare hands and used a C-arm X-ray machine for fluoroscopy.The differences between the two groups were compared in terms of pubic branch screw operation time,intraoperative bleeding volume,intraoperative fluoroscopy time,guide needle adjustment times,fracture reduction quality,and Modified acetabular fracture function score at the last follow-up.Part Ⅲ: The 26 patients with acetabular fractures were divided into two groups for comparison.The control group: the patients were given symptomatic treatment with common western medicines for oral administration;the observation group: the Jingtaohe Chengqi Decoction was added on the basis of the observation group.Results PartⅠ: When the Dynamic Anterior Plate-screw System for Quadrilateral area pubic branch screw is placed diagonally atthe leading edge,midpoint of anterior and posterior edges,posterior edge,and at the midpoint of anterior and posterior edges,screw A may The theoretical maximum length of males were(47.06 ± 4.78)mm,(49.14 ± 4.02)mm,(48.74 ± 3.51)mm,(50.80 ± 7.35)mm,and females were(33.69 ± 7.05)mm,(42.58 ± 4.98)mm,(43.8 ± 4.97)mm,(42.21 ± 6.24)mm;The maximum theoretical length of screw B that can be inserted is(31.50 ± 3.55)mm,(44.19 ± 4.34)mm,(54.05 ± 7.11)mm,(47.77 ± 4.25)mm for males,and(23.82 ± 5.35)mm,(38.17 ± 7.43)mm,(46.98 ± 7.31)mm,(42.12 ± 6.87)mm;The maximum theoretical length of screw C can be placed in(25.86 ± 1.88)mm,(32.54 ± 5.68)mm,(35.45 ± 8.72)mm,(43.71 ± 5.47)mm for males,and(22.95 ± 2.79)mm,(27.06 ± 4.85)mm,(27.63 ± 7.02)mm,(32.66 ± 5.73)mm for females;The differences in screw length and gender between groups were statistically significant(P <0.05).Screw A is angled with the inner and lower surface of the pubic bone when the nail is placed diagonally at the anterior,midpoint,anterior and posterior edges of the upper surface of the pubic bone,Males were(27.71 ± 5.36)°,(22.27 ± 4.30)°,(16.98 ± 3.79)°,(24.67 ± 4.68)°,females were(37.00 ± 11.25)°,(24.18 ± 4.13)°,and(18.25)± 2.09)°,(24.56 ± 5.37)°;Screw B is angled to the inner and lower surface of the pubic bone when the nail is placed diagonally at the anterior,midpoint,anterior and posterior edges of the upper surface of the pubic bone,Males are(58.92 ± 10.24)°,(36.80 ± 6.65)°,(22.57 ± 4.95)°,(33.56 ± 6.27)°,females are(58.21 ± 6.88)°,(31.97 ± 7.85)°,and(19.07 ± 6.76)°,(29.48 ± 7.14)°;The screw C isangled to the inner and lower surface of the pubic bone when the nail is placed diagonally at the leading edge,the midpoint of the leading edge and the trailing edge,at the midpoint of the leading edge and the trailing edge,Males are(49.21 ± 5.62)°,(32.87 ± 5.35)°,(21.49 ± 5.01)°,(25.27 ± 8.06)°,and females are(41.26 ± 5.6)°,(26.61 ± 5.93)°,and(16.88)± 3.23)°,(19.08 ± 3.99)°.The differences between men and women at the four angles of screw C were statistically significant(P< 0.05),and the differences between men and women at the four angles of screw A and B were statistically significant(P> 0.05).There were no significant differences between the genders(P> 0.05).Screw A is angled with the sagittal plane of pelvis when the nail is placed diagonally at the anterior,midpoint,anterior and posterior edges of the upper surface of the pubic bone,Males were(3.29 ± 0.68)°,(3.34 ± 0.62)°,(2.99 ± 0.68)°,(6.99 ± 2.99)°,females were(9.10 ± 0.92)°,(6.55 ± 0.60)°,and(4.55 ± 0.63)°,(9.83 ± 0.85)°;Screw B is angled with the sagittal plane of pelvis when the nail is placed diagonally at the anterior,midpoint,anterior and posterior edges of the upper surface of the pubic bone,Males are(16.30 ± 1.43)°,(10.61 ± 1.17)°,(3.54 ± 0.31)°,(12.53 ± 2.64)°,females are(25.33 ± 1.40)°,(11.17 ± 1.14)°,and(4.24 ± 0.29)°,(20.72 ± 0.66)°;The screw C is angled with the sagittal plane of pelvis when the nail is placed diagonally at the leading edge,the midpoint of the leading edge and the trailing edge,at the midpoint of the leading edge and the trailing edge,Males are(20.06 ± 0.71)°,(11.98 ± 0.44)°,(6.81 ± 0.60)°,(37.17 ± 4.30)°,and females are(23.99 ± 1.21)°,(14.89 ± 0.55)°,and(5.85 ± 0.52)°,(30.43 ± 0.56)°.The angles between the screws and the sagittal plane between the groups was not statistically significant except for the midpoint of the B screw,and the remaining differences were statistically significant(P< 0.05).There were no significant differences between the genders(P> 0.05).Part Ⅱ: In the three-dimensional digital planning guide group,the average operation time was(88.75±11.20)min,the average intraoperative blood loss was(183.58±30.65)ml,the average X-ray fluoroscopy time during the operation was(26.33±9.40)s,and the number of guide needle adjustments was(1.08±0.67)times,which was less than that in the conventional group:(113.50±18.83)minutes,(251.71±26.98)ml,(37.07±6.71)s,and(2.64±0.63)times in the conventional group,and the difference between the two groups was statistically significant(P <0.05).Patients in both groups were followed up.The average follow-up time of the three-dimensional digital planning group was(14.75±2.73)months,and the average nail placement group was(15.57±3.65)months.The fracture reduction quality of the two groups of patients was evaluated according to the Matta reduction standard: the satisfaction rate of reduction in the three-dimensional digital planning group was 91.67%(11/12),and the satisfaction rate of reduction in the conventional nail placement group was 85.71%(12/14).Results of Modified acetabular fracture function score at the last follow-up,the three-dimensional digital planning group was(15.08 ± 1.00)and the conventional nail placement group was(15.14 ± 1.29).There was no statistically significant difference in the above data(P > 0.05).Part Ⅲ: The two groups of patients were compared in the abdomen fullness relief,the first exhaust,the first defecation,and the disappearance of constipation.The time observation of the occurrence of the four indexes was significantly less than that of the control group;the total effective rate of the observation group was 92.8%,which was significantly higher than that in the control Group(83.3%)(P <0.05).Conclusion Computer-assisted anatomical measurement to provide a reference for the placement of pubic branch screws of the Dynamic Anterior Plate-screw System for Quadrilateral area.In clinical applications,three-dimensional digital planning can shorten the operation time,reduce intraoperative bleeding,intraoperative fluoroscopy time,and the number of needle adjustments,which is more advantageous than conventional nail placement.The traditional Chinese medicine prescription Taohe Chengqi Decoction has a clear effect in treating abdominal distension and difficulty in defecation after acetabular fracture. |
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