The Clinical Efficacy Of Sacroiliac Complex Injury Treated With Reconstruction Plate Via The Anterior Approach

Objective:To retrospectively observe the outcome and residual vertical displacement of Sacroiliac Complex Injury (SCI) managed by reconstruction plate via the ilioinguinal approach,and explore the relationship between them.Methods:Based on inclusion criteria and exclusion criteria, collected the clinical information of patients with SCI who were treated with reconstruction plate through the ilioinguinal approach form October2007to June2011at Wuhan General Hospital of Guangzhou Command. Objects of the study were selected after removing lost or refused followed-up patients. All the cases taked X-ray radiography such as pelvic anteroposterior, inlet and outlet bits, three dimensional CT scan before operation. All the cases were treated through ilioinguinal approach, making a curved incision along the iliac crest from the anterior superior iliac spine to extend backwards,exposing fracture and dislocation, then fixing the fractures with two pelvic reconstruction plates as the horizontal "8" when reduced satisfactori ly, a long enough screw was screwed into the sacral side,at least two screws were screwed into the iliac side. Continue to skeletal traction about6to lOKg after operation. Taking X-ray radiography such as pelvic anter-oposterior, inlet and outlet bits, three dimensional CT scan3days after operation to find out the results of vertical shift. The above cases were followed up with clinical examination, the residual vertical displacement in X-ray radiography as pelvic anter-oposterior and the functional results scored with the Majeed functional recovery by the patients. Based on X-ray radiography or three dimensional CT scan before and after operation, the post-operative residual vertical displacement was assessed using the Tornetta and Matta reduction evaluation. The functional results were scored with the Majeed functional recovery system. It was statistically analyzed between them.Results:Obtain42cases of complete clinical data were selected since October2007to June2011according to inclusion criteria and exclusion criteria, then39cases were selected as the objects of study after removing lost or refused followed-up patients. All patients were followed up from6to48months (mean16months), the incision didn’t healed by first intention in two cases and the injury of fifth lumbar nerve root remained in two. Excellence rate of the reduction quality was76.9%. In all of them, there were less than4mm (excellent) of the residual vertical displacement in11patients,4to10mm (good) in19,10to20mm (fair) in8and more than20mm (poor) in1. Excellence rate of the functional outcome was71.8%. Excellent function happened in18patients, good in10, fair in9and poor in2. In the residual vertical displacement, there was statistical significance between less than10mm and more than10-mm, but no difference between0to4-mm and4to10-mm.Conclusion:The reconstruction plate via the anterior approach can attain satisfactory effect even if it could not provide enough resistance to vertical shear of Sacroiliac Complex. The affected limb bone tracted for3to6weeks is the important auxiliary treatment, can reduce or antagonize vertical stress, prevent to shift once again. There is no apparent interfere in the post-operative function if the residual vertical displacement is lesser than10-mm in Sacroiliac Complex.