| Objective: Pelvic fractures are very common in clinical, injuries areusually serious and complicated. There are many treatments currently, but theyhave various kinds of limitations. To this end, we designed and manufacturedMinimally Invasive Adjustable Plate(MIAP), trying to treat posterior pelvicring injuries. This study is to compare the efficacy of posterior pelvic ringinjuries treated by MIAP and reconstructive plate.Methods: From October2008to September2011,36patients withposterior pelvic ring injuries in our hospital treated by open reduction andinternal fixation were reviewed.16cases fixed with MIAP (group A),8malesand8females, with the mean age of (40.2±13.7) years.20cases fixed withreconstructive plate (group B),9males and11females, with mean age(34.4±10.0) years.19cases were caused by car accident,12by fall fromheight,5by smash of heavy object. Two groups of patients were fixedtemporarily in hospital after fracture, and the wound were bandagedcompressed to stop bleeding. According to the different circumstances ofpatients, debridement and suturing or urethra reconstuction and bladdersuturing were underwent, for patients who existed posterior pelvic ringdamage with vertical displacement or combined with lower limb fracture weretreated with continuous bone traction. Anteroposterior, inlet and outlet viewsof pelvic X-ray film, CT inspection and3D reconstruction were generallyunderwent preoperatively to get more information of fracture and choose theappropriate surgical methods.Group A took the prone position in surgery, made longitudinal incisionabout4~6cm along the both sides of posterior superior iliac spine to expose,and made lateral subcutaneous tunnel between them. First using C-arm X-rayto assess facture displacement. Then use intraoperative traction or pry by instruments to auxiliary replace for the patients who have residual verticaldisplacement. And for the patients who have anteroposterior displacement,place the coarse screws into the posterior superior iliac spine to auxiliaryreplace by pressing or pulling hemipelves, then remove the screws afterreplacement and those screws were usually located below the location ofMIAP screws and will not disturb the bone’s holding strength of the MIAP.After correcting the vertical and anteroposterior displacement, fit the two sidesof MIAP’s Z-shaped plate with the sacroiliac joint, the side panels were fittedwith inner side of iliac crest, the upper panels were fitted with posteriorsuperior iliac spine, the bottom panels were fitted with dorsal sacrum, thenplaced two screws to both panels of the Z-shaped plate to fix the sacroiliacjoint. Connected the connecting rod to the sleeve into the subcutaneous tunnel.If the middle sacral crest barrier, we can make a length of about2~3cmlongitudinal incision above it, or from one side of posterior superior iliac spineincision to expose it diagonally and cut it off. Then connected the rod to theboth sides of the Z-shaped plate, rotating the sleeve under the surveillance ofthe C-arm X-ray, elongate or shorten the device to replace. Group B also tookthe prone position, made a lateral incision about20~25cm between the bothsides of posterior superior iliac spine, and cut the skin, subcutaneous tissues,and deep fascia, stripping the muscles behind the sacrum, exposing thefracture. Replaced the posterior pelvic ring fracture carefully by pressing,intraoperative traction and prying, avoiding nerve injuries. According to thedistance of both sides of the posterior superior iliac spine, pre-bend thereconstructive plate and fit with the cortical bone of lateral posterior superioriliac spine. Placed2~3screws to fix the plate on each side, noticing thedirection of the screws to avoid penetrating the medial cortical bone into thesacroiliac joint. Finally, used C-arm X-ray to check the fixation, then flushedthe incision, suture each layer of tissues in turn.Mean Injury Severity Score of group A was14.4(ranged from9to29),group B was11.8(ranged from4to25). According to AO classification:9patients were type B,7patients were type C in group A and14patients were type B,6patients were type C in group B. Two groups were treatedoperatively (7.2±3.1) days and (8.1±3.4) days after the injury respectively.Record the operative time, intraoperative fluoroscopy time, intraoperativeblood loss, length of incision, fracture healing time, postoperative Majeedstandard and using SPSS19.0statistical software to manage all the data,P<0.05stands for having statistical significance, to compare the efficacy.Results:36cases were followed up from12to45months, with theaverage time of23.4months. In group A, operative time was（75.6±13.6）min,intraoperative fluoroscopy time wa（s8.2±0.9）s, intraoperative blood loss was（210.6±39.9）ml, length of incision wa（s9.1±1.4）cm, fracture healing timewas（3.5±1.0）months. In group B, operative time was（156.8±32.5）min,intraoperative fluoroscopy time wa（s7.6±1.4）s, intraoperative blood loss was（311.0±87.2）ml, length of incision was（14.0±5.0）cm, fracture healingtime was（3.6±0.9）months. Using Majeed standard to evaluate the hip jointfunction, group A scored (85.6±8.1), group B scored (80.1±9.0). In group B,1case had fracture malunion,1case got infected on the incision. Operative time,intraoperative blood loss and the length of incision in group A were less thanwhich in group B, group A scored more than group B, and the differences havestatistical significance(P<0.05). Fracture healing time and intraoperativefluoroscopy time have no statistically significant differences. And the case ingroup B who got incision infected have recovered after treatment. Accordingto the Majeed standard,11cases were excellent,4cases were good,1casewas fair, and the excellent and good rate was94%in group A,8cases wereexcellent,9cases were good,3cases were fair, and the excellent and good ratewas85%. The difference was not statistically significant（χ2=0.088，P>0.05）.Conclusion: MIAP is minimally invasive and pressure controllable, andpostoperative follow-up shows good quality, the excellent and good rate of thefunctional recovery in group A was94%, significantly better than which ingroup B. Using MIAP to fix posterior pelvic ring injuries has manyadvantages, including shorter operation time, smaller length of incision, lessblood loss, strong strength of fixation, low complication rate and no soft tissues irritation caused by improper placement of internal fixation, which ismore effective than using reconstructive plate, provides a new approach forposterior pelvic ring injuries treatment. |
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