| Background:With the economic development of our country, transportation and the construction industry accident of high energy violence has been increasing the occurrence of pelvic fractures. As usual, such as traction,pelvic suspension and other non surgical treatment of pelvic fractures,due to poor reduction and fixation, unable to restore the mechanical properties of the pelvis, the treatment effect is poor. Since the 1980 s,along with the progress of fracture treatment concept and surgical technique, that the unstable pelvic fractures should be surgical treatment has been widely recognized by the Department of orthopedics. The pelvic ring can be divided into the anterior and posterior ring of pelvis by acetabulum. Anterior pelvic ring is composed of bilateral pubic,ischial ramus and the pubic symphysis,which is far worse than the posterior pelvic ring in physiology stability.When violence acts on the pelvis, usually injury of the anterior pelvic ring happens prior to the posterior ring. The common fixation methods include external fixation, closed reduction or navigation percutaneous cannulated screw fixation and open reduction with internal fixation(Pfannenstiel approach, the Ilioinguinal approach, modified Stoppa approach).Perspective or navigation assisted reduction have a relativly high requires in the equipment and technical relatively; open reduction and internal fixation such as Pfannenstiel incision, ilioinguinal approach, modified Stoppa approach, either expose a limited area of surgery, or damage too much. How to be safe, effective, and minimally invasive treatment of unstable anterior pelvic ring fracture has become a problem in the orthopedics of trauma.Objective:Describe the subcutaneous approach and the ilioinguinal approach combined with MIPO techniques in the treatment of anterior pelvic ring fractures, compare the effectiveness of two methods for anterior pelvic ring fracture treatment, and provide new research ideas and directions.Method:A retrospective study of 29 cases of pelvic anterior ring fracture treated by minimally invasive surgery was conducted, the Second Affiliated Hospital of Jilin University from September 2013 to September2015. Male patients, 20 cases, female 9 cases. Age 25-63 years of age, the average age of 40 years of age. According to Tile pelvic fracture classification method: A2 type 2 cases, type B1 2 cases,type B2 7 cases,type B3 11 cases, C 7 cases. According to the operation method, the patients is divided into A, B groups, in which 17 cases of A group received a subcutaneous approach combined with MIPO technology, B group of 12 cases of patients with the ilioinguinal approach combined with MIPO internal fixation surgery. All patients were followed up to collect data and received further guide to the treatment and rehabilitation of patients.Result:Group A: operation incision length was 7-15 cm, 10.8 ± 2.4cm;operation time 26-78 min, 42.7 ± 9.2min; intraoperative blood loss60-150 ml, 94.1±24ml. According to the standard, Matta reduction score:excellent in 13 cases, good in 4 cases, general in 0 cases, poor in 0 cases,Majeed rehabilitation function score, excellent in 12 cases, good in 4,general in 0, and poor in 1. All patients did not have serious complications, 1 case of screw loosening, removed after bone union.In group B, the incision length was 7-15 cm, 10.8±2.4cm, operation time 27-55 min, 40.1±6.8min, bleeding amount 140-550 ml,239.17±51ml. According to the standard, Matta reduction score: excellent in 10 cases, good in 2 cases, general in 0 cases, poor in 0 cases, Majeed rehabilitation function score, excellent in 8 cases, good in 3 cases, general in 1 cases, and poor in 0 cases. All patients were not found severe complications, 1 case of fat liquefaction, after dressing the wound also reached 1 healing, 2cases of abnoemal sound and vanished after removal of interal fixator..Parametric data, such as operative time, fluoroscopic time, and blood loss, were described as mean SEM and compared using Student t tests.Proportional values were compared using χ 2 analysis or Fisher exact test where applicable. For each test,a P value <0.05 was defined as significant.Conclusion:1. Subcutaneous Approach and the Ilioinguinal Approach with Minimally Invasive Plating Osteosysthesis technique are good mathod in anterior pelvic fracture treatment.2.There was no significant difference in operation time, reduction effect and functional outcome between two groups, the amount of bleeding was significantly less in A team than that in B team;... |
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