| Objective In this paper,the stability and internal fixation stress of single sacroiliac joint screw,sacroiliac joint screw combined with anterior column screw and anterior ring plate separatly were analyzed by finite element method.The clinical effect of minimally invasive treatment of Tilt pelvic fracture was analyzed retrospectively,which provide an alternative treatment options for the Tilt pelvic fractures.Methods Part One: Finite element modeling software was used to build three internal fixation models for treating tilt pelvic fracture,the fracture was fixed with single sacroiliac joint screw(A Group),sacroiliac joint screw combined with anterior column screw(B Group),sacroiliac joint screw combined with anterior ring plate(C Group).Compressive stress tests were applied in each group with 600 N.The maximal stress of the each internal fixation,the stress of fracture site were measured when the fracture was contacted.Part Two: From May 2010 to December 2017,97 Tilt pelvic patients were treated at our department,they were divided into 5 groups.20 patients were received operation with open reduction and internal fixation via ilioinguinal approach,10 males and 10 females.27 patients were operated with percutaneous sacroiliac screw combined with retrograde anterior column screw fixation assisted by navigation,including 15 cases of males,12 cases of females.15 patients were received percutaneous sacroiliac screw combined with anterior ring limited incision reconstruction plate internal fixation assisted by navigation,8 males and 7 females,20 patients were operated with percutaneous sacroiliac screw combined with anterior ring external fixator assisted by navigation,12 cases of males,8 cases of females.15 of them used navigation combined with digital programming.The 5 groups were compared in terms of operation time,blood loss,postoperative complications,reduction quality and the last follow-up Majeed pelvic fractures function score.Part three: Retrospective analysis of 44 cases of Tilt pelvic fractures treated by incision reduction and internal fixation through the ilioinguinal approach from May 2010 to December 2017 at the Wuhan General Hospital of the People's Liberation Army.According to the different treatment methods,it is divided into 2 groups: simple Western medicine treatment group(Group A): 20 cases.10 men and 10 women;Combined treatment group of traditional Chinese and Western medicine(group B): 24 cases,13 cases of male and 11 cases of female.Early postoperative patients in group A were confined to bed to turn over frequently,with multiple movements of toe joint and ankle joint to prevent thrombosis.In the middle stage,lower extremity muscle contraction activity,hip joint main passive flexural exercise and lower extremity straight leg elevation exercise were the main features;Later can be assisted to get out of bed to start standing and walking exercise.The combined treatment group of Chinese and Western medicine was treated with Yunnan Baiyao capsule in the early stage to relieve swelling,relieve pain,and promote blood circulation and blood stasis;In the middle period,it was mainly continuous tendons,and oral grafts were seven centimeters.In the later period,liver and kidney were supplemented,Qi and blood were raised,and Shujin were active.Oral Xianling Gou capsule was taken.The two groups were compared with each other in terms of operation time,intraoperative bleeding amount,post-operative landing time,postoperative complication rate,post-operative fracture reduction,Matta standard score,Majeed function score,and post-operative VAS score.Results Part One: Measuring the fracture line node displacementof these three kinds of internal fixation under the same loading method analysis.Compared the fracture line mean node displacement of posterior pelvic ring,they are all A group< B group<Comparated group,the same with the fracture line mean node displacement of anterior pelvic ring.The maximum stress of internal fixation of three groups of sacroiliac screws occurred at the broken end of sacral fracture(32 kpa)in the control group,which was much less than the yield strength of the screws.the maximum stress of sacroiliac screws in various fracture models was control group > group A > group B.This indicates that anterior ring internal fixation plays an important role in fracture fixation.The maximum stress(5kpa)of the front column screw was significantly lower than that of the front ring steel plate(13kpa)compared with the distribution of the internal fixation stress in the front ring of group A and group B.Standing position simulation,compared with early stay in bed after clinical surgery has a bolder hypothesis,more effectively illustrates the internal fixation of standing position immediate stability.Part Two: The incidence of postoperative complications in group a was significantly higher than that in group C and D,?2=4.27,p < 0.05,indicating that minimally invasive treatment of tilt pelvic fracture reduced the incidence of postoperative complications.Postoperative complications occurred in group B compared with group C and D,?2= 14.81,p<0.05,the difference was statistically significant,indicating that although the anterior ring external fixator is easy to operate,but compared with the anterior ring screw,there will be complications such as nail tract infection,long-term pain of the anterior ring,the anterior ring plate compared with the anterior ring screw will also appear fat liquefaction problems,so navigation under the sacroiliac screw combined with anterior column screw minimally invasive,postoperative complications occurred less.Matta pelvic fracture reduction score excellent rate of five groups compared,p < 0.05,the difference was not statistically significant,indicating that open reduction and internal fixation for the correction of displacement effect is better,but the study selected the object of fracture displacement is not obvious,so navigation under the nail there is no difference between the groups,the excellent rate of reduction are higher.The excellent and good rate of major ed function score in the last follow-up was higher than 0.05(p>0.05).Part Three:Patients in the group of simple Western medicine treatment group(Group A)and the group of Chinese and Western medicine combined treatment group(Group B)have time to go to the field after surgery Group A[(17.05 ± 1.73)weeks] Obviously later than Group B[(14.21 ± 0.25)weeks](T = 7.961,P 0.05).In group A,there were 2 cases with short-term sustained pain,3 cases with deep venous thrombosis,1 with pressure sores,2 with wound infection,and the complication rate was 40 %(8/20).One case of deep venous thrombosis of the lower extremities and two wound infections in Group B were significantly lower than 12.5 %(3/24)of Group A(?2 = 4.219,P 0.05).The last follow-up of Majeed pelvic fracture functional score: A group excellent 15 cases,good 3 cases,can be 2 cases,excellent rate of 90 %;There were 18 excellent cases in Group B,4 good cases,2 cases,and 91.7 %(?2 = 0.654,P > 0.05).The difference of 1 week,4 weeks and 12 weeks of VAS was statistically significant in the two groups(P 0.05).There was no statistically significant difference in VAS after 6 months,9 months and 12 months(P > 0.05).Conclusion There was no significant difference between anterior and posterior fixation in the treatment of tilt pelvic fracture,and both had better biomechanical stability.however,the stress of sacroiliac joint screw combined with retrograde anterior column screw internal fixation device was less,and simply fixing the posterior ring could not stabilize tilt pelvic fracture.Mini-invasive internal fixation assisted by navigation has the advantages of short operation time,less intraoperative bleeding,less postoperative complications,and navigation assisted percutaneous sacroiliac screw internal fixation combined with retrograde anterior column screw internal fixation has more advantages,is a reliable surgical method for the treatment of tilt pelvic fracture,clinical worthy of popularization and application. |
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