Anatomical Study Of Ilium Nail Imagery And Clinical Application With Improved TIFI Technique

Purposes:To discuss the technical points and technical advantages of the improved TIFI technique in the repair of completely unstable posterior pelvic ring fractures.Methods:1.Twenty patients(10 males and 10 females)with pelvic 3D reconstruction in the CT room of our hospital were selected,aged 20-65 years,with an average age of 3 8 years.The inclusion criteria were:mature bones without deformities,tumors,fractures,etc.Randomly selected imaging data of unilateral iliac bones for study;2.Performed surgical treatment at Yanbian University Affiliated Hospital from March 2015 to July 2017 Clinical data of 17 patients with completely unstable pelvic posterior ring fracture treated with modified TIFI were retrospectively analyzed.Age 25-57 years old(mean 42 years old);Causes of injury:10 cases of car accident injuries,4 cases of fall injuries at high altitudes,2 cases of fistula pressure injuries,and 1 case of other injuries.According to the CT and X-ray,examination,and secondary confirmation during the operation,the AO/OTA classification criteria for pelvic fractures were C1.2 type 9 cases,C1.3 type 2 cases,C2.2 type 4 cases,C2.3 2 cases);17 patients were combined with multiple injuries(16 cases of limb fractures,4 cases of traumatic brain injury,9 cases of thoracic trauma,4 cases of bladder rupture,2 cases of radial nerve injury,6 cases were admitted to the hospital in a state of shock.Seventeen patients were divided into two groups in the direction of the track,group A(12 cases)underwent modified TIFI technique to fix the posterior pelvic ring,and group B(5 cases)underwent conventional TIFI technique to fix the posterior pelvic ring.The following aspects were evaluated and analyzed:1.The amount of bleeding after fixation,the time of surgery,the number of intraoperative C-arm irradiations,and the length of the inserted screws;2.Postoperative X-rays on the posterior ring of the pelvis AP,40° entrance,40° exit The maximum displacement that can be measured and Matta grading assessment;3.The patient's Majeed functional score at the 6th month after follow-up.Results:1.The length of the nail path in the traditional TIFI technology nail placement region was 63.6±3.6 mm for males and 55.9±4.0 mm for females;the diameter of nail lanes was 10.2±0.7 mm for males and 9.7±0.8 mm for females.The length of the nail path of the modified TIFI technique in the nail setting region was 110.2±6.9 mm for males and 97.6±4.6 mm for females;the diameter of nail lanes was 7.5±10.3 mm for males and 7.3±0.5 mm for females.The optional area of the modified nail tread plane of the TIFI technique is a fan-shaped area in the 0 to 300° direction of the anterior inferior spine of the hemipelvis at the tangential line of the entry point and the ischial tangent line in the plane of the tibial plate.2.In clinical treatment,none of the 17 patients had intraoperative nerve and vascular injuries,incision infections,displacement and rupture of internal fixations.Group A:intraoperative blood loss 57.9±10.3ml,operation time 52.1±16.3min,C-arm irradiation frequency 21.1±5.9,screw length 67.9±3.3mm;Postoperative Matta score:excellent in 8 cases,good in 3 cases,In 1 case,the difference was 0 and the excellent rate was 92%.Postoperative Majeed score was excellent in 7 cases,good in 3 cases,fair in 2 cases,poor in 0 cases,and the excellent and good rate was 83.3%.Group B:intraoperative blood loss 52.0±5.7ml,operation time 56.0±15.6min,C-arm irradiation frequency 26.6±9.3,screw length 51.0±4.2mm;Postoperative Matta score:excellent in 3 cases,good in 2 cases,In 0 cases,the difference was 0 cases,and the excellent rate was 100%.Majeed score was excellent in 3 cases,good in 1 case,fair in 1 case,poor in 0 case,and the excellent and good rate was 80.0%.Conclusion:1.The TIFI technique is recommended for the placement of the tibial screw with the insertion point of the tibial plate outer plane and the anterior spine of the ischial large incision tangential hemiplegia at 150 2.In the treatment of posterior pelvic ring injuries,the improved TIFI technique can avoid the risk of neurological and vascular injury by avoiding large ischial notches compared to conventional TIFI techniques,while allowing the use of longer screws.There was no statistically significant difference in the amount of intraoperative blood loss,the time of surgery,and the number of X-ray irradiation between the two groups,and there was a statistically significant difference in screw length.