Research And Development Of Minimally Invasive Reduction System For Pelvic Fracture And Its Preliminary Application

Background:The traditional treatment of pelvic fractures,open reduction and internal fixation,although it can directly look at the area of injury,is beneficial to anatomic reduction.However,because of the deep position of the posterior pelvic ring,the operative approach needs large incision and extensive soft tissue dissection.Therefore,the important problems of vascular and nerve injury and wound infection are increasing.Subsequent surgical treatment is also very difficult.Pelvic fracture closed reduction and minimally invasive screw technology can avoid intraoperative or postoperative complications caused by open reduction.It has become the development direction of pelvic fracture for doctors in Department of orthopedics.The advantages of minimally invasive treatment,such as small incision,small injury,less blood loss and rapid recovery after operation,have gradually become one of the important choices in the treatment.But for minimally invasive treatment,the reduction of pelvic fractures is a prerequisite for minimally invasive treatment,and it is difficult to achieve an ideal minimally invasive reduction.The traditional closed reduction process is entirely dependent on the manipulation of the surgeon,and has high technical requirements for the surgeons.The whole process needs to be monitored under intraoperative X-ray,and the radiation exposure to medical staff is too large.In addition,the disadvantages of traditional closed reduction are as follows:(1)after continuous lower limb traction,it is necessary to maintain position by manipulative reduction.Secondly,when internal fixation is performed,the reduction position is easy to lose.(4)due to the human error of the doctor,it causes the error of the reset judgment,resulting in the implants of the built-in objects and the irreparable iatrogenic injury to the patients.A successful closed reduction depends on an accurate preoperative assessment of the fracture.Accurate description and analysis of the spatial displacement of pelvic fractures is an important part of preoperative evaluation,laying the foundation for developing appropriate treatment strategies and clear restoration paths.The traditional classification of pelvic fractures is based on the empirical analysis of doctors' image data.The existing classification system only provides partial information about pelvic fractures,and lacks the displacement details of the pelvic specific plane.With the development of modern medical treatment and the deepening understanding of pelvic fractures,the existing typing has been unable to fully meet the needs of clinical and scientific research,and it is more difficult to directly apply to preoperative planning for closed reduction of precise pelvic fractures.Object(1)The intervention measures of hemodynamic unstable pelvic fractures were discussed by meta analysis.(2)To establish pelvic displacement measurement based on pelvic plain film,and to explore its reliability and validity,in order to provide more detailed and detailed shift information for guiding pelvic fracture closed reduction.(3)Based on the above pelvic displacement measurement method based on pelvic plain film,we develop pelvic displacement calculation system,and discuss its reliability and validity,and ultimately provide a simple and easy measuring tool for pelvic displacement analysis.Methods1)According to the requirements of systematic reviews,the detailed inclusion and exclusion criteria should be formulated,and the database was retrieved.The RevMan provided by Cochrane collaboration network was used to analyze meta by fixed effect model and random effect model.Heterogeneity was tested on the heterogeneity of each study.(2)By decomposing the pelvic displacement,and establishing the Cartesian coordinate system based on the pelvis in the three-dimensional space,we choose the mark points,so as to set up the pelvis displacement measurement method based on pelvis plain film.Then a retrospective case-control study was conducted to observe the consistency of the pelvic displacement measurement in the interobserver,and the consistency with CT and 3D reconstruction.A prospective randomized controlled trial was used to determine the effectiveness of the pelvic displacement measurement in clinical application.(3)Based on the method of pelvic displacement measurement,the pelvic displacement calculation system is developed under the C#environment,and the preliminary clinical application is carried out.In this study,a retrospective case-control study was conducted to observe the inter observer consistency(reliability)and the consistency with the gold standard of pelvic displacement calculation system.Results(1)For patients with hemodynamic instability,pelvic cavity packing is recommended as a priority.If there is still hypotension,embolization is necessary.According to the results of this study,the scheme can significantly reduce mortality in acute and non controlled pelvic hemorrhage,and does not increase the incidence of infection.(2)This study showed that pelvic radiographs of pelvic displacement measurement method based on displacement analysis is not only a simple and effective method of pelvic fracture,the analysis of the results of the reliability analysis approach of pelvic 3D reconstruction of CT images,in the course of clinical application of the guidance of unstable pelvic fracture with closed reduction also proved its clinical effectiveness in the environment,the lack of CT equipment in remote areas or in operation,has important clinical significance.(3)The software is a pelvis displacement calculation system based on DICOM format for pelvis plain film(entry,exit and positive slice).It can measure the specific displacement mode of pelvis in a semi-automatic way.The reliability and validity of the software were preliminarily explored.It is found that the software is close to CT and its 3D reconstruction in reliability.Compared with the gold standard,the software is very effective(Kappa=0.939,95%confidence interval:0.905-0.973).And the learning time is short,and it is more suitable for young surgeons with limited pelvic fracture experience.ConclusionThe relevant design and results of this study can effectively improve the doctors'understanding of the minimally invasive internal fixation techniques for pelvic fracture reduction.The associated minimally invasive treatment of pelvic fractures is simpler,safer,easier to master,and a satisfactory effect.