Application Of Anterior And Posterior Annulus Combined With Internal Fixation In The Treatment Of APC-2 Pelvic Fracture

Objective: APC-2 pelvic fracture may involve some damage of posterior pelvic ring,often leading to sacroiliac ligament injury.In clinical treatment,if the stability of pelvic ring is insufficient,it often leads to many complications after operation and affects the healing of patients.At present,the clinical treatment of APC-2 pelvic fracture methods are: 1.external fixator treatment.2.External fixator combined with posterior ring internal fixation.3.Treatment of anterior ring porous pubic joint plate.4.Treatment of anterior ring porous pubic plate combined with posterior ring sacroiliac plate.5.Treatment of anterior ring porous pubic plate combined with posterior ring percutaneous closed intradermal nail.Among them,anterior ring porous pubic union dismissal plate combined with anterior ring porous pubic union plate combined with posterior ring percutaneous closed intradermal nail is currently a better clinical effect and more controversial two surgical methods.This paper retrospectively analyzed two groups of patients treated by anterior ring porous pubic union dismissal plate and anterior ring porous pubic union plate combined with posterior ring percutaneous closed intradermal nail.The advantages and disadvantages of the two groups were compared,and the clinical experience was summarized.The purpose of this study was to investigate the effect of combined pelvic anterior ring and pubic fixation plus posterior pelvic ring fixation on the treatment of APC-2 pelvic fractures.Methods: Thirty-one patients with APC-2 unstable pelvic fractures admitted to our hospital from September 2016 to September 2018 were retrospectively analyzed.Among them,24 were males,aged 20-65 years,with an average age of(41 + 9.9)years.According to Tile classification,23 cases were type B2 and 8 cases were type B3.18 patients received anterior pubic symphysis fixation combined with posterior ring percutaneous sacroiliac screw fixation(anterior and posterior ring combined with internal fixation group),13 patients received simple anterior ring fixation(anterior ring internal fixation group).The failure of internal fixation,Majeed pelvic function score and visual analogue score were analyzed according to the operation time,intraoperative bleeding volume,fracture healing time,post-operative X-ray and CT observation of screw loosening.Through the analysis of the results,the advantages and disadvantages of the two surgical methods were compared.Results: All 31 patients were followed up for 6 to 24 months,with an average of 12 months.There was no significant difference in blood volume between the two groups(P > 0.05).The operation time of anterior ring fixation group was shorter than that of anterior and posterior ring fixation group(P < 0.05).Among the patients with simple anterior ring internal fixation,there were 5 cases of screw loosening,2 cases of re-internal fixation,1 case of anterior ring internal fixation combined with posterior ring internal fixation,and 0 cases of re-internal fixation.Postoperative Majeed score and VAS score in the combined anterior and posterior ring fixation group were better than those in the anterior ring fixation group(P < 0.05).Conclusion: Under the existing medical technology conditions,anterior ring internal fixation and anterior and posterior ring combined internal fixation for the treatment of APC-2 pelvic fractures can have sufficient stability in the early stage,but in the healing process after surgery,anterior ring internal fixation combined with posterior ring internal fixation can achieve better results.In conclusion,the anterior ring combined with posterior ring internal fixation surgery for APC-2 pelvic fractures has the advantages of better stability,fewer complications,less pain and better curative effect than the simple anterior ring internal fixation surgery.It can effectively treat APC-2 pelvic fracture.