Clinical Effect Of Surgical Treatment For Unstable Pediatric Pelvic Fracture

BackgroundAs child's pelvis has more cartilage and thicker periosteum,and it has more elasticity and ductility,so it can absorb more violent energy without fracture.Therefore,pelvic fracture in children is relatively rare,and its treatment method is also controversial.The traditional view is that children's skeletal system is not yet mature and has good remodeling ability.The conservative treatment of pelvic fractures in most children can achieve good results.However,recent studies have shown that conservative treatment of pelvic fractures in children will bring lumbosacral pain,claudication,scoliosis and other complications,which will seriously affect the quality of life of children.Therefore,some scholars believe that the unstable pelvic fractures in children caused by high-energy injury should be reduced and fixed by surgery.However,so far,there are still few studies on the surgical treatment of pelvic fractures in childrenPurposeThe purpose of this study was to analyze and evaluate the clinical effect of surgical treatment of unstable pelvic fractures in toddlers.To investigate the clinical effect of lateral-rectus approach in unstable pelvic fractures in school-age childrenMethods1.A retrospective analysis of clinical data of 9 unstable pelvic fractures in toddlers undergoing surgical treatment in our hospital from June 2012 to December 2018.By collecting patients' medical records,the basic personal information,operation time,intraoperative blood loss and postoperative complications of the patients were summarized and analyzed.Mears-Velyvis evaluation criterion and pelvic asymmetry were used to evaluate the reduction quality of fractures Functional outcome was evaluated at the last follow-up.And the clinical function was assessed according to the Cole's grading scale.2.A retrospective analysis of clinical data of 5 unstable pelvic fractures in school-age children undergoing surgical treatment in our hospital from January 2018 and September 2019.The operation time,intraoperative blood loss and postoperative complications of the patients were collected,and the reduction quality of fractures was evaluated by Mears-Velyvis evaluation criterion and pelvic asymmetry,and the clinical function was assessed according to the Cole's grading scale.Results1.9 cases of unstable pelvic fractures in toddlers were treated by surgery,with an average operation time of 260 min.The mean intraoperative blood loss was 261 ml,According to Mears-Velyvis evaluation criterion,7 patients were satisfactory reduction,and 2 patients were unsatisfactory reduction,with a satisfaction rate of 78%.The mean pelvic asymmetry:7.1±5.6mm before surgery,3.9±1.3mm after surgery,and 4.0±1.4mm at the last follow-up.The deformity index of the pelvis:0.050±0.037 before surgery,0.032±0.013 after surgery,and 0.029±0.010 at the last follow-up.In the last follow-up,the clinical efficacy was excellent in 5 cases,good in 2 cases,fair in 1 case and poor in 1 case,with the overall excellent and good rate was 78%.Postoperative complications recorded included:1 case with internal fixation loosening,bilateral lower extremities discrepancy,walking with mild claudication;1 case of fracture displacement,pelvic malunion;The epiphysis injury of the iliac wing resulted in asymmetric bilateral iliac wing development in 4 children,but did not affect walking.2.5 cases of unstable pelvic fractures in school-age children were treated by lateral-rectus approach,with an average operation time of 191 min.The mean intraoperative blood loss was 680 ml.Fracture reduction quality:1 case of anatomical reduction,4 cases of satisfactory reduction,with a satisfaction rate of 100%.The mean pelvic asymmetry:12.2±3.6mm before surgery,4.0±1.3mm after surgery,and 4.2±1.6mm at the last follow-up.The deformity index of the pelvis:0.056±0.016 before surgery,0.018±0.006 after surgery,and 0.019±0.008 at the last follow-up.In the last follow-up,the clinical efficacy was excellent in 2 cases,good in 2 case and fair in 1 case,with the overall excellent and good rate was 80%.Only 1 child had mild claudication,and there were no other complications such as lumbosacral pain,scoliosis and pelvic malunion.ConclusionsThe incidence of unstable pelvic fractures in children is increasing gradually,and timely intervention by appropriate surgical methods can achieve satisfactory early effect.The lateral-rectus approach has a small trauma and a large exposure range,which can be used as an option for the management of such injuries,but its long-term effect still needs further study.