| The First Part:Injury characteristics of Tile C3 pelvic fractureObjective:A retrospective study of 136 patients with Tile C type pelvic fractures,analysis the injury characteristics and combined injuries of Tile C3 type pelvic fracturesMethod:The clinical data of 357 patients with pelvic fractures admitted to the Department of Traumatology and Orthopedics of Shandong Provincial Hospital from January 2014 to December 2020 were retrospectively analyzed.Among them,136 cases were Tile C pelvic fractures and met the inclusion criteria in this study.According to the classification of Tile fractures,136 cases of Tile C pelvic fractures were divided into three groups,namely Tile C1 group,Tile C2 group,and Tile C3 group.The gender,age,cause of injury,fracture injury time,pelvic treatment method,hospital stays,combined injury status(Open pelvic fracture,traumatic shock,brain injury,thoracic organ injury,abdominal organ injury,number of limbs and spine fractures,urinary system injury,reproductive system injury,lumbosacral nerve injury,and acetabular fracture)between the Tile C3 group and the Tile C group and between the Tile C1,Tile C2,and Tile C3 groups were analyzed respectively.Result:According to the classification of Tile pelvic fractures,76 were Tile C1 type pelvic fractures,30 cases were Tile C2 type pelvic fractures,and 30 cases were Tile C3 type pelvic fractures.Comparing the Tile C3 group with the Tile C group,there was no statistically significant difference in gender,age,cause of injury,fracture time,treatment method,hospital stays(P>0.05).Among the combined injuries,there was no statistically significant difference among open pelvic fractures,craniocerebral injuries,abdominal organ injuries,reproductive system injuries and acetabular fractures(P>0.05);combined traumatic shock,thoracic organ injuries,number of limbs and spine fractures,urinary system injury and lumbosacral nerve injury,the difference was statistically significant(P<0.05).There were no statistically significant differences among the Tile C1 group,Tile C2 group and Tile C3 group in gender,age,cause of injury,fracture time,and treatment options(P<0.05).Further comparison between the groups,the difference is still no statistical significance(P>0.05).The hospital stays of the three groups of patients gradually increased with the severity of pelvic fracture injuries,and the difference was statistically significant(P<0.05).Further comparison between the groups,the difference between the Tile C1 group and the Tile C3 group was statistically significant(P<0.05).Comparison of combined injuries:There was no significant difference between the three groups of patients with open pelvic fracture,craniocerebral injury,abdominal organ injury,and acetabular fracture(P>0.05),and further comparison between the groups,the difference was still not statistically significant(P>0.05):Comparing with traumatic shock,the difference is statistically significant(P<0.05),and further comparing between groups,the difference is statistically significant(P<0.05);Complicating thoracic organ injury,number of limbs and spine fractures,reproductive system damage,and lumbosacral nerve damage were compared with statistical significance(P<0.05).Further comparison between the groups,there was a statistically significant difference between the Tile C1 group and the Tile C3 group,the Tile C2 group and the Tile C3 group(P<0.05);Comparing the combined urinary system injury,the difference was statistically significant(P<0.05).For further comparison between the groups,the difference between the Tile C1 group and the Tile C2 group,the Tile C1 group and the Tile C3 group was statistically significant(P<0.05)Conclusion:Tile C3 pelvic fracture is the most severe type of pelvic fracture,combined with serious injuries.Compared with Tile C1 and Tile C2 pelvic fractures,patients with Tile C3 pelvic fractures have longer hospital stays and a higher incidence of combined injuries,especially in combined traumatic shock,thoracic organ injuries,urinary system injuries,limb and spine fractures injury and lumbosacral nerve injury.Once clinically diagnosed as a Tile C3 pelvic fracture,we must pay attention to its combined injury for treatment,so as to save the patient’s life and promote the patient’s prognosis.The Second Part:Treatment options for TileC3 pelvic fracturesObjective:The clinical data of 30 patients with Tile C3 pelvic fractures were retrospectively analyzed,and the emergency treatment methods,treatment options and curative effects of the patients were analyzed.Method:A retrospective analysis of the clinical data of 30 Tile C3 pelvic fracture patients admitted to the Department of Traumatology and Orthopedics of Shandong Provincial Hospital from January 2014 to December 2020,and all meet the inclusion criteria in this study.There were 20 males and 10 females,aged from 14 to 61 years old,with an average age of(35.6±12.6)years;13 cases of traffic accident injuries,9 cases of fall injuries,5 cases of heavy object injuries,and 3 cases of crush injuries;ISS score 25～59 points,with an average of(41.7±10.0)points;observe the treatment options for patients with Tile C3 pelvic fractures of different classifications,and record the operation time,intraoperative blood loss,fracture healing time and postoperative complications.At the last follow-up,the visual analogue scale(VAS)was used to evaluate the improvement of the pain;the pelvic fracture Matta score was used to evaluate the quality of fracture reduction;the pelvic Majeed function score was used to evaluate the functional recovery.Result:All patients were successfully treated,and none of them died.3 cases underwent hemiplegia,the operation time was(103.3±12.5)min,and the intraoperative blood loss was(6666.6±1388.9)ml.7 cases used external fixator to fix the pelvis as the final treatment.20 cases were treated with surgical incision and internal fixation.The operation time was 150-600 minutes,with an average of(321.5±127.3)minutes,and the intraoperative blood loss was 500-3000 ml,with an average of(1705.0±813.5)ml.All patients were followed up for 6 to 60 months,with an average of 35.4±17.8 months.10 patients who did not undergo open reduction treatment had a postoperative VAS score(4.3±1.3).According to the Matta pelvic fracture reduction standard evaluation at the last follow-up:0 cases were excellent,5 cases were good,3 cases were fair,and 2 case was poor.The excellent and good rate was 50%.Majeed functional score at the last follow-up:0 cases were excellent,3 cases were good,5 cases were fair,and 2 cases were poor.The excellent and good rate was 30%.In 20 patients who underwent open reduction,the postoperative VAS score was(1.8±0.8).According to Matta’s pelvic fracture reduction standard evaluation at the last follow-up,11 cases were excellent,6 cases were good,3 cases were fair.The excellent and good rate was 85%.Majeed functional score at the last follow-up:9 cases were excellent,7 cases were good,4 cases were fair.The excellent and good rate was 80%.5 patients developed venous thrombosis of the lower extremities after the operation,and the anticoagulation treatment showed good results.The internal fixation was exposed in 2 cases one year after the operation,and the wounds healed well after the internal fixation was taken out.Conclusion:Tile C3 pelvic fractures have extremely poor stability,combined with serious injuries,and complex and diverse conditions.Sufficient understanding should be given clinically,and its treatment is a severe challenge for clinicians.Organizing a multidisciplinary treatment system with trauma and orthopedics as the core can effectively improve the treatment rate of patients and save patients’lives.Surgical treatment is currently the most effective treatment plan,helping to relieve pain,promote fracture healing and restore pelvic function.For different fracture classifications,a suitable and firm internal fixation should be selected on the basis of the principle of joint fixation of the pelvic anterior and posterior ring,which is essential to restore the biomechanical stability of the pelvis. |
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