| Background:Vertical shear pelvic fracture is the most serious type of pelvic fracture in the Young-Burgess classification.The treatment of vertical shear pelvic fractures is a challenge in the field of trauma and orthopedics due to the deep fracture location,irregular peripheral bone structure,peripheral vascular and nerve intensification and fracture biplanar displacement.For patients with lumbosacral plexus injury,most scholars recommend the use of a posterior surgical approach to expose and reduce the fracture,and to use iliac lumbar fixation or triangular fixation to maintain stability.However,the posterior fixation method is difficult to correct the rotation and displacement of the pelvis,affect the structural integrity and mobility of lumbar spine and cannot be effectively decompressed and released the nerve entrapment caused by frontal compression.At the same time,this type of fracture has vertical and rotational instability,so heavy traction,continuous maintenance of the reduction,and multiple fluoroscopy to confirm the quality of the reduction are required during reduction.Therefore,in order to solve the problems above,we applied the lateral-rectus approach(LRA)to the treatment of vertical shear pelvic fractures with lumbosacral plexus injury and the treatment of fresh vertical shear pelvic fractures combined with external pelvic frame reduction system based on the anatomical characteristics of pelvic.Finally,both of them achieved good results in clinical applications.Purpose:This study aims to investigate the clinical efficacy of lateral-rectus approach for vertical shear fracture of pelvis combined with lumbosacral plexus nerve injury and the clinical efficacy of the combination of LRA and the external pelvic frame reduction system in the treatment of fresh vertical shear pelvic fractures.Methods:1.From August 2010 and August 2018,data of 37 cases with vertical shear pelvic fractures combined with lumbosacral plexus nerve injury treated by lateral-rectus approach were retrospectively analyzed.The perioperative data were collected,and the neurological recovery was evaluated by the criteria proposed by the Nerve Injuries Committee of the British medical research council(BMRC).2.From September 2017 to December 2018,data of 13 cases with vertical shear pelvic fractures treated by lateral-rectus approach combined with external pelvic frame reduction system were retrospectively analyzed.The perioperative data were collected,and the clinical function was evaluated by the Majeed functional scoring criteria.Results:1.The mean operation time of 37 patients was 155.0 min,the mean blood loss was 1070 ml,and the mean healing time was 10.1 weeks.According to the criteria proposed by BMRC,the neurological recovery was evaluated:22 cases had complete recovery,12 cases had partial recovery,and 3 cases had not recovered at the last follow-up.2.The average operation time of the 13 patients was 117.7 min,the average blood loss was 254.6 ml,and the average healing time was 10 weeks.At the last follow-up,according to the Majeed functional scoring criteria,the results were excellent in 11 patients and good in 2 patients.Conclusions:LRA is an ideal surgical approach for treatment of pelvic vertical shear fractures complicated with lumbosacral plexus nerve injury,because it can well expose the medial pelvic joint from the sacroiliac joint to the symphysis pubis,allow direct release of the lumbosacral plexus nerve compressed and stretched,and,together with traction of the lower limbs,lead to satisfactory fracture reduction.Furthermore,in the treatment of fresh vertical shear pelvic fractures,LRA combined with optional pelvic reduction frame assisted reduction in the treatment of vertical shear pelvic fractures can improve the quality of fracture reduction and more accurate and safer placement of internal fixation,and reduce the frequency and dose of radiation exposure of patients and surgeons,thus shorten the operation time,reduce the amount of bleeding,and improve the efficacy of the operation. |
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