| BackgroundThe treatment of pelvic fractures is challenging in trauma orthopedics.Most scholars have only studied the treatment of posterior pelvic ring injuries in the past.With the improvement of biomechanical experiments and the development of digital orthopedics,the importance of the anterior ring has been further verified,and the anatomical reduction and rigid fixation of anterior pelvic ring injury have attracted increasing attention.Traditional methods for treating anterior pelvic ring injury include external fixation frame fixation,pedicle rod system subcutaneous internal fixation,percutaneous lag screw fixation,and plates and screws fixation,of which the clinical efficacy remains controversial.PurposesThis project aims to design a Pubic Symphysis Orthotic Compression Anatomic Plate(PSOCAP)with biplane-assisted reduction and fixation,verify its biomechanical properties,explore its usage in treating diastasis or fractures around pubic symphysis,analyze its clinical efficacy,and eventually provide a more efficient and safer internal fixation for the treatment of anterior pelvic ring injury.MethodsDesign the PSOCAP with digital orthopedic technology.Established the intact pelvic model and verify its validity via finite element analysis.On this basis,the pelvic model of pubic symphysis diastasis is established.Combine it separately with PSOCAP,traditional retropubic reconstructive plate,medial pubic symphysis reconstructive plate,pubic symphysis double plates,and suprapubic lag screws.Analyze the oriental relative displacement,total displacement,and stress distribution of each group.Verify the fixation effectiveness and safety performance of PSOCAP.From January 2021 to June 2022,the cases of 16 patients with fracture and dislocation around the pubic symphysis treated with PSOCAPs via modified STOPPA approach were retrospectively analyzed.The operation time,intraoperative blood loss and postoperative complications were recorded.The quality of fracture reduction was evaluated according to the Matta standard,and the postoperative functional recovery was evaluated by the Majeed scoring system.ResultThe max displacement of the intact pelvic model is 4.122mm,the max stress is 23.207MPa.The modeling method,displacement,stress distribution and results are similar to other studies,and the model is verified.The max stress of the PSOCAP group is 587.250MPa,and the displacement of the X-axis,Y-axis,Z-axis oriental displacement and total displacement are 0.04444±0.01538mm,0.02930±0.02701mm,0.07639±0.02489mm and 0.09794±0.02445.According to the Kruskal-Wallis test,the mean displacement of each axis and total displacement in the PSOCAP group are smaller than that of medial pubic symphysis reconstructive plate group and the lag screw group(P<0.05).The mean values of the X-axis,Y-axis oriental displacement and the total displacement are smaller than that of retropubic reconstructive plate group(P<0.05).However,there is no significant difference of the data between the PSOCAP group and the double plates group,and the mean Z-axis oriental displacement is not significantly different from retropubic reconstructive plate group(P>0.05).The operation time of 16 patients ranged from 40 to 90min(58±15min)and the intraoperative blood loss was from 50 to 250mL(median 85 mL).According to Matta score,10 cases of fracture reduction were evaluated as excellent,3 were good and 3 were fair.All 16 patients were followed up for 6 to 18 months(10±3 months),and the fractures healed completely.At the last follow-up,Majeed score results were evaluated as excellent in 5 cases,good in 7 cases,and fair in 4 cases.No such postoperative complications as fracture displacement or internal fixation failure occurred.ConclusionPSOCAP has a safe and reliable function of biplane fixing,which can improve anatomical reduction rate and achieve strong internal fixation.PSOCAP combined with modified STOPPA approach for the treatment of fractures or dislocation around pubic symphysis has good clinical efficacy. |
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