A Comparative Study of the Treatment of Posterior Pelvic Ring Fracture Dislocation:Posterior Tensile Plates Fixation and Percutaneous Sacroiliac Lag Screw Fixation
|Keywords||pelvic fracture internal fixation treatment outcomes|
Background and purpose:The incidence of pelvic fractures is next to limbs and spine fractures,but the incidence of hemorrhagic shock is about40%higher than that of the latters, complications are more common,and the mortality rate is much higher,1.4times than that of non-pelvic fractures.As pelvic fracture can seriously endanger patients’ functions in late,Clinicians pay more and more attention to the treatment of them now,with the gradual popularization of the concept of orthopedic damage control in the clinical,the survival rate of severe pelvic fractures is significantly higher,it provide the necessary conditions for dealing with pelvic fractures effectively in later.The posterior pelvic ring is an important support structure in carrying or weight-bearing, it carry70%of the whole weight in the pelvic,while the anterior pelvic ring account for30%.Unstable posterior pelvic ring fracture is usually associated with the anterior pelvic ring injury,but the stability of the posterior ring is much more important.Over the years,the traditional surgical methods have shortcomings,such as maximize the trauma,increased postoperative complications,it makes great challenges for the clinical treatments of fractures,so it becomes the focus in this field of research to explore a minimal invasive and reliable internal fixation for the posterior ring fractures.Sacroiliac screw and posterior tensile plate are two common approaches to the treatment of posterior pelvic ring fractures.Matta[31.contrived the sacroiliac screw technology in the1980s, it fixes the ilium to the sacrum by lag screws which go through the sacroiliac joint.Schlider designed a horizontal sacrum fixture(TFD),it treats the posterior pelvic ring fractures by fix reconstruction plate across the sacrum to the rear of spina iliaca.There were45cases of clinical datas of posterior pelvic ring fractures which were treated with posterior tensile plate or sacroiliac screw fixation from October2005to December2011in our hospital,and analyzed retrospectively to compare the clinical outcomes of the treatment of posterior pelvic ring fracture dislocations with posterior minimally invasive tensile plate fixation and percutaneous sacroiliac lag screw fixation,and to evaluate their safety and practicality.Methods:1、ObjectsFrom October2005to December2011,there were45patients with unstable pelvic fractures,22of them were treated with percutaneous sacroiliac lag screw fixation, and the other23patients were underwent minimally invasive tensile plate fixation,and the perioperative parameters and postoperative rehabilitation indicators were compared.2、Observation indexSurgery-related indicators:operation time, amount of bleeding,length of incision. Postoperative rehabilitation indicators: degree of postoperative pain,postoperative hospital stay,postoperative complications, postoperative outcomes assessment. 3、Basis for comparison of treatment and clinical outcomes evaluation.According to Matta and Tornetta’s criteria,defined the separation of posterior pelvic ring lese than or equal to4mm as excellent,4-10mm as good,11-20mm as fair,>20mm as poor.The clinical outcomes evaluation:according to Majeed criteria,evaluate the recovery of patient’s pain,standing,sitting,sex life and work,grade85-100as excellent,70-84as good,55-69as fair,<55as poor.4、Statistical analysisSPASS12software was used for data processing after the datas were collected.Compare the operation time, amount of bleeding,length of incision,degree of postoperative pain,postoperative hospital stay,postoperative complications of the two groups with T-test.Compare their differences of rate and postoperative outcomes evaluation with Chi-square test.it was considered statistically significant difference if p-value was less than0.05.Results:There were45patients with unstable posterior pelvic fractures who were treated in our hospital from October2005to December2011.All of the patients were followed up for6-20months,means12months. There were12males and11females with an average age of39years (range25-61years) in tensile plate group,and13males and9females with an average age of42years (range21-63years) in sacroiliac screw group.There were comparability in operation time, amount of bleeding,length of incision,degree of postoperative pain,postoperative hospital stay,postoperative complications between plate group and sacroiliac screw group. Operation time:102-165min in tensile plate group,means131.9±21.6min,and62-101min in sacroiliac screw group,means92.3±12.1min.Amount of bleeding:240-563ml in tensile plate group,means405.4±140.1ml,and12-38ml in sacroiliac screw group,means25.0±10.8ml(p<0.05).Degree of postoperative pain:middle in tensile plate group,gentle in sacroiliac screw group.Hospital stay:15-21d in tensile plate group,means18.7±2.5d,and5-11d in sacroiliac screw group,means8.5±1.2d(p<0.05).There were statistically differences in operation time, amount of bleeding,length of incision,degree of postoperative pain,postoperative hospital stay between plate group and sacroiliac screw group.There was no statistically difference in postoperative complications between them,there was1case of pulmonary infection(4.35%) and1case of incisional infection(4.35%) in tensile plate group;1case of pulmonary infection(4.55%) in sacroiliac screw group,no incisional infection happened.There were no nails bent or broken or other complications in the two groups.Compares of postoperative X-ray evaluation,reset effects and functions recovery:there were17(73.9%)excellent,5(21.7%)good,1(4.3%)fair,0(0)poor in tensile plate group,15(68.2%)excellent,5(22.7%)good,2(9.1%)fair,0(0)poor in sacroiliac screw group with Matta and Tornetta criteria.there were15(65.2%)excellent,6(26.1%)good,2(8.7%)fair,0(0)poor in tensile plate group,13(59.1%)excellent,8(36.4%)good,1(4.5%)fair,0(0)poor in sacroiliac screw group with Majeed criteria.There was no statistically difference(According to the Yates chi-square test correction method X2=0.0016,p=0.9682,p>0.05).Conclusion:Percutaneous sacroiliac lag screw fixation,with the advantages of positioning accuracy,minimal truama,less bleeding,less pain and faster recovery etc, is an ideal method of minimally invasive surgery for the treatment of posterior pelvic ring fracture.but it needs a long surgical learning curve and a higher technical requirements for the surgeon.The learning curve of posterior tensile plate group is short, although the trauma is slightly larger than the former,it’s more appropriate for patients with sacroiliac joint fracture or iliac fracture,it fixes reliably and meets the biomechanical requirements. In conclusion,it’s very important to make sufficient preoperative preparations and select a appropriate internal fixation approache.