Objective To investigate the pathogenesis, diagnosis, and treatment of the gluteal muscle contracture associated with an unequal leg length caused by the pelvis obliquity (GMC-PO).Methods The retrospective analysis was made on the clinical features and the follow-up results in 132 patients who had been admitted from January 1990 to December 2004 for GMC-PO. Among them, 73 weremale and 59 were female with a range in age from 5 to 26 years (average, 11 yr). All the patients were characterized by unsymmetrical contracture of the gluteal muscles, including unilateral and bilateral contracture. Of the patients, 89 had a clear limping and 78 had a clearly-unequal leg length. The X-ray examination revealed pelvis obliquity in 97 cases and an increased angle of the femur neck in 11 cases. The arc longitudinal incision was made into the posterolateral area nearby the greater trochanter and then lysis of thegluteal muscles was performed, combined with the skin traction of both legs andexercise training. Results Of the 132 patients withunequal gluteal muscle contracture before operation, 13 had a relative length difference of 0.5-1.5 cm between the 2 legs, 1 had a difference of 3.0 cm,and the remaining 118 patients had an equal leg length. Excellent and good resultswere achieved in 118 and 13 patients, respectively after the surgical release of the gluteal muscle contracture by the arc longitudinal incision into the posterolateral area nearby the greater trochanter,combined with postoperative skin traction and functional exercises. Only 1 patient had a poor result. The follow-up for 3 months to 14 years showed that thecure rate was as high as 99.2%.Conclusion The gluteal musclecontracture associated with an unequal leg length caused by the pelvis obliquity is a result of the unequal gluteal muscle contracture between the 2 hips and it can be cured with a comprehensive therapeutic method including the surgical release of the gluteal muscle contracture by the arc longitudinal incision into the posterolateralarea nearby the greater trochanter, and postoperative skin traction as well as the functional exercise.
This article reviews the development and progress in the field of limb salvage treatment, surgical techniques, and function reconstruction of pelvic malignant tumors in China in the past 30 years. Based on the surgical classification of pelvic tumor resection in different parts, the development of surgical techniques and bone defect repair and reconstruction methods were described in detail. In recent years, in view of the worldwide problem of biological reconstruction after pelvic tumor resection, Chinese researchers have systematically proposed the repair and reconstruction methods and prosthesis design for bone defects after resection of different parts for the first time in the world. In addition, a systematic surgical classification (Beijing classification) was first proposed for the difficult situation of pelvic tumors involving the sacrum, as well as the corresponding surgical plan and repair and reconstruction methods. Through unremitting efforts, the limb salvage rate of pelvic malignant tumors in China has reached more than 80%, which has preserved limbs and restored walking function for the majority of patients, greatly reduced surgical complications, and achieved internationally remarkable results.
ObjectiveTo compare the effectiveness of anterior subcutaneous pelvic internal fixator (INFIX) and plate internal fixation in treatment of unstable anterior pelvic ring fractures.MethodsThe clinical data of 48 patients with unstable anterior pelvic ring fractures who met the selection criteria between June 2014 and December 2019 were retrospectively analyzed. Among them, 21 cases were treated with INFIX (INFIX group), and 27 cases were treated with plate (plate group). There was no significant difference in gender, age, body mass index, cause of injury, time from injury to operation, Injury Severity Score (ISS), and fracture type between the two groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, partial weight-bearing time, and complete weight-bearing time were recorded and compared between the two groups. Matta standard was used to evaluate the quality of fracture reduction, and Majeed score system was used to evaluate the functional recovery of pelvic fracture after operation.ResultsThe patients in both groups were followed up for an average of 12.5 months (range, 6-16 months). The operation time and intraoperative blood loss in INFIX group were significantly lower than those in plate group (t=−11.965, P=0.000; t=−20.105, P=0.000). There was no significant difference in the quality of fracture reduction, fracture healing time, partial weight-bearing time, and complete weight-bearing time between the two groups (P>0.05). At 14 weeks after operation, there was no significant difference in the scores of pain, working, standing and walking, and total scores between INFIX group and plate group (P>0.05), but there were significant differences in sitting and sexual intercourse scores (t=−4.250, P=0.003; t=−6.135, P=0.006). The incidences of lateral femoral cutaneous nerve injury, femoral nerve injury, and heterotopic ossification were significantly higher in INFIX group than in plate group (P<0.05), while the incidence of incision infection was lower in INFIX group than in plate group (P<0.05).ConclusionCompared with the plate internal fixation, the INFIX internal fixation can obtain the similar effectiveness for the unstable anterior pelvic ring fracture and has the advantages of shorter operation time, less blood loss, and lower risk of infection.
Objective To compare the reduction qualities of three-dimensional visible technique without fluoroscopy and two-dimensional fluoroscopy for unstable pelvic fractures during operations. Methods The clinical data of 40 patients with unstable pelvic fractures, who met the selection criteria in three clinical centers between June 2021 and September 2022, were retrospectively analyzed. According to the reduction methods, the patients were divided into two groups. Twenty patients in trial group were treated with unlocking closed reduction system combined with three-dimensional visible technique without fluoroscopy; 20 patients in control group with unlocking closed reduction system under two-dimensional fluoroscopy. There was no significant difference in the gender, age, injury mechanism, Tile type of fracture, Injury Severity Score (ISS), and the time between injury to operation between the two groups (P>0.05). The qualities of fracture reduction according to the Matta criteria, operative time, intraoperative blood loss, fracture reduction time, times of fluoroscopy, and System Usability Scale (SUS) score were recorded and compared. Results All operations were successfully completed in both groups. According to the Matta criteria, the qualities of fracture reduction were rated as excellent in 19 patients (95%) in trial group, which was better than that in the control group (13 cases, 65%), with a significant difference (χ2=3.906, P=0.048). The operative time and intraoperative blood loss had no significant differences between the two groups (P>0.05). The fracture reduction time and times of fluoroscopy were significantly less in trial group than in control group (P<0.05), and SUS score in trial group was significantly higher in trial group than in control group (P<0.05). ConclusionCompared to using unlocking closed reduction system under two-dimensional fluoroscopy, three-dimensional visible technique without fluoroscopy can significantly improve the reduction quality of unstable pelvic fractures without prolonging the operative time, and is valuable to reduce iatrogenic radiation exposure for patients and medical workers.
Objective To investigate the early effectiveness of transiliac-transsacral screws internal fixation assisted by augmented reality navigation system HoloSight (hereinafter referred to as “computer navigation system”) in the treatment of posterior pelvic ring injuries. MethodsA retrospective analysis was made in the 41 patients with posterior pelvic ring injuries who had been treated surgically with transiliac-transsacral screws between June 2022 and June 2023. The patients were divided into navigation group (18 cases, using computer navigation system to assist screw implantation) and freehand group (23 cases, using C-arm X-ray fluoroscopy to guide screw implantation) according to the different methods of transiliac-transsacral screws placement. There was no significant difference in gender, age, body mass index, causes of injuries, Tile classification of pelvic fracture, days from injury to operation, usage of unlocking closed reduction technique between the two groups (P>0.05). The time of screw implantation, the fluoroscopy times, the guide wire adjustment times of each screw, and the incidence of complications were recorded and compared between the two groups. The position of the transiliac-transsacral screw was scanned by CT within 2 days after operation, and the position of the screw was classified according to Gras standard. ResultsThe operation was successfully completed in both groups. The time of screw implantation, the fluoroscopy times, and the guide wire adjustment times of each screw in the navigation group were significantly less than those in the freehand group (P<0.05). There were 2 cases of incision infection in the freehand group, and the incision healed by first intention after active dressing change; there was no screw-related complication in the navigation group during operation and early period after operation; the difference in incidence of complications between the two groups (8.7% vs. 0) was not significant (P=0.495). According to the Gras standard, the screw position of the navigation group was significantly better than that of the freehand group (P<0.05). ConclusionCompared with the traditional freehand method, the computer navigation system assisted transiliac-transsacral screws internal fixation in the treatment of posterior pelvic ring injuries has advantages of improving the accuracy of screw implantation and reducing radiation damage and the time of screw implantation.
Objective To explore the relative prognostic factors of Tile C pelvic injury after iliolumbar fixation. Methods Between March 2007 and March 2010, 60 patients with Tile C pelvic injuries were surgically treated with iliolumbar fixation, including 39 males and 21 females with an average age of 37 years (range, 17-66 years). Of them, 27 cases were classified as Tile C1, 20 as Tile C2, and 13 as Tile C3. The preoperative injury severity score (ISS) was 12-66 (mean, 29.4). The time from injury to surgery was 2-25 days (mean, 8.1 days). Iliolumbar fixation was performed in all patients. Unconditional logistic analysis was used to analyze the relationship between the age, sex, body mass index (BMI), operation opportunity, the preoperative combined injury, classification of fracture, the postoperative complication, reduction outcome, sacral nerve injury, and the time of physical exercise and the prognosis. Results All 60 patients were followed up 12-56 months (mean, 27.3 months). Infection of incisions occurred in 12 cases and were cured after dressing change; healing of incision by first intention was obtained in the other patients. Delay sacral nerve injury was found in 15 patients, 6 patients underwent nerve decompression, and 9 underwent conservative treatment. Ten patients had nail protrusion of Schanz screws at the posterior superior illac spine, and 3 patients had pain, which was relieved after removal of the internal fixator. One patient had bone-grafting nonunion of sacroiliac joint, which was improved by pressured bone graft. Five patients had the beam breakage without significant effect. Six patients had deep vein thrombosis, among them 4 underwent filter and 2 underwent nonsurgical treatment. The healing time of fracture was 3-6 months (mean, 3.9 months). According to the Matta function score, the results were excellent in 31 cases, good in 24 cases, fair in 3 cases, and poor in 2 cases with an excellent and good rate of 91.7% at last follow-up. Majeed score was 58-100 (mean, 86), 28 were rated as excellent, 12 as good, 16 as fair, and 4 as poor with an excellent and good rate of 66.7%. The logistic analysis showed that the age, sex, BMI, and postoperative complications were not prognostic factors; early operation (within 10 days), early function exercises (within 7 days), the better reduction quality, and the less sacral nerve injury were in favor of prognosis; and the worse preoperative combined injury and pelvic injury were, the worse the prognosis was. Conclusion Operation opportunity, the preoperative combined injury, reduction outcome, sacral nerve injury, and the time of physical exercise are all significantly prognostic factors of Tile C pelvic injuries
ObjectiveTo evaluate the feasibility and effectiveness of percutaneous cannulated screw fixation for the treatment of Day type Ⅱ pelvic crescent fracture.MethodsThe clinical data of 14 patients with Day type Ⅱ pelvic crescent fractures underwent closed reduction and percutaneous cannulated screw fixation between January 2009 and July 2016 were retrospectively analysed. There were 9 males and 5 females, aged 17-65 years (mean, 38 years). The causes of injury included traffic accident in 8 cases, falling from height in 3 cases, bruise injury in 3 cases; all were closed fractures. According to Tile classification, there were 8 cases of type B, 6 cases of type C. There were 13 cases combined with fracture of the anterior pelvic ring, including 8 cases of superior and inferior ramus of pubis fracture, 1 case of superior ramus of pubis fracture with symphysis separation, and 4 cases of symphysis separation. The interval of injury and admission was 1- 72 hours (mean, 16 hours), and the interval of injury and operation was 3-8 days (mean, 5 days). After operation, the reduction of fracture was evaluated by the Matta evaluation criteria, the clinical function was assessed by Majeed function assessment.ResultsThe operation time was 35-95 minutes (mean, 55 minutes), cumulative C-arm fluoroscopy time was 3-8 minutes (mean, 5 minutes), no iatrogenic vascular injury and pelvic organ damage occurred. Postoperative X-ray films at 2 days indicated that 2 cases of vertical shift and 2 cases of mild rotation were not completely corrected. Postoperative CT examination at 3 days indicated that 2 pubic joint screws broke through the obturator bone cortex. None of the pubic ramus screws entered into the acetabulum, but a screw of superior pubic branch broke through the posterior cortical of superior pubic branch, a screw of posterior ilium column broke through the medial bone cortex of the ilium, and no clinical symptom was observed. One patient suffered from wound infection in the pubic symphysis, then healed after 2 weeks of wound drainage, the other wounds healed by first intention. According to Matta criterion for fracture reduction, the results were excellent in 9 cases, good in 4 cases, and fair in 1 case with an excellent and good rate of 92.9%. All patients were followed up 8-24 months (mean, 14 months). All fractures healed at 4 months and restored to the normal walking at 6 months after operation, 3 patients suffered from slight pain in the sacroiliac joints and slight claudication when they were tired or walked for a long time and unnecessary for special treatment. One patient felt pain in the back of the iliac spine when he was lying down. During the follow-up, no screw loosening or other internal fixation failure occurred. At last follow-up, according to Majeed functional evaluation criteria, the results were excellent in 7 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 85.7%.ConclusionThe percutaneous cannulated screw fixation is a safe treatment for Day type Ⅱ pelvic crescent fracture, which has a reliable fixation and good effectiveness.
Objective To summarize the current research progress of second sacral alar-iliac (S2AI) screw technique for reconstruction of spinopelvic stability. Methods The recent original literature concerning development, clinical applications, anatomy, imageology, and biomechanics of S2AI screw technique in reconstruction of spinopelvic stability was reviewed and analyzed. Results As a common clinical strategy for the reconstruction of spinopelvic stability, S2AI screws achieve satisfactory effectiveness of lumbosacral fixation without complications which were found during the application of traditional iliac screws technique. S2AI screw technique is more difficult to place screws by hand because of its narrow screw trajectory. Although the S2AI screws trajectory pass through 3 layers of bone cortex, the biomechanical cadaveric study demonstrate that no statistical difference in stiffness was found between the traditional iliac and S2AI screw in a spinopelvic fixation model. Conclusion S2AI screw technique should be a safe and feasible method for reconstruction of spinopelvic stability in place of the traditional iliac screw technique.