BACKGROUNDThe delayed diagnosis of pelvi-ureteric junction (PUJ) disruption in children following blunt abdominal trauma can result in loss of function of the involved kidney. We examined the potential for kidney preservation and the limits of diagnostic delays.

METHODSA retrospective review of 17 cases of PUJ disruption at Beijing Children's Hospital from 1993 to 2009 was done with respect to diagnosis, treatment and follow-up.

RESULTSThe interval from trauma to diagnosis of PUJ disruption was (52 ± 52) days. If one case with nephrectomy was excluded, the interval from trauma to diagnosis was (40 ± 20) days. The average time between injury and first treatment was (49 ± 25) days. Pelvi-ureteric reanastomosis and caliceal ureterostomy were performed separately in 11 and 4 patients, respectively. Ileal replacement for ureter injuries was finally performed in one patient. Hydronephrosis of the injured kidney was reduced and the function improved in 15 out of 17 patients (88%). Only one patient received nephrectomy and the nephrectomy rate was 5.9%.

CONCLUSIONDifferential renal function at the PUJ disruption side can be saved and the rate of nephrectomy reduced by appropriate surgery if the time to diagnosis and first treatment is limited to within two months.

Abdominal Injuries ; complications ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Kidney ; injuries ; surgery ; Kidney Pelvis ; injuries ; surgery ; Male ; Retrospective Studies ; Ureter ; injuries ; surgery ; Ureteral Obstruction ; etiology ; surgery

OBJECTIVE: To review the research progress of pubic symphysis diastasis and provide effective reference for orthopedic surgeons in the diagnosis and treatment of pubic symphysis diastasis. METHODS: The anatomy, injury mechanism, treatment, and other aspects of pubic symphysis diastasis were summarized and analyzed by reviewing the relevant research literature at domestically and internationally in recent years. RESULTS: The incidence of pubic symphysis diastasis is high in pelvic fractures, which is caused by the injury of the ligaments and fibrocartilage disc around the pubic symphysis by external force. The treatment plan should be individualized according to the pelvic stability and the needs of patients, aiming to restore the stability and integrity of the pelvis and improve the quality of life of patients after surgery. CONCLUSION At present, the research on pubic symphysis diastasis still needs to be improved. In the future, high-quality, multi-center, and large-sample studies are of great significance for the selection of treatment methods and the evaluation of effectiveness for patients with pubic symphysis diastasis.
Female ; Humans ; Pubic Symphysis Diastasis/etiology* ; Quality of Life ; Pubic Symphysis/injuries* ; Pelvis/surgery* ; Fractures, Bone/surgery*

OBJECTIVETo observe the therapeutic effects of iliac nail in the treatment of lumbar sacral and pelvis reconstruction.

METHODSForm January 2004 to February 2010,10 patients (4 males and 6 females, ranging age from 25 to 75 years, with an average of 46.5 years ) were treated. Among the patients, 5 cases were L5S1 vertebral tuberculosis, 2 cases were sacral giant-cell tumors and 3 cases were severe osteoporosis combined with lumbar sacral slipping. The main symptoms manifested low back pain, limited activity and dysphasia before treatment. Iliac nail and lumbar-sacral pedicle screw were used for reconstruction of lumbar-sacral spine and pelvis. Nakai scale was used to evaluate therapeutic effects, Suk scale for osseous fusion.

RESULTSAll operations were succeful, obtained primary healing. All the patients were followed up, and the mean time of follow-up was 24 months (ranged from 18 to 36 months). The complications, such as weakness and decreased sensation of lower libs and activity, increased spinal cord injury, were not occurred after operation. According to Nakai scale, 7 cases got excellent result, 2 good and 1 fair. All bone graft were bony fusion with an average time of 3.5 months.

CONCLUSIONIliac nail can fixed well between lumbar vertebra and pelvis and solve the problem of fixation due to pathological changes of lumbosacral region. It is an ideal method of less blood loss and operating time.

Adult ; Aged ; Bone Nails ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Internal Fixators ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Pelvis ; injuries ; surgery ; Sacrum ; injuries ; surgery

A locked pubic ramus body is an unusual variant of lateral compression injury. Till date, there have been only 25 cases reported in the published literature. We herein described a case where the right pubic ramus was entrapped within the opposite obturator foramen with an overlap of greater than 4 cm, with associated urethral injury. When all maneuvers of closed and instrumented reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate. The patient underwent delayed urethral repair 10 weeks after the index surgery. At 3-year follow-up, the patient has sexual dysfunction especially difficulty in maintaining erection, secondary urethral stricture, heterotopic ossification, and breakage of implants.
Humans ; Pubic Bone/injuries* ; Follow-Up Studies ; Osteotomy, Sagittal Split Ramus ; Pelvis ; Urethra/surgery* ; Pubic Symphysis/injuries*

BACKGROUND: The Stoppa (intrapelvic) approach has been introduced for the treatment of pelvic-acetabular fractures; it allows easy exposure of the pelvic brim, where the bone quality is optimal for screw fixation. The purpose of our study was to investigate the surgical outcomes of unstable pelvic ring injuries treated using the Stoppa approach for stable anterior ring fixation. METHODS: We analyzed 22 cases of unstable pelvic ring injury treated with plate fixation of the anterior ring with the Stoppa approach. We excluded cases of nondisplaced rami fracture, simple symphyseal diastasis, and parasymphyseal fractures, which can be easily treated with other techniques. The average age of the study patients was 41 years (range, 23 to 61 years). There were 10 males and 12 females. According to the Young and Burgess classification, there were 12 lateral compression, 4 anteroposterior compression, and 6 vertical shear fracture patterns. The fracture location on the anterior ring was near the iliopectineal eminence in all cases and exposure of the pelvic brim was required for plate fixation. All patients were placed in the supine position. For anterior plate fixation, all screws were applied to the anterior ramus distally and directed above the hip joint proximally. Radiologic outcomes were assessed by union time and quality of reduction by Matta method. The Merle d'Aubigne-Postel score was used to evaluate the functional results. RESULTS: The average radiologic follow-up period was 16 months (range, 10 to 51 months). All fractures united at an average of 3.5 months (range, 3 to 5 months). According to the Matta method, the quality of reduction was classified as follows: 16 anatomical (73%) and 6 nearly anatomical (27%) reductions. There were no cases of screw or implant loosening before bone healing. The functional results were classified as 7 excellent (32%), 12 good (55%), and 3 fair (13%) by the Merle d'Aubigne-Postel score. There were no wound complications, neurovascular injuries, or other complications related to the surgical approach. CONCLUSIONS: Stable anterior ring fixation placed via the Stoppa approach can result in excellent reduction and stable screw fixation with a low complication rate.
Adult ; Female ; Fracture Fixation, Internal/adverse effects/*methods ; Hip Fractures/*surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones/injuries/*surgery ; Pelvis/injuries/*surgery ; Retrospective Studies ; Young Adult

ObjectiveTo investigate the treatment of azoospermia induced by iatrogenic injury to the bilateral vas deferens.

METHODSWe retrospectively analyzed 11 cases of azoospermia caused by iatrogenic injury to bilateral vas deferens. The patients were aged 20－33 years, all diagnosed with azoospermia preoperatively and none with a history of pelvic operation. Seven of them had received bilateral inguinal hernia repair and the other 4 undergone bilateral orchidopexy in the childhood.

RESULTSIntraoperative exploration of the bilateral inguinal region was performed in all the patients. Bilateral vas deference atresia was found in the inguinal canal in 6 cases, which was treated by microscopic vasovasostomy following removal of the atresic segment. Vas deferens residual was observed in or near the deep inguinal ring in the other 5 cases, with the distal vas deferens inaccessible, which was treated by bilateral vasovasostomy in 3 cases and unilateral vasovasostomy in 2 (for longer defect segment than could be anastomosed) following combined laparoscopic exploration of the abdominal cavity. The patients were followed up for 3－12 months postoperatively, during which sperm were detected in 7 cases, with sperm concentration ranging from 0.4×10⁶/ml to 35×10⁶/ml and grade a+b sperm from 15% to 46%.

CONCLUSIONSFor the diagnosis of azoospermia, especially in patients with no history of pelvic operation, special attention should be paid to iatrogenic injury to the vas deferens. For the treatment of the disease, non-tension vasovasostomy is essential and, when necessary, the vas deferens can be reconstructed by changing its anatomical path and shortening its length.

Adult ; Azoospermia ; surgery ; Hernia, Inguinal ; surgery ; Humans ; Iatrogenic Disease ; Laparoscopy ; Male ; Microsurgery ; Pelvis ; surgery ; Retrospective Studies ; Sperm Count ; Vas Deferens ; injuries ; Vasovasostomy ; Young Adult

OBJECTIVETo analyze the pelvic stability after type I resection of iliac tumor.

METHODSSix adult cadaveric specimens were tested. The iliac subtotal resection models were established according to Ennecking's type I resection. Markers were affixed to the key region of the pelves. Axial loading from the proximal lumbar was applied by MTS load cell in the gradient of 0-500 N in the double feet standing state. Images in front view were obtained using CCD camera. Based on Image J software, displacements of the first sacral vertebrae (S1) of the resected pelves and the intact pelves were calculated using digital marker tracing method with center-of-mass algorithm.

RESULTSSerious instabilities were found in the resected pelves. S1 rotational movements around the normal side femoral head of the resected pelvis were found. The average vertical displacement of S1 of the resected pelvis was (7 +/- 3) mm under vertical load of 500 newtons, which were 8.3 times compared to the intact pelvis. The average angle of S1 rotation around the normal side femoral head of the resected pelvis was (4.0 +/- 1.8) degrees, which were 12.5 times compared to the intact pelvis.

CONCLUSIONSBiomechanical model of type I resection of iliac tumor are established. Essential pelvic reconstruction must be introduced because of the serious instability of the bone defection after tumor resection.

Adult ; Aged ; Biomechanical Phenomena ; Bone Neoplasms ; physiopathology ; surgery ; Female ; Humans ; Ilium ; injuries ; Male ; Middle Aged ; Models, Biological ; Pelvis ; physiopathology ; Range of Motion, Articular

OBJECTIVE: This study was conducted to ascertain the correlation between preserved pelvic nerve networks and bladder function after laparoscopic nerve-sparing radical hysterectomy. METHODS: Between 2009 and 2011, 53 patients underwent total laparoscopic radical hysterectomies. They were categorized into groups A, B, and C based on the status of preserved pelvic nerve networks: complete preservation of the pelvic nerve plexus (group A, 27 cases); partial preservation (group B, 13 cases); and complete sacrifice (group C, 13 cases). To evaluate bladder function, urodynamic studies were conducted preoperatively and postoperatively at 1, 3, 6, and 12 months after surgery. RESULTS: No significant difference in sensory function was found between groups A and B. However, the sensory function of group C was significantly lower than that of the other groups. Group A had significantly better motor function than groups B and C. No significant difference in motor function was found between groups B and C. Results showed that the sensory nerve is distributed predominantly at the dorsal half of the pelvic nerve networks, but the motor nerve is predominantly distributed at the ventral half. CONCLUSION: Various types of total laparoscopic nerve-sparing radical hysterectomies can be tailored to patients with cervical carcinomas.
Adult ; Aged ; Female ; Humans ; Hypogastric Plexus/injuries ; Hysterectomy/adverse effects/*methods ; Laparoscopy/adverse effects/*methods ; Middle Aged ; Neoplasm Staging ; Pelvis/innervation ; Peripheral Nerve Injuries/etiology/*prevention & control ; Postoperative Period ; Urinary Bladder/*innervation/physiopathology ; Urodynamics ; Uterine Cervical Neoplasms/pathology/*surgery