OBJECTIVE: To review the clinical characteristics of patients with traumatic spinopelvic dissociation (SPD) and explore the diagnostic and therapeutic methods. METHODS: A clinical data of 22 patients with SPD who underwent surgical treatment between March 2019 and August 2024 was retrospectively analyzed. There were 13 males and 9 females, with an average age of 35.5 years (range, 14-61 years). The causes of injury included falling from height in 16 cases, traffic accidents in 5 cases, and compression injury in 1 case. Sacral fractures were classified based on morphology into "U" type (9 cases), "H" type (7 cases), "T" type (4 cases), and "λ" type (2 cases). According to the Roy-Camille classification, there were 4 cases of type Ⅰ, 12 cases of type Ⅱ, 2 cases of type Ⅲ, and 4 cases of type Ⅳ. The Cobb angle was (35.7± 22.0)°. Sixteen patients were accompanied by lumbosacral trunk and cauda equina nerve injury, which was classified as grade Ⅱ in 5 cases, grade Ⅲ in 5 cases, and grade Ⅳ in 6 cases according to the Gibbons grading. The time from injury to operation was 2-17 days (mean, 5.7 days). Based on the type of sacral fracture and sacral nerve injury, 6 cases were treated with closed reduction and minimally invasive percutaneous sacroiliac screw fixation, 16 cases were treated with open reduction and lumbar iliac fixation (8 cases)/triangular fixation (8 cases). Among them, 11 patients with severe fracture displacement and kyphotic deformity leading to sacral canal stenosis or bony impingement within the sacral foramen underwent laminectomy and sacral nerve decompression. X-ray films and CT were reviewed during followed-up. The Matta score was used to evaluate the quality of fracture reduction. At last follow-up, the Majeed score was used to assess the functional recovery, and the Gibbons grading was used to evaluate the nerve function. RESULTS: All operations were successfully completed. All patients were followed up 8-64 months (mean, 20.4 months). Two patients developed deep vein thrombosis of the lower limbs, 2 had incision infections, and 1 developed a sacral pressure ulcer; no other complications occurred. Radiological examination showed that the Cobb angle was (12.0±6.8)°, which was significantly different from the preoperative one ( t=6.000, P<0.001). The Cobb angle in 16 patients who underwent open reduction was (14.9±5.5)°, which was significantly different from the preoperative one [(46.8±13.9)° ] ( t=8.684, P<0.001). According to the Matta scoring criteria, the quality of fracture reduction was rated as excellent in 8 cases, good in 7 cases, fair in 5 cases, and poor in 2 cases, with an excellent and good rate of 68.2%. Bone callus formation was observed at the fracture site in all patients at 12 weeks after operation, and bony union achieved in all cases at last follow-up, with a healing time ranging from 12 to 36 weeks (mean, 17.6 weeks). At last follow-up, the Majeed score was rated as excellent in 7 cases, good in 10 cases, fair in 4 cases, and poor in 1 case, with an excellent and good rate of 77.3%. One patient experienced a unilateral iliac screw breakage at 12 months after operation, but the fracture had already healed, and there was no loss of reduction. Among the 16 patients with preoperative sacral nerve injury, 11 cases showed improvement in nerve function (6 cases) or recovery (5 cases). CONCLUSION SPD with low incidence, multiple associated injuries, and high incidence of sacral nerve injury, requires timely decompression of the sacral canal for symptomatic sacral nerve compression, fractures reduction, deformities correction, and stable fixation.
Humans ; Adult ; Female ; Male ; Retrospective Studies ; Middle Aged ; Spinal Fractures/diagnostic imaging* ; Adolescent ; Sacrum/diagnostic imaging* ; Fracture Fixation, Internal/methods* ; Young Adult ; Pelvic Bones/surgery* ; Treatment Outcome ; Bone Screws

Objective:To evaluate the short-term efficacy of our modified anterior pelvic ring internal fixator(INFIX) in the treatment of anterior pelvic ring injuries.Methods:A retrospective study was conducted to analyze the clinical data from the 16 patients with pelvic anterior ring injury who had been treated with our modified INFIX at Department of Orthopaedics, The First Hospital Affiliated to Bengbu Medical University from June 2020 to June 2023. There were 9 males and 7 females with an age of (49.1±14.3) years. According to the AO/OTA classification, 10 cases were of type B2 and 6 cases of type C1. Their time from injury to surgery was (7.6±2.9) days. Fixation with our modified INFIX was as follows: Three pedicle screws were inserted into the anterior inferior iliac spine on one side and into the pubic symphysis on both sides. Next, a subcutaneous tunnel was created from the anterior inferior iliac spine incision toward the pubic symphysis, and connecting rods were inserted for fixation. The surgical incision length, intraoperative blood loss, surgical time, postoperative fracture reduction quality, fracture healing time, incidence of complications during follow-up, and pelvic functional recovery at the last follow-up were recorded in this cohort.Results:In this cohort, surgical incision length was (5.8±0.4) cm, intraoperative blood loss (75.4±11.9) mL, and surgical time (66.1±8.9) min. By the end of one week after surgery, the quality of fracture reduction was evaluated according to the Matta scoring criteria as excellent in 11 cases and as good in 5 cases. All patients were followed up for (17.4±3.1) months after surgery. The fractures got united in all the 16 patients after (11.2±1.2) weeks. At the last follow-up, the pelvic function recovery was evaluated according to the Majeed scoring system as excellent in 13 cases and as good in 3 cases, yielding a Majeed score of (90.1±4.2) points. During the follow-up period, no patient developed complications such as nerve injury, wound infection, or loosening, breakage or withdrawal of internal fixation devices.Conclusion:In the treatment of anterior pelvic ring injuries, our modified INFIX has the advantages of few complications, simple operation and minimal invasion, leading to good short-term efficacy.

Objective:To evaluate the short-term efficacy of our modified anterior pelvic ring internal fixator(INFIX) in the treatment of anterior pelvic ring injuries.Methods:A retrospective study was conducted to analyze the clinical data from the 16 patients with pelvic anterior ring injury who had been treated with our modified INFIX at Department of Orthopaedics, The First Hospital Affiliated to Bengbu Medical University from June 2020 to June 2023. There were 9 males and 7 females with an age of (49.1±14.3) years. According to the AO/OTA classification, 10 cases were of type B2 and 6 cases of type C1. Their time from injury to surgery was (7.6±2.9) days. Fixation with our modified INFIX was as follows: Three pedicle screws were inserted into the anterior inferior iliac spine on one side and into the pubic symphysis on both sides. Next, a subcutaneous tunnel was created from the anterior inferior iliac spine incision toward the pubic symphysis, and connecting rods were inserted for fixation. The surgical incision length, intraoperative blood loss, surgical time, postoperative fracture reduction quality, fracture healing time, incidence of complications during follow-up, and pelvic functional recovery at the last follow-up were recorded in this cohort.Results:In this cohort, surgical incision length was (5.8±0.4) cm, intraoperative blood loss (75.4±11.9) mL, and surgical time (66.1±8.9) min. By the end of one week after surgery, the quality of fracture reduction was evaluated according to the Matta scoring criteria as excellent in 11 cases and as good in 5 cases. All patients were followed up for (17.4±3.1) months after surgery. The fractures got united in all the 16 patients after (11.2±1.2) weeks. At the last follow-up, the pelvic function recovery was evaluated according to the Majeed scoring system as excellent in 13 cases and as good in 3 cases, yielding a Majeed score of (90.1±4.2) points. During the follow-up period, no patient developed complications such as nerve injury, wound infection, or loosening, breakage or withdrawal of internal fixation devices.Conclusion:In the treatment of anterior pelvic ring injuries, our modified INFIX has the advantages of few complications, simple operation and minimal invasion, leading to good short-term efficacy.

OBJECTIVE: To investigate the surgical technique and effectiveness of titanium elastic nail (TEN) assisted retrograde channel screw implantation of superior pubic branch. METHODS: The clinical data of 31 patients with pelvic or acetabular fractures treated with retrograde channel screw implantation in superior pubic branch between January 2021 and April 2022 were retrospectively analyzed. Among them, 16 cases were implanted with assistance of TEN (study group) and 15 cases were implanted under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification of pelvic fracture, Judet-Letournal classification of acetabular fracture, and time from injury to operation between the two groups ( P>0.05). The operation time, fluoroscopy times, and intraoperative blood loss of each superior pubic branch retrograde channel screw were recorded during operation. X-ray films and three-dimensional CT were reexamined after operation, the quality of fracture reduction was evaluated by Matta score standard, and the position of channel screw was evaluated by screw position classification standard. The fracture healing time was recorded during the follow-up, and the postoperative functional recovery was evaluated by Merle D'Aubigne Postel score system at last follow-up. RESULTS: Nineteen and 20 retrograde channel screws of superior pubic branch were implanted in the study group and the control group, respectively. The operation time, fluoroscopy times, and intraoperative blood loss of each screw in the study group were significantly less than those in the control group ( P<0.05). According to the postoperative X-ray films and three-dimensional CT, none of the 19 screws in the study group penetrated out of the cortical bone or into the joint, and the excellent and good rate was 100% (19/19); in the control group, there were 4 screws of cortical bone penetration, and the excellent and good rate was 80% (16/20); the difference between the two groups was significant ( P<0.05). Matta score standard was used to evaluate the quality of fracture reduction, there was no patient in the two groups with poor reduction results, and the difference was not significant between the two groups ( P>0.05). The incisions of the two groups healed by first intention, and there was no complication such as incision infection, skin margin necrosis, and deep infection. All patients were followed up 8-22 months, with an average of 14.7 months. There was no significant difference in healing time between the two groups ( P>0.05). At last follow-up, the difference in functional recovery evaluated by the Merle D'Aubigne Postel scoring system between the two groups was not significant ( P>0.05). CONCLUSION TEN assisted implantation technique can significantly shorten the operation time of retrograde channel screw implantation of superior pubic branch, reduce the times of fluoroscopy, and have less intraoperative blood loss and accurate screw implantation, which provides a new safe and reliable method for minimally invasive treatment of pelvic and acetabular fractures.
Humans ; Titanium ; Fracture Fixation, Internal/methods* ; Blood Loss, Surgical ; Retrospective Studies ; Bone Screws ; Treatment Outcome ; Fractures, Bone/surgery* ; Spinal Fractures ; Hip Fractures