Objective:To evaluate a novel classification of sacroiliac screw bony channels based on CT axial scans proposed by the present study and a new grading system for accuracy and safety of sacroiliac screw placement.Methods:A retrospective study was conducted to analyze the data of 132 patients with pelvic fracture who had undergone percutaneous fixation of the posterior pelvic ring with sacroiliac screws at Department of Emergency Surgery, Qilu Hospital of Shandong University from January 2023 to January 2025. In this cohort, 79 cases were male and 53 ones female, with an age of (44.9±12.4) years. According to the Denis classification of sacral fractures, 69 cases were of type 1, 54 cases of type 2 and 9 cases of type 3. A total of 160 sacroiliac screws were placed in this cohort. Based on the preoperative CT axial plain scans of the sacrum, a novel CT classification of sacroiliac screw bony channels was proposed as follows: S 1 screw parallel channel (71 screws inserted), S 1 screw oblique channel (31 screws inserted), and S 2 screw parallel channel (58 screws inserted). A new grading system for accuracy and safety of sacroiliac screw placement was developed based on the position of sacroiliac screw relative to that of sacroiliac bony channel in postoperative CT axial scan: grade 1: screw completely within the bony channel; grade 2: screw incompletely within the bony channel without contacting the anterior or posterior cortex; grade 3: contacting but not penetrating the cortex; grade 4: penetrating the cortex. Six senior surgeons verified the inter-observer consistency and intra-observer repeatability of the new grading system for accuracy and safety of sacroiliac screw placement. Results:According to the new grading system for accuracy and safety of sacroiliac screw placement, of the 160 sacroiliac screws placed in the 132 patients, 122 were graded as grade 1, 19 as grade 2, 9 as grade 3, and 10 as grade 4, yielding an excellent and good rate of 88.13% (141/160), and an acceptability rate of 93.75% (150/160). The Kappa values for inter-observer consistency and intra-observer repeatability of the new grading system were 0.87 and 0.97, respectively. All the 132 patients were followed up for (18.3±3.6) months after surgery. During the follow-up period, none of the patients experienced such complications as retraction, breakage, or infection of the screws. Screw loosening occurred in some patients who were followed up for more than 1 year [5.51% (7/127), with 3 S 1 screws of grade 3 and 4 S 1 screws of grade 4]. Conclusion:The novel classification of sacroiliac screw bony channels based on CT axial scans proposed by the present study and the new grading system for accuracy and safety of sacroiliac screw placement can lead to a high acceptability rate of sacroiliac screw placement, indicating clinical practicality of the novel classification and the new grading system.

Objective:To evaluate a novel classification of sacroiliac screw bony channels based on CT axial scans proposed by the present study and a new grading system for accuracy and safety of sacroiliac screw placement.Methods:A retrospective study was conducted to analyze the data of 132 patients with pelvic fracture who had undergone percutaneous fixation of the posterior pelvic ring with sacroiliac screws at Department of Emergency Surgery, Qilu Hospital of Shandong University from January 2023 to January 2025. In this cohort, 79 cases were male and 53 ones female, with an age of (44.9±12.4) years. According to the Denis classification of sacral fractures, 69 cases were of type 1, 54 cases of type 2 and 9 cases of type 3. A total of 160 sacroiliac screws were placed in this cohort. Based on the preoperative CT axial plain scans of the sacrum, a novel CT classification of sacroiliac screw bony channels was proposed as follows: S 1 screw parallel channel (71 screws inserted), S 1 screw oblique channel (31 screws inserted), and S 2 screw parallel channel (58 screws inserted). A new grading system for accuracy and safety of sacroiliac screw placement was developed based on the position of sacroiliac screw relative to that of sacroiliac bony channel in postoperative CT axial scan: grade 1: screw completely within the bony channel; grade 2: screw incompletely within the bony channel without contacting the anterior or posterior cortex; grade 3: contacting but not penetrating the cortex; grade 4: penetrating the cortex. Six senior surgeons verified the inter-observer consistency and intra-observer repeatability of the new grading system for accuracy and safety of sacroiliac screw placement. Results:According to the new grading system for accuracy and safety of sacroiliac screw placement, of the 160 sacroiliac screws placed in the 132 patients, 122 were graded as grade 1, 19 as grade 2, 9 as grade 3, and 10 as grade 4, yielding an excellent and good rate of 88.13% (141/160), and an acceptability rate of 93.75% (150/160). The Kappa values for inter-observer consistency and intra-observer repeatability of the new grading system were 0.87 and 0.97, respectively. All the 132 patients were followed up for (18.3±3.6) months after surgery. During the follow-up period, none of the patients experienced such complications as retraction, breakage, or infection of the screws. Screw loosening occurred in some patients who were followed up for more than 1 year [5.51% (7/127), with 3 S 1 screws of grade 3 and 4 S 1 screws of grade 4]. Conclusion:The novel classification of sacroiliac screw bony channels based on CT axial scans proposed by the present study and the new grading system for accuracy and safety of sacroiliac screw placement can lead to a high acceptability rate of sacroiliac screw placement, indicating clinical practicality of the novel classification and the new grading system.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective To study the anatomic morphology of posterior column of ilium(PCI)and valne of lumbo-iliac fixation(LIF)in pelvic ring reconstruction following communited Denis Ⅲ sacral fractures.Methods A total of 17 hemi-sectional pelvis and dry ilia were selected to observe the length,width and height(safety and standard)of PCI,when a detailed description was done on the methods determining entry point and operation techniqus for iliac screws anchoring.Nine patients with eommunited sacral fractures involving Denis Ⅲ areas combined with neurologic deficits were decompressed for recovery of neurological function and reconstruction of pelvic ring by using LIF.Postoperative follow-up was done on role of LIF and result of neural rehabilitation.Results PCI was mean 110.57 mm in length,24.24 mm in width,14.54 mm in standard height and 31.46 mm in safe height.Nine patients could turn over in bed immediately following operation and walk one month later.A follow-up for 13-37 months in eight patients showed stable reconstructed pelvic ring,sound function of movement and bone graft fusion,which met the target of keeping stability of fractured extremity and pelvis.Conclusions pCI can provide anatomic support for LIF.When decompression and fixation is needed for sacral fractures combined with anterior pelvic ring disruptions,LIP can provide stable fixation and play an important role in reconstruction,nursing and rehabilitation of pelvic ring.

[Objective]To research the influence of spinal cord blood flow(SCBF) and the evoked potential(EP) by the extramarrow impacting and to explore the correlation and regularity between the spinal cord blood flow and evoked potential after spinal cord injury.[Method]Normal 120 SD rats were randomized into 4 groups,with 30 in each.Group A was the control group.In groups B,C,D,impacts of 10,15,20N were given to lamina respectively.The blood flow of impacting position and evoked potential were observed at different time points including 0 min,1 h,6 h,1 d,6 d,12 d,24 d.[Result]The blood flow of spinal cord represents a dimning trend with the impacting load raising.The blood flow of group A,had no marked change,the SEP and MEP also.The blood flow of group B represented a temporaly lowing,then recovered normal,the SEP and MEP also.The blood flow of group C and D represented a continuous lowing,then slowly raising.The group C recovered normal at 24d,the group D still lower than normal.[Conclusion]The impact load to lamina can influence the spinal cord function through altering the spinal cord blood flow.There is evident correlation between the SCBF and EP.