Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.

Objective:To investigate the effect of the placement of a drainage tube on the prognosis of patients with pelvic fractures treated by modified Stoppa approach.Methods:The medical records of patients with pelvic fractures treated with modified Stoppa approach from August 2012 to August 2017 were retrospectively analyzed. A total of 43 patients including 32 males and 11 females (mean age 47.6 years, range from16 to 69) were included in the study. According to Young-Burgess classification, there were 12 cases of Lateral Compression type LC-I type; 20 cases of Anterior and Posterior Compression type APC-I type and 11 cases of APC-II type. All patients were treated with modified Stoppa approach to reduce the fracture and fix with plate and screw. According to whether a drainage tube was placed during the operation, 22 cases were placed with a drainage tube (drainage group), and 21 cases were not placed with a drainage tube (non-drainage group). The main observation indicators were the intraoperative conditions, antibiotic application, incision suture removal time, postoperative body temperature change, hospital stay and clinical function (Harris score).Results:Wound infection was not observed in two groups. The duration of antibiotic use in the drainage group was 5.0 d (2.0, 8.0) d, and the non-drainage group was 4.0 d (2.0, 5.0) d, the difference was not statistically significant ( Z=1.161, P=0.924). The hospital stays of the two groups were 18.5 d (15.0, 24.3) d and 19.0 d (13.0, 26.0) d, respectively, and the difference was not statistically significant ( Z=0.542, P=0.591). The operation time was 150.2±52.4 min in the drainage group and 138.8±41.2 min in the non-drainage group, and the difference was not statistically significant ( t=0.791, P=0.433). The blood loss in the drainage group was 604.6±387.3 ml, and the non-drainage group was 581.0±275.0 ml. The difference was not statistically significant ( t=0.276, P=0.784). The postoperative body temperature changes of patients in the drainage group and non-drainage group were on day 1 (37.5±0.5 ℃ vs. 37.4±0.4 ℃, t=0.322, P>0.05), day 3 (37.1±0.4 ℃ vs. 37.0±0.4 ℃, t=0.286, P>0.05), day 5 (37.0± 0.3 ℃ vs. 36.8±0.2 ℃, t=2.127, P>0.05), on the 7th day (36.8±0.2 ℃ vs. 36.7±0.4 ℃, t=0.491, P>0.05), the difference was not statistically significant. The time for suture removal of surgical incision was 14.1±0.6 d in the drainage group and 13.9±0.6 d in the non-drainage group, and the difference was not statistically significant ( t=1.072, P=0.329). The Harris scores of the two groups were 96 (91, 100) points for the drainage group and 96 (93, 97) points for the non-drainage group, and the difference was not statistically significant ( Z=0.107, P=0.607). Conclusion:There is no significant influence of the application of drainage on recovery of wound or function for patients with pelvic surgery.

The Letournel-Judet classification system for acetabular fractures is widely used, but there are still some shortcomings, such as incomplete classification and confusion of classification concepts, which cannot effectively guide the treatment. Professor Hou Zhiyong proposed and elaborated an improved acetabular fracture classification system based on the concept of three columns of acetabulum. However, the credibility and repeatability of the classification still lacked validation from clinical data. In this regard, the author included 463 patients with relatively complete imaging data admitted to Third Hospital of Hebei Medical University and Honghui Hospital affiliated to Xi'an Jiaotong University Medical College in the past five years. Four trauma orthopedists classified the patients according to the modified classification method of acetabular fracture. After two months, the original sequence of imaging data was disrupted and re-classified by the same trauma orthopedists. The consistency of the classification was evaluated by Kappa test and compared with Letournel-Judet classification. The results showed that credibility and repeatability of the modified classification were higher than Letournel-Judet classification, suggesting the feasibility of clinical application.

Objective: To explore the clinical outcome an anatomic quadrilateral surface plate for both-column acetabular fractures through the Stoppa combined with iliac fossa approach. Methods: A retrospective study of the patients with both-column acetabular fractures treated with an anatomic quadrilateral surface plate through the Stoppa combined with iliac fossa approach from November 2015 to June 2017 was performed. Nineteen patients including 16 males and 3 females met the inclusion criteria. The mean age of included patients was 49.11 years (range, 25-68 years). There were 8 cases of fall injury, 7 cases of car accident injury and 4 cases of crushing injury. There were 11 cases of C1 type injury, 7 cases of C2 type, and 1 case of C3 type according to Tile classification. Patients included in this study were both-column acetabular fractures according to Letournel-Judet classification. There were six cases associated with posterior wall detachment. Minimally Stoppa combined with iliac fossa approach was performed to manage the displaced fragments. First, the anteromedially displaced iliopubic fragment was managed with a reconstruction plate through iliac fossa approach. Then, the medially displaced ischiadic fragment could be fixed with an anatomic quadrilateral surface plate through the Stoppa approach. The reduction quality was assessed by postoperative radiographs and CT scans according to the criteria proposed by Matta. The function of hip joint was assessed by the Merle d'Aubigné-Posteal score modified by Matta. Results: The average operation time and blood loss were 115.26 min (range, 90-160 min) and 534.21 ml (range, 300-1000 ml), respectively. The mean length surgical incision was 18.82 cm (range, 16-20 cm). Average follow-up time was 19.84 months (range, 12-28 months). According to Matta criteria of reduction quality, anatomic reduction was obtained in 14 cases, and satisfactory reduction was gained in 3 cases, while unsatisfactory reduction was found in 2 cases (satisfactory rate=89.47%). All fractures healed well and mean healing time was 3.32 months (range, 3-5 months). The mean Merle d’Aubigné-Posteal score modified by Matta was 16.95 (range, 13-18), including 12 cases of excellent, 4 cases of good, and 3 cases of fair (satisfactory rate=84.21%). Intraoperative injury of lateral femoral cutaneous nerve developed in a case and obturator nerve damage occurred in another patient, respectively. Relevant symptoms were totally disappeared after two months’ conservative treatment (including neurotrophic therapy combined with adduction exercise of the affected thigh). Iliac fossa hematoma occurred in a case and relevant symptom was eliminated after puncture. Conclusion Satisfactory clinical outcome of both-column acetabular fractures could be obtained by the anatomic quadrilateral surface plate through the Stoppa combined with iliac fossa approach.

Osteofascial compartment syndrome (OFCS) is clinically common and is well known to orthopedic surgeons.Clinicians attach great importance to OFCS because of its severe clinical consequences,and decompression of fascial compartment is often performed in emergency treatment.This article reviews the literature on the threshold of fascial compartment decompression proposed by many scholars in the past and discusses the problems in the clinical diagnosis of acute compartment syndrome,especially the inconsistent pressure thresholds as the indication for emergency decompression surgery.By observing calf fractures patients with tension blister,we found that the pressure of fascia decreased sharply upon the appearance of blisters.Meanwhile,the swelling gradually subsided as well as the clinical manifestations of pain and parasthsia.In view of the uncertainty of various thresholds of fascial decompression and self-decompression,the concepts of myofascial self-release law and muscle-swelling syndrome were first proposed.The author believes that when intracompartmental pressure rises to a point,some unknown mechanisms of fascia can achieve self-decompression.Therefore,no compartment syndrome will take place.We also emphasize that the ' muscle-swelling syndrome'should be strictly distinguished from the soft tissue necrosis caused by crush syndrome and acute limb vascular injury,so as to provide more precise treatment.We believe that without external restrictions such as casts,splints and compression bandages,the muscle-swelling syndrome can achieve self decompression by releasing the pressure in the compartment through tension blisters,and there is no need for fasciotomy.

Objective: To evaluate the possibility of transverse sacroiliac screw placement in different segments of the sacrum. Methods: Data of 80 pelvic CT scans (slice thickness ≤1.0 mm) archived in CT department of the Third Hospital of Hebei Medical University from September 2016 to October 2017 were retrospectively collected. Mimics software was used to rebuild the pelvis three-dimensional model. According to whether the sacral 1(S₁) segment could place the transverse sacroiliac screws or not, all the sacrums were divided into normal group (n=55) and dysmorphic group (n=25). Simulation the S₁, sacral 2(S₂) transverse sacroiliac screw placement in 3-Matic software. Analysis whether there was any difference in maximum diameter and length of S₂ transverse sacroiliac screw between the normal group and the dysmorphic group. The pelvic CT data of the dysmorphic group were measured, and the optimal tilt angle and length of the oblique S₁ screw were obtained. The feasibility of transverse sacroiliac screw insertion in sacral 3(S₃) segment was evaluated.t-test, rank sum test, and χ² test was used to analyze data, respectively. Results: In the dysmorphic group, the largest diameter of the S₁ transverse screw was (4.9±1.6)mm, and the normal group was (13.6±3.6)mm (t=-15.07, P=0.00). In the dysmorphic group, the largest diameter of S₂ transverse screw was (13.8±3.0)mm, and was (12.4±2.2)mm in the normal group(t=2.11, P=0.04). There was no significant difference in the length of S₂ transverse sacroiliac screw between the two groups (t=0.47, P=0.64). In the dysmorphic group, the anterior vertebral height of S₁ was (23.1±4.0)mm, which was significantly higher than that of the normal group ((14.1±4.2)mm)(t=9.01, P=0.00). The angle of S₁S₂ in the dysmorphic group was 10.9°(3.8°, 17.6°), which was significantly larger than that of the normal group (2.0°(1.0°, 2.0°) (Z=-4.03, P=0.00). In the dysmorphic group, the incline angle of the oblique S₁ sacroiliac screw was (35.6±6.2)°, the anteversion angle was (37.2±4.4)°, and the mean screw length was (90.2±4.7)mm. In the dysmorphic group, the placement rate of S₃ transverse sacroiliac screw was 48.0%, and that of the normal sacral group was 9.1%. Conclusions There is often dysmorphic in the sacrum in patients with large S₁ anterior vertebral height and S₁S₂ angle. Sacral dysmorphic patients with posterior pelvic ring injury may be treated with S₁ pedicle oblique sacroiliac screws. S₃ transverse sacroiliac screws should be carefully placed, especially for the absence of sacral dysmorphic in patients.

Objective To investigate the clinical effect of homeopathic reduction with minimally invasive adjustable plate in treatment of sacral fractures.Methods A retrospective case-control study was conducted to assess the data of 89 patients with sacral fractures treated from January 2013 to January 2015.There were 49 males and 40 females,with a mean age of 37.8 years (range,18-70 years).Denis classification was type Ⅰ in 24 patients,type Ⅱ in 48,and type Ⅲ in 17.Patients were divided into three groups according to fixation methods:homeopathic reduction with minimally invasive adjustable plate group (Group A,n =30),sacroiliac screw group (Group B,n =31) and iliolumbar rod group (Group C,n =28).Operation time,blood loss,intraoperative radiographic time,and complications were recorded.Reduction quality was assessed using the Matta criteria.Bone healing was evaluated based on X-ray appearance.Functional outcome was evaluated using the Majeed score at last tollow-up.Results Operation time was significantly lower in Group A [(109.3 ± 14.4) min] and Group B [(114.2 ± 17.7) min] than Group C [(126.8 ± 15.7)min] (P ＜ 0.05),but there was no significant difference between Groups A and B (P ＞ O.05).Blood loss was significantly lower in Group A [(433.3 ± 121.3)ml] and Group B [(461.3 ± 130.8)ml] than Group C [(785.7 ±205.0)ml] (P ＜0.05),but there was no significant difference between Groups A and B (P ＞ 0.05).Radiographic time was (5.6 ± 1.9) s in Group A,(13.4 ± 3.1)s in Group B,and (8.4 ± 2.5)s in Group C,showing significant difference among the three groups (P ＜ 0.05).Excellence rate of Matta score in Group A [70％ (21/30)] and Group C [86％ (24/28)] was higher than that in Group B [32％ (10/31)],but the there was no significant difference between Group A and C (P ＞ 0.05).Fracture healing was found in all patients and no nonunion was observed.Excellent rate of Majeed score in Group A [80％ (24/30)] and Group C [82％ (23/28)] was higher than that in Group B [54％ (17/31)],but the there was no significant difference between Groups A and C (P ＞0.05).Complication rate in Group B [29％ (9/31)] and GroupC [29％ (8/28)] were higher than that in Group C [3％ (1/30)],but the there was no significant difference between Groups B and C (P ＞ 0.05).Conclusion For sacral fractures,homeopathic reduction with minimally invasive adjustable plate can reduce operation time and intraoperative radiographic time,improve reduction rate and lower incidence of complications.

Objective To explore the safety and clinical efficacy of radical transurethral photoselective vaporization of bladder tumours (RPVBT) combined with chemotherapy in the treatment of muscle invasive bladder cancer.Methods Collected during Sept.2010 to Sept.2012,a total of 34 patients with muscle invasive bladder cancer who refuse or older,merge the heavier medical disease,difficult to tolerate radical cystectomy.Using RPVBT,vaporization resection to the bladder wall fat layer,postoperatively systemic chemotherapy of gemcitabine combined cisplatin and bladder perfusion chemotherapy of pharmorubicin.The operation time、the first recurrent time and recurrent rate,and the survival rate were measured.Results Operation are completed smoothly,operating time is 30.5-69.0 min and average 49.2 min,intraoperative rinses quantity is 5.9-10.7 L and average 8.3 L.Intraoperative no obvious bleeding,intraoperative no serioue complications,postoperative pathological diagnosis is invasive epithelial cell carcinoma of the urinary tract,pathology classification:low level 15cases,the high level 19 cases.Followup of 12 to 36 months,an average of 21 months,9 cases of recurrence,2 cases underwent radical cystectomy,7 cases again RPVBT,the first tumor recurrence time 3-20 months,11 months and the median time to relapse recurrence rate 26.5％ (9/34),3 cases of relapses diedof bladder cancer metastasis,31 cases of survival.Conclusion Treatment of RPVBT combination chemotherapy in patients with locally invasive bladder cancer,small trauma,less bleeding,high safety,have certain curative effect,It could be a effective treatment strategy for patients of high-risk elderly or unwilling to accept Radadical cystectomy.

ObjectiveTo investigate the ideal method of neoadjuvant hormonal therapy (NHT) for locally advanced prostate cancer.MethodsSixty cases of patients diagnosed with locally advanced ( T3 -T4 N0M0) prostate cancer were treated with NHT combined with intensity modulated radiotherapy (IMRT),They were randomly divided into 3 groups with 20 cases in each group.Group A with NHT 2 weeks,Group B with NHT 3 months,Group C with NHT 6 months.Endocrine duration began with NHT until 12 months after the end of IMRT.The PSA and prostate volumes were detected by transrectal ultrasound and Qmax was tested after NHT and every 3 months after IMRT.Results After NHT,the median PSA of different groups were decreased to 24.88,0.20 and 0.07 μg/L,respectively.There was significant difference ( P ＜ 0.05 ).The prostate volume in groups B and C reduced significantly ( P ＜ 0.05 ).The group B reduced 20.8％ and the group C reduced 39.5％.The Qmax of group B and C were ( 11.70 ± 2.81 ) and ( 14.45 ±2.61 ) ml/s respectively.After 12 months of endocrine combined with IMRT:(①)PSA.There was significant difference (P ＜0.01 ) with group C ＜ group B ＜ group A.②The prostate volume.The reducing of groups B and C were more obvious than group A ( P ＜ 0.01 ).There was no significant difference between group B and group C ( P ＞ 0.05).③Qmax.There was significant difference (P ＜ 0.01 ) among the 3 groups with group C ＞ group B ＞ group A.ConclusionsNHT combined with IMRT is an ideal method for locally advanced prostate cancer.The NHT time before IMRT treatment should last at least 3 months.

Objective To investigate ideal solution of neoadjuvant hormomal therapy (NHT) for locally advanced prostate cancer.Methods 60 patients diagnosed with locally advanced (T3-4N0M0) prostate cancer were treated with NHT.They were randomly divided into 3 groups of 20 cases.A group:NHT 2 weeks,B group:NHT 3 months,C group:NHT 6 months.Results The median PSA of A,B and C group after NHT were 24.88 (6.62-55.86),0.20 (0.05-12.07) and 0.07 (0.01-2.01) ng/ml,respectively.There was statistically significance compared with those in untreatment ( all P =0.00).There was statistically significant (P =0.00)among groups.The prostate volume of A,B and C group were (49.50+14.19),(47.35±17.99) and (36.15±7.17)ml,respectively.There was statistically significance in the B and C group compared with that in untreatment (P =0.04,0.00).There was statistically significant between A and C group and between B and C group (P =0.00,0.01).The Qmax of A,B and C group were (8.75±2.15),(11.7±2.81) and (14.45±2.61) ml/s,respectively.There was statistically significance in the B and C group compared with untreatment (both P =0.00).There was statistically significance among groups (all P =0.00).Conclusion The NHT time should last at least 3 months in order to reduce PSA and prostate volume and to increase the Qmax.