Clinical Research Of Iliolumba Fixation In The Treatment Of Posterior Pelvic Ring Injury

Objective:To analysis the results of follow-up and clinical data in patients of posterior pelvic ring injury treated with iliolumbar fixation, evaluate the value of intraoperative decompression for neurologic recovery.Methods:From January2006to December2011, the clinical data of18cases injuried the posterior ring of pelvis undergoing iliolumbar fixation treatment were analyzed retrospectively. There were12males and6females,their ages ranging from19to54years with an average of34.5years old. The causes of injury included traffic accidents in8patients, crush in6patients and fall from height in4patients. According to the Tile classification, there were1in B2type,1in B3type,5in C1type,6in C2type,5in C3type. Accompanied by the sacral fractures in15cases. Sacral fracture according to the Denis classification, â… 1cases, â…¡3cases, â…¢11cases(U-shaped fractures in5cases, H-type fracture6cases).13cases injuried the anterior ring of pelvis, diastasis of the symphysis pubis6cases, fracture of superior and inferior ramus of pubis7cases, acetabular fractures2cases. Associated injuries:L5transverse process fractures10cases, thoracic vertebra fracture1case, lumbar vertebra fracture3cases, limb fractures6cases, Splenic rupture2cases, liver rupture1case, fracture of ribs3cases, hemopneumothorax1case, pneumothorax2case, head injury4cases. Urinary system injury3cases, sacral plexus injury12cases. The posterior pelvic ring injury of all cases were treated by iliolumbar fixation. Postoperative radiological assessment included pelvic X-ray, CT and three dimensional CT Reconstruction. Maximum residual displacement in various directions were recorded and graded according to the method of Tornetta and Matta. The functional outcomes were evaluated using the Majeed score. Neurologic deficits were classified according to Gibbons.Using SPSS17.0statistical software process the data of preoperative and postoperative Gibbons score. Using the paired t test to compare metering data. P <0.05difference is statistically significant.Results:The time from trauma to iliolumbar fixation was2-42days, the mean time was9days. The mean operative time was140min (range,90-210min). The mean estimated blood loss during the operation was1030ml (range,400-2400ml).No one was lost to the follow-up.One patient developed superficial wound infections which was resolved with dressing changes and antibiotics. All fractures went on to union. Secondary loss of reduction or hardware failure did not occur. The mean time to full weight bearing was7weeks (range,3-13weeks). In patients with neurologic impairment, one patient did not improve, the others had partial to full neurologic recovery, the average Gibbons score improved from3.4preoperatively to2.1after the operation, preoperative and postoperative differences in paired comparison is statistically significant (P<0.05). Radiographically, According to Tornetta and Matta criterion, eight were excellent, eight good, one fair, and one poor, the excellent and good rate was88.9%. According to the Majeed functional scoring,the mean score was80points (range,48-94points), which were graded as follows:6, excellent;9, good;2, fair; and1, poor, the excellent and good rate was83.3%.Conclusions:Iliolumbar fixation simulates the the normal load transfer of posterior pelvic ring,has good biomechanical stability, the fixation is reliable, allow patients early weight-bearing exercise, the operation is relatively simple, a lower rate of complications, can well restore stability of the posterior ring of pelvis, especially suitable for patients of posterior pelvic ring injury with serious sacral fractures(H, U-comminuted sacral fractures), the functional and radiological results are very good. Patients with sacral nerve injury, intraoperative Sacral decompression can improve the symptoms of sacral nerve injury.