The Surgical Treatment Of Posterior Pelvic Ring Fractures

Background and purpose：As the rapid development in the field of traffic, tall building and mining industry, thefrequency of pelvic fracture has been increasing year after year. Pelvic fracturebelongs to high energy trauma, and often accompanied by multiple injury, which maylead to high mortality and morbidity. The traditional treatments of pelvic fracture wereconservative treatment, such as traction, plaster, pelvic sling et al, which cannotrestore the pelvic anatomy relationship, gave rise to pelvic malunion. With thedevelopment of the clinical management of the pelvic fracture and the increasingdemand from pelvic fracture patient for better life quality, advent and applications ofnew implants, the treatment of pelvic fracture with open reduction and internalfixation has gained approval from both surgeons and patients. At present, the internalfixation methods available for posterior pelvic ring methods include:(1) the pelvisreconstruction plate;(2) sacroiliac screw;(3) the sacrum rods;(4) locking plate astension band;(5) lumbar-sacral-iliac screws combined support fixation;(6) Othercombined internal fixation method. The purpose of this study was to analyse theclinical outcomes of the different internal fixation method for the posterior pelvic ringfractures and explore the ideal surgical treatment.Research object and methods:Twenty-seven patients with posterior pelvic ring fractures received minimallyinvasive surgery in the department of orthopedic surgery of the first affiliatedhospital of Zhengzhou university from July2010to December2013were analyzedretrospectively. There were17males and10females with a mean age of41.5years (18to62years).10patients with17patients with male, female, average age was41.5years (18-62years). Injury causes are following: traffic accident injury (18cases),falling injury (4cases), crash injury(3cases), other injuries(2cases).According to theTile pelvic fractures classification, the fracture types were confirmed by both theimaging examination and intraoperative evaluation. The ype B2and B3were16cases and11cases respectively. There were limbs and spine fractures in5cases,7urinary system injury(5cases), traumatic brain injury (3cases), sacral nerve injury(2cases). Two patients were at shock at admission and received anti shock treatmenttimely. The patients with accompanied injures received related department consultation and treatment. With the stabilization of the vital signs and comprehensiveassessment of the patients, an internal fixation surgery was performed5-12days afterinjury. In group A,22patients received posterior percutaneous internal fixation withreconstruction plate as tension band, in group B,5patients underwent posteriorpercutaneous internal fixation with sacroiliac screws.Results:All the27patients finished the postoperative follow-up, with a average of约18±5.7months(from6to24months). The follow-up was performed with telephone callfor those who did not live in their home town. An AP view of pelvis X-ray wasobtained at the last follow-up. In group A, the average operation time was45.3±15.8min (36-68min), the average blood loss was67.1±16.7ml(52-95ml), the averageincision length was5.2±1.4cm(5-9cm), the average times for intraoperative X-rayexamination was1.5±0.5(1-3). In group B, the average operation time was173±21.9min (150-237min), the average blood loss was5.5±1.5ml(3-10ml), the averageincision length was2.5±0.9cm(2-3cm), the average times for intraoperative X-rayexamination was18.8±3.7(15-23). Majeed score results showed that excellent andgood rate was95.6%in group A(excellent:17, good:4, fair:1), and100%in groupB(excellent:3, good:2). The satisfactory fracture reduction was achieved for allpatients in both groups with the excellent and good rate of100%for Matta grading.All the patients had a primary incision healing and bony healing.Conclusions:Majeed grading is taken basing on patients self statement and could be influenced bythe self-awareness and self-control ability, so tends to be subjective. Basing on thecomprehensive consideration of the surgical result, surgical adaptability, surgicalsafety and the convenience, it may be concluded that the posterior percutaneousinternal fixation with reconstruction plate as tension band is superior in the surgicaltreatment of the posterior pelvic ring fractures.