| BackgroundHolistic view of traditional Chinese medicine is the understanding of integrity,unity and item about people,things and phenomena,which emphasizes man is an organic whole,and the integrity of a part.It believes that the local is the whole local,rather than isolated local,lesion of the local morphological structure can affect the whole,and lead to the lesion of the overall structure and function.From the holistic view,ilium can be taken as a whole,which has an irregular fan shape,by the ilium,the iliac wing(internal and external plate),iliac crest,such as composition.Structure and function of each part are different,but not isolated,unrelated to each other,as the body organs are connected to each other,such as iliac wing fractures often by ilium body spread or extends to the iliac crest,and anatomic reduction of the iliac crest often indicates a good reduction of the iliac wing.The structure and function of each part are parts of the whole,and are the basics of normal physiological function of ilium.At the same time the ilium as a local part of the hip or pelvis,the developed gluteus muscle attachment to its facies lateralis,which plays an important role to hip joint stability and activity.The medial front part forms the boundary of the great pelvis,which protects the important blood vessels,nerves and some organs in the abdominal cavity.The posterior auricle forms the sacroiliac joint with the sacrum.The distal iliac crest is fused with the ischium and pubic bone to form the acetabulum.With the social progress and development,the construction industry and transportation industry have been rising steadily,and the number of patients with pelvic and acetabular fractures caused by high energy is increasing.At present,the clinical treatment of pelvic and acetabular fractures focuses on the restoration of the stability of the pelvic ring,the matching relationship between the head and the socket of the hip joint,and the leveling of the joint surface,so that patients can achieve better recovery of hip joint function.Iliac wing fractures may occur alone or as part of pelvic or acetabular fracture.Iliac wing fractures alone account for 2.2%of pelvic fractures,and are mostly simple fractures,which often do not affect the stability of the pelvic ring or the formation of the joint surface,and therefore have not attracted enough attention from clinicians.But iliac fracture can also lead to lesions of the structure and function of the pelvis and acetabulum,and the clinical reset sequence of pelvic and acetabulum fractures is from the near to the distant,the proximal bone block is template about distal fracture block,this means that when the acetabulum fractures with iliac fractures,the proximal(iliac)bad reduction will enlarge the remote(acetabulum)degree of displacement of fracture,therefore in the process of such fracture reduction,accurate reduction of the proximal(iliac)bone is necessary to facilitate reduction of the distal(acetabular)fracture.But at the moment,only for such fracture clinical evaluation of acetabulum fracture restoration,ignored the quality of iliac fracture reduction,as a result,the reduction of acetabular fracture was not good enough according to the Matta standard in many patients with poor reduction of iliac fracture,which significantly affected the clinical efficacy of acetabular fracture.Therefore,it is reasonable to believe that in the treatment of acetabular fractures,not only the local reduction quality of acetabular fractures should be valued,but also the reduction of proximal iliac fractures should be valued.The iliac fractures should be treated as intra-articular fractures to achieve accurate reduction,which is the same as acetabular fractures.The Matta criteria is ofen used to evaluate the quality of postoperative reduction of pelvic fractures,including iliac crest fractures,emphasizes counterpoint but ignores alignment.This is due both to the neglect of the holistic view of pelvis and to the lack of anatomic data within the iliac crest.At present,due to the lack of data on the overall shape of the ilium,the existing anatomical parameters can no longer be used to guide clinical treatment of ilium fractures,and more detailed anatomical data are urgently needed.However,due to the special structure of the ilium,it is impossible to directly measure the anatomical data with compasses,protractor and other conventional tools to further supplement the anatomical data.To this end,on the basis of summarization of previous research experience,we selected the original images of intact adult pelvis scanned by CT in our hospital,and established a three-dimensional pelvic model with the help of digital medical software to carry out anatomical research on the overall morphology of the iliac bone and the surrounding bone,providing theoretical support for clinical reduction of iliac bone fractures.Part oneInfluence of degree of iliac fracture reduction on postoperative effect of acetabular high double-column fractureObjectiveBased on the holistic view theory,the position of the entire pelvis or hemipelvises during acetabular fractures will affect the quality of intraoperative reduction,rather than focusing on the acetabular portion alone.For acetabular fractures involving the ilium,the degree of acetabular reduction is often evaluated clinically using the Matta standard,but the iliac reduction is not compared with the situation,focusing on the local rather than the whole.This study will retrospectively analyze the quality of iliac and acetabular fractures,reduction in double-column fractures,and discuss the importance of iliac anatomical structure in acetabular fracture reduction.MethodsBetween January 2014 and December 2018,a series of 42 patients with acetabular fractures complicated with iliac wing(high anterior column)fractures were treated at our department.They were24 males 18 females,with a mean age 46.6 years(range,from 23 to65 years).By the Letournel-Judet classification,all the fractures were high double-column fractures and closed fractures.The delay from injury to surgery averaged 9.6 days(from 3 to 21 days).All cases were treated via the ilioinguinal approach with internal fixation with the technique of DAPSQ,and short plate fixation on the inner side of the iliac wing when necessary.After surgery,the reduction quality of iliac bone fracture and acetabular fracture was evaluated according to the standard of Matta radiology.The patients with excellent and poor reduction of iliac bone fracture were divided into two groups to compare the excellent and good rate of acetabular fracture reduction and its function in iliac bone fracture with different reduction quality.ResultsAll patients completed the operation successfully,and the reduction quality of iliac bone fracture was assessed according to the Matta evaluation criteria.All patients were divided into two groups: 30 patients in the iliac bone fracture reduction group with excellent reduction,and 12 patients in the iliac bone fracture reduction group with poor reduction.There were no statistically significant differences between the two groups in age,gender,injury to operation time,operation time,and intraoperative blood loss(P > 0.05).Postoperative quality of acetabular fracture reduction was evaluated according to Matta radiological criteria.The rate of excellent and good acetabular fracture reduction was86.7% in the excellent reduction group of iliac fracture and 41.7%in the poor reduction group of iliac fracture,and there were significant differences between the two groups(P<0.05).At the final follow-up,the modified Merle d 'aubigne-postel scoring system was used to evaluate the hip function of the affected side.The rate of excellent and good hip function was 90.0% in the excellent reduction group of iliac fracture and 50.0% in the poor reduction group of iliac fracture,and there were significant differences between the two groups(P<0.05).ConclusionAs part of the pelvis and acetabulum,the degree of iliac fracture reduction significantly affect the quality of acetabulum fracture reduction and its curative effect.When iliac fracture reduction is poor,acetabular fracture reduction and functional excellence rate is also low,suggesting that the recovery of ilium normal anatomic structure is the base of acetabulum fracture reduction,is of great significance in the treatment of acetabulum fracture,and is also the concrete embodiment of holistic view of traditional Chinese medicine in the acetabular fracture treatment.Part twoDigital measurement and clinical significance of normal adult iliac crest plane deflection AngleObjectiveBased on the holistic view,the normal structure of the ilium is the basis for its physiological function.The Matta standard is ofen used to evaluate the quality of postoperative reduction of iliac fractures,but the standard only emphasizes counterpoint,but ignores alignment.This is due both to the neglect of the holistic view of pelvis and to the lack of anatomic data within the iliac crest.In this study,the overall morphology of the iliac crest was observed and the digital measurement was performed on the three-dimensional CT reconstruction data of the complete pelvis of normal adults,so as to obtain the horizontal deflection angle of the normal adult,s iliac crest,providing anatomical reference for the clinical reduction of iliac fracture.MethodsPelvic CT scan data of 60 normal adults(120 sides)in our hospital from June 2016 to June 2018 were collected,including 30males(mean 44.0 years old)and 30 females(mean 48.9 years old).The3 D pelvic model was reconstructed and the iliac crest horizontal deflection angle was measured using Mimics 20.0 and Geomagic Studio12.0 software.ResultsThe horizontal plane of iliac crest is similar to "S".There were no significant differences in the above indices between the left and right sides of the pelvis(P>0.05).The deflection angles of the anterior-middle iliac crest between male and female(mixed left and right)were(134.58 ± 8.96)° and(131.77 ± 8.39)°,and the deflection angles of the mid-posterior iliac crest were(150.77 ±9.03)°and(148.19 ±8.64)°,respectively.And there was no significant difference between the two groups(P>0.05).The mid-posterior deflection angle was significantly larger than that of the anterior-middle deflection angle(P<0.001).ConclusionThe horizontal plane of normal adult iliac crest is similar to "S",but the mid-posterior deflection angle was significantly larger than that of the anterior-middle deflection angle,relevant data make up the lack of iliac bone anatomical parameters,which is conducive to the reduction and internal fixation of iliac bone fractures.Part threeDigital measurement of the Angle of inclination of the iliac wing relative to the quadrilateral surface and the radian of the iliac crestObjectiveBased on the holistic view,ilium has a special shape,and the second part of this thesis shows the iliac crest horizontal deflection angle was the result of looking down from the top.According to the clinical habits,in ilium,the lateral view is very important to make a clear definition of the special form of ilium,and there is no literature reported about the Angle of inclination of the iliac wing relative to the quadrilateral surface and the radian of the iliac crest.This research measured by digital anatomy,clear the Angle of inclination of the iliac wing relative to the quadrilateral surface and the radian of the iliac crest,which can be more comprehensive understanding of the form and the related parameters of ilium,clarify right iliac overall view,and provide anatomical parameters for evaluating iliac fracture on the line,and pelvic or acetabulum fracture reduction.MethodsPelvic CT scan data of 60 normal adults(120 sides)in our hospital from June 2016 to June 2018 were collected,including 30males(mean 44.0 years old)and 30 females(mean 48.9 years old).The Mimics 20.0 and Geomagic Studio 12.0 software were used to 3d reconstruct the pelvic data and the bone markers were selected to determine the lateral central axis of the quadrilateral surface,and the overall iliac crest inner lip,the anterior middle iliac crest inner lip and the posterior iliac crest outer lip were projected onto the corresponding plane respectively.The inclination Angle of different parts of the iliac wing relative to the quadrilateral surface and the radian of the iliac crest were measured.ResultsThere was no statistically significant difference between right and left in the inclination Angle of the inner plate of the iliac wing relative to the medial quadrilateral surface and the radian of the iliac crest(P>0.05).Between male and female(mixed left and right)relative to the medial quadrilateral surface the anterior inclination Angle of the iliac wing were respectively(144.32±5.35)° and(142.47±4.41)°,relative to the medial quadrilateral surface the middle inclination Angle of the iliac wing were respectively(130.41±3.57)° and(131.19±4.44)°,the radian of the anterior middle iliac crest inner lip were respectively(1.90±0.15)and(1.92±0.16),the radian of the posterior iliac crest outer lip were respectively(1.14±0.25)and(1.20 ± 0.20),and there waere no statistically significant differences(P>0.05).Between male and female relative to the medial quadrilateral surface the posterior inclination Angle of the iliac wing were(102.84±3.58)° and(106.61±3.00)°,and the radian of the overall iliac crest inner lip were respectively(2.90±0.16)and(2.72±0.13),respectively.There were significant differences between male and female(P<0.05).ConclusionDifferent parts of the inner wing of the normal adult ilium have different inclination angles relative to the quadrilateral surface,and the order from the largest to the smallest is the anterior inclination Angle,the medial inclination Angle,and the posterior inclination Angle of the iliac wing.Both the inner lip of the iliac crest and the outer lip of the iliac crest are curved in a circular arc,but with different curved radians.The relevant data make up for the deficiency of the anatomical parameters of the iliac crest,which is conducive to guiding the reduction and internal fixation of the iliac or acetabular fractures. |
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