EFFECT OF ILIOLUMBAR FIXATION IN PATIENTS WITH Tile C PELVIC INJURY AND ANALYSIS OF RELATIVE FACTORS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GE Zhenxin ¹ , WANG Ben ¹ , ZHANG Dongzheng ¹ , LIU Zhaojie ² , ZHANG Yinguang ² , JIA Jian ²

1The Graduate College of Tianjin Medical University, Tianjin, 300200, P.R.China;;
2Area III of Department of Orthopedic Trauma, Tianjin Hospital. Corresponding author: JIA Jian, E-mail: jiajian1969@yahoo.com.cn;

Corresponding author：

Keywords：

Pelvic injury; Spinal internal fixation system; Fracture internal fixation; Relative factor

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Objective To explore the relative prognostic factors of Tile C pelvic injury after iliolumbar fixation. Methods Between March 2007 and March 2010, 60 patients with Tile C pelvic injuries were surgically treated with iliolumbar fixation, including 39 males and 21 females with an average age of 37 years (range, 17-66 years). Of them, 27 cases were classified as Tile C1, 20 as Tile C2, and 13 as Tile C3. The preoperative injury severity score (ISS) was 12-66 (mean, 29.4). The time from injury to surgery was 2-25 days (mean, 8.1 days). Iliolumbar fixation was performed in all patients. Unconditional logistic analysis was used to analyze the relationship between the age, sex, body mass index (BMI), operation opportunity, the preoperative combined injury, classification of fracture, the postoperative complication, reduction outcome, sacral nerve injury, and the time of physical exercise and the prognosis. Results All 60 patients were followed up 12-56 months (mean, 27.3 months). Infection of incisions occurred in 12 cases and were cured after dressing change; healing of incision by first intention was obtained in the other patients. Delay sacral nerve injury was found in 15 patients, 6 patients underwent nerve decompression, and 9 underwent conservative treatment. Ten patients had nail protrusion of Schanz screws at the posterior superior illac spine, and 3 patients had pain, which was relieved after removal of the internal fixator. One patient had bone-grafting nonunion of sacroiliac joint, which was improved by pressured bone graft. Five patients had the beam breakage without significant effect. Six patients had deep vein thrombosis, among them 4 underwent filter and 2 underwent nonsurgical treatment. The healing time of fracture was 3-6 months (mean, 3.9 months). According to the Matta function score, the results were excellent in 31 cases, good in 24 cases, fair in 3 cases, and poor in 2 cases with an excellent and good rate of 91.7% at last follow-up. Majeed score was 58-100 (mean, 86), 28 were rated as excellent, 12 as good, 16 as fair, and 4 as poor with an excellent and good rate of 66.7%. The logistic analysis showed that the age, sex, BMI, and postoperative complications were not prognostic factors; early operation (within 10 days), early function exercises (within 7 days), the better reduction quality, and the less sacral nerve injury were in favor of prognosis; and the worse preoperative combined injury and pelvic injury were, the worse the prognosis was. Conclusion Operation opportunity, the preoperative combined injury, reduction outcome, sacral nerve injury, and the time of physical exercise are all significantly prognostic factors of Tile C pelvic injuries

Citation： GE Zhenxin,WANG Ben,ZHANG Dongzheng,LIU Zhaojie,ZHANG Yinguang,JIA Jian. EFFECT OF ILIOLUMBAR FIXATION IN PATIENTS WITH Tile C PELVIC INJURY AND ANALYSIS OF RELATIVE FACTORS. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(11): 1285-1290. doi: Copy

1.	Burgess AR. Fractures of the pelvis: Part I. the pelvic ring//Rockwood CA, Green DP, eds. Fractures in Adults. Philadelphia: JB Lippincott, 1996: 1399-1442.
2.	陈静, 王满宜, 张奇, 等. 三种内固定物固定骨盆后环损伤稳定性的生物力学比较. 中华骨科杂志, 2011, 31(11): 1232-1237.
3.	Papakostidis C, Kanakaris NK, Kontakis G, et al. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop, 2009, 33(2): 329-338.
4.	关骅, 石晶, 郭险峰, 等. 脊髓损伤神经学分类国际标准(2000年修订). 中国康复理论与实践, 2001, 7(2): 49-52.
5.	Tornetta P 3rd, Matta JM. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res, 1996, (329): 186-193.
6.	Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
7.	Tile M. Fractures of the Pelvis and Acetabulum. 3rd ed. Baltimore: Williams and Wilkins, 2003: 345.
8.	Barei DP, Shafer BL, Beingessner DM, et al. The impact of open reduction internal fixation on acute pain management in unstable pelvic ring injuries. J Trauma, 2010, 68(4): 949-953.
9.	陈红卫, 王子阳, 黄洪斌, 等. 经皮重建钢板与经皮骶髂螺钉固定治疗Tile C型骨盆后环骨折. 中华骨科杂志, 2009, 29(11): 1019-1022.
10.	黄涛, 庞清江, 张前法, 等. 不稳定型骨盆骨折的手术重建. 中国修复重建外科杂志, 2005, 19(7): 554-557.
11.	Tile M. Acute pelvic fractures: I. causation and classification. J Am Acad Orthop Surg, 1996, 4(3): 143-151.
12.	Tile M. Internal fixation. Fractures of the pelvis and acetabulum. 2nd ed. Baltimore: Williams and Wilkins, 1995: 189-193.
13.	贾健, 王建民, 何杨, 等. 骨盆损伤中移位骶骨骨折的手术治疗. 中华骨科杂志, 2009, 29(12): 1109-1115.
14.	Käch K, Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg, 1994, 97(1): 28-38.
15.	Jones CB, Sietsema DL, Hoffmann MF. Can lumbopelvic fixation salvage unstable complex sacral fractures? Clin Orthop Relat Res, 2012, 470(8): 2132-2141.
16.	Schildhauer TA, Bellabarba C, Nork SE, et al. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma, 2006, 20(7): 447-457.
17.	Kenzo U, Yasuo K, Takafumi Y, et al. Fracture of the pelvic ring: a retrospective review of 224 patients treated at a single institution. Eur J Orthop Surg Traumatol, 2011, 21(4): 251-257.
18.	Henderson RC. The long-term results of nonoperatively treated major pelvic disruptions. J Orthop Trauma, 1989, 3(1): 41-47.
19.	Schildhauer TA, Josten C, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma, 1998, 12(5): 307-314.
20.	Hoskins J, Lewis PB, Smith S, et al. Diagnosis and management of sacral fracture. Spine Surgery, 2011, 12(9): 1-8.
21.	Miranda MA, Riemer BL, Butterfield SL, et al. Pelvic ring injuries. A long term functional outcome study. Clin Orthop Relat Res, 1996, (329): 152-159.
22.	Sugimoto Y, Ito Y, Tomioka M, et al. Risk factors for lumbosacral plexus palsy related to pelvic fracture. Spine (Phila Pa 1976), 2010, 35(9): 963-966.
23.	Jang DH, Byun SH, Jeon JY, et al. The relationship between lumbosacral plexopathy and pelvic fractures. Am J Phys Med Rehabil, 2011, 90(9): 707-712.
24.	Tan GQ, He JL, Fu BS, et al. Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability. Injury, 2012, 43(8): 1318-1325.
25.	Suzuki T, Shindo M, Soma K, et al. Long-term functional outcome after unstable pelvic ring fracture. J Trauma, 2007, 63(4): 884-888.

1. Burgess AR. Fractures of the pelvis: Part I. the pelvic ring//Rockwood CA, Green DP, eds. Fractures in Adults. Philadelphia: JB Lippincott, 1996: 1399-1442.
2. 陈静, 王满宜, 张奇, 等. 三种内固定物固定骨盆后环损伤稳定性的生物力学比较. 中华骨科杂志, 2011, 31(11): 1232-1237.
3. Papakostidis C, Kanakaris NK, Kontakis G, et al. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop, 2009, 33(2): 329-338.
4. 关骅, 石晶, 郭险峰, 等. 脊髓损伤神经学分类国际标准(2000年修订). 中国康复理论与实践, 2001, 7(2): 49-52.
5. Tornetta P 3rd, Matta JM. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res, 1996, (329): 186-193.
6. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
7. Tile M. Fractures of the Pelvis and Acetabulum. 3rd ed. Baltimore: Williams and Wilkins, 2003: 345.
8. Barei DP, Shafer BL, Beingessner DM, et al. The impact of open reduction internal fixation on acute pain management in unstable pelvic ring injuries. J Trauma, 2010, 68(4): 949-953.
9. 陈红卫, 王子阳, 黄洪斌, 等. 经皮重建钢板与经皮骶髂螺钉固定治疗Tile C型骨盆后环骨折. 中华骨科杂志, 2009, 29(11): 1019-1022.
10. 黄涛, 庞清江, 张前法, 等. 不稳定型骨盆骨折的手术重建. 中国修复重建外科杂志, 2005, 19(7): 554-557.
11. Tile M. Acute pelvic fractures: I. causation and classification. J Am Acad Orthop Surg, 1996, 4(3): 143-151.
12. Tile M. Internal fixation. Fractures of the pelvis and acetabulum. 2nd ed. Baltimore: Williams and Wilkins, 1995: 189-193.
13. 贾健, 王建民, 何杨, 等. 骨盆损伤中移位骶骨骨折的手术治疗. 中华骨科杂志, 2009, 29(12): 1109-1115.
14. Käch K, Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg, 1994, 97(1): 28-38.
15. Jones CB, Sietsema DL, Hoffmann MF. Can lumbopelvic fixation salvage unstable complex sacral fractures? Clin Orthop Relat Res, 2012, 470(8): 2132-2141.
16. Schildhauer TA, Bellabarba C, Nork SE, et al. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma, 2006, 20(7): 447-457.
17. Kenzo U, Yasuo K, Takafumi Y, et al. Fracture of the pelvic ring: a retrospective review of 224 patients treated at a single institution. Eur J Orthop Surg Traumatol, 2011, 21(4): 251-257.
18. Henderson RC. The long-term results of nonoperatively treated major pelvic disruptions. J Orthop Trauma, 1989, 3(1): 41-47.
19. Schildhauer TA, Josten C, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma, 1998, 12(5): 307-314.
20. Hoskins J, Lewis PB, Smith S, et al. Diagnosis and management of sacral fracture. Spine Surgery, 2011, 12(9): 1-8.
21. Miranda MA, Riemer BL, Butterfield SL, et al. Pelvic ring injuries. A long term functional outcome study. Clin Orthop Relat Res, 1996, (329): 152-159.
22. Sugimoto Y, Ito Y, Tomioka M, et al. Risk factors for lumbosacral plexus palsy related to pelvic fracture. Spine (Phila Pa 1976), 2010, 35(9): 963-966.
23. Jang DH, Byun SH, Jeon JY, et al. The relationship between lumbosacral plexopathy and pelvic fractures. Am J Phys Med Rehabil, 2011, 90(9): 707-712.
24. Tan GQ, He JL, Fu BS, et al. Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability. Injury, 2012, 43(8): 1318-1325.
25. Suzuki T, Shindo M, Soma K, et al. Long-term functional outcome after unstable pelvic ring fracture. J Trauma, 2007, 63(4): 884-888.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECT OF ILIOLUMBAR FIXATION IN PATIENTS WITH Tile C PELVIC INJURY AND ANALYSIS OF RELATIVE FACTORS

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