A retrospective study of 65 cases of huge sacrococcygcal teratomas were surveyed. The long term functional prospect of the benign tumor was excellent. The characteristics of the normal and pathological anatomy of the pelvic floor were mentioncd. Based on these, the authors described some personal experiences of the procedures, and discussed some problems of the reconstruction of the pelvic floor.
Objective To evaluate the sensitivity， specificity, and accuracy of magnetic resonance imaging （MRI） in characterizing adnexal masses. Methods The databases such as the Cochrane Library, PubMed， EMbase， CNKI， and WanFang Data were searched on computer from 1991 to 2011. The reviewers screened the trials according to inclusion and exclusion criteria strictly, extracted the data， and assessed the methodology quality. Meta-analysis were performed using the Metadisc 1.40 software. The acquired pooled sensitivity, specificity， and summary receiver operating characteristic curve （SROC） were used to describe the diagnostic value. The pooled likelihood ratios were calculated based on the pooled sensitivity and specificity. Results Ten case-control studies involving 649 women who were suspected to have pelvic masses were included and 729 masses were confirmed by the postoperative histopathology. The pooled statistical results of meta-analysis showed that：the sensitivity and specificity of MRI were 〔89%（84%-92%）， P=0.046 6〕 and 〔87% （83%-90%）， P=0.000 2〕 respectively, the positive and negative likelihood ratios of MRI were 6.25（P=0.008 5） and 0.14（P=0.029 1） respectively, and the area under the SROC curve （AUC） was 0.941. The sensitivity and specificity of ultrasound were 〔87%（82%-91%）， P=0.000 0〕 and 〔73%（69%-77%）, P=0.000 0〕 respectively, the positive and negative likelihood ratios of MRI were 3.07（P=0.000 0） and 0.18（P=0.000 1） respectively， and the AUC was 0.897. The speci?city and accuracy of MRI in characterizing female pelvic masses were higher than ultrasound obviously. Conclusion According these evidences， the MRI should be recommended to the women who are suspected to have pelvic masses as a preferred.
【Abstract】 Objective To evaluate the effectiveness of percutaneous fixation with il iosacral screw in the management of unstable pelvic fractures. Methods From March 2003 to January 2007, 15 patients with unstable pelvic fractures were treated by percutaneous fixation with il iosacral screws. There were 6 males and 9 females, aged 21-56 years. Fractures were caused by traffic accident in 8 cases, high fall ing in 6 cases and crushing injury in 1 case. The disease course ranged from 4 hours to 3 days. Of 15 patients, 7 had fractures of pubium and sacrum; 2 had fractures of il ium and sacrum; 4 had dislocation of sacroil iac joint with fractures of pubic rami; and 2 had dislocation sacroil iac joint with fracture of sacrum of pubium. Anterior fixation was performed by means of plating in 3 cases, by external fixation in 7 cases, and by both in 5 cases. Results The blood loss was from 1 000 to 1 500 mL in 4 patients with acetabular fracture and about 50 mL in the others. The average operative time was 153.6 minutes (range, 60-305 minutes). Fifteen patients were followed up 6 months to 3 years with an average of 18months. According to Matta criterion for fracture reduction, the results were excellent in 14 cases and good in 1 case. After a follow-up of 28.8 months, fracture union was achieved in all patients. Screw loosening occurred in 1 case, pain of lumbosacral region in 3 cases after tiredness and mild claudication in 2 cases. Nine patients returned to their occupation, three patients changed occupation, and 3 patients could not work at last follow-up. According to Majeed functional scoring, the results were excellent in 11 cases and good in 4 cases. Conclusion Percutaneous il iosacral screw fixation is a useful method in treatment of unstable pelvic fracture.
ObjectiveTo explore the value of recombinant inferior vena cava filter (IVCF) in the prevention of perioperative pulmonary embolism in patients with lower limb or pelvic fracture combined with deep venous thrombosis (DVT).MethodsThe clinical data of 168 patients with lower limb or pelvic fracture combined with DVT were analyzed retrospectively.ResultsThe filters were successfully implanted in 168 patients, and the recoverable filters were removed after (48.3±4.8) d (14–97 d). The filters were removed successfully in 159 cases, and the removal rate was 94.6%. Sixty-one cases were found to have thrombus on the filter after contrast examination or removal of vena cava filter, that is, the thrombus interception rate was 36.3%.ConclusionFor patients with lower limb or pelvic fracture combined with DVT, the rechargeable vena cava filter can effectively stop thrombosis and avoid pulmonary embolism.
Objective To investigate the biomechanical differences of three internal fixation approaches, namely improved Galveston (IG), reconstruction plate (RP), and il iosacral screw (LS) to the posterior pelvic ring fracture dislocation and provide experimental evidence for the cl inical appl ication of proper internal fixation method. Methods Six donatedfresh adult cadaver pelvic specimens (age averaged 45 years old) were numbered randomly and their normal biomechanics were tested by the measure instrument (MTS855 Mini-Blonix). The displacement values of normal pelvis were measured under the vertical compression (800 N) and reverse direction compression (8 N·m). Then they were made into left Denis I pelvic fracture and fixed with the IG, RP, and LS, respectively, in different orders. Biomechanics test was conducted on the fixed pelvis from both the vertical and the reversed directions. Results Concerning the direction of vertical ity and torsion, the order of fracture displacement from small to large was the normal pelvis, LS, IG and RP. There was no significant difference between LS and the normal pelvis (P gt; 0.05), and the differences between other tow groups were significant (P lt; 0.05). Conclusion The LS fixation can provide better stabil ity for posterior pelvic ring fracture dislocation when compared with IG and RP.
Objective To investigate the effectiveness of modified internal fixator (INFIX) to fix the anterior pelvic ring for Tile C1.3 pelvic fracture by comparing with the traditional INFIX. MethodsThe patients with Tile C1.3 pelvic fractures admitted between April 2018 and June 2021 were taken as the study objects. Of them, 55 cases were included in the study according to the selection criteria. During operation, the anterior pelvic ring was fixed with the modified INFIX in 30 cases (modified group) and with the traditional INFIX in 25 cases (control group). The posterior pelvic ring in 55 cases was fixed with sacroiliac screws. There was no significant difference between the two groups in gender, age, cause of injury, time from injury to operation, and combined injury (P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. The X-ray film was taken to evaluate the reduction of the anterior pelvic ring after operation, grade the reduction according to the Matta scoring standards, and observe the fracture healing and healing time. The function was evaluated according to Majeed scoring standards during follow-up. Results The operation time of the modified group was significantly longer than that of the control group (Z=–3.837, P<0.001), but there was no significant difference in the intraoperative blood loss between the two groups (t=–1.831, P=0.076). All patients were followed up 12-18 months (mean, 14 months). X-ray film reexamination showed that the excellent and good rate of Matta scoring for anterior pelvic ring reduction in the modified group was 88.00%, which was significantly better than that in the control group (63.33%) (χ2=4.373, P=0.037). All fractures healed, and the fracture healing time of the modified group and the control group was (12.04±3.59) and (14.83±4.83) weeks respectively, with a significant difference (t=2.401, P=0.020). At last follow-up, the excellent and good rates of Majeed scoring were 80.00% in the modified group and 76.67% in the control group, with no significant difference (χ2=0.089, P=0.766). In the modified group, 2 cases (8%) had complications, all of which were incision infection above pubic symphysis. In the control group, 9 cases (30%) had complications, including 5 cases of lateral femoral cutaneous nerve injury, 2 cases of femoral nerve paralysis, and 2 cases of delayed fracture healing. The incidence of complications was significantly lower in the modified group than in the control group (χ2=4.125, P=0.042). ConclusionCompared with the traditional INFIX, the modified INFIX to fix the anterior pelvic ring for Tile C1.3 pelvic fracture has fewer complications, better stability, shorter fracture healing time, and lower risk of nerve injury.
Objective To investigate the effectiveness of 5G remote robotic surgery in the treatment of pelvic fractures. Methods A retrospective analysis was conducted on the clinical data of 160 patients with pelvic fractures admitted between July 2023 and June 2024 who met the selection criteria. Among these patients, 80 underwent internal fixation surgery with the assistance of 5G remote robotic surgery (5G group), while 80 received local robotic surgical assistance (control group). Baseline characteristics, including gender, age, body mass index, disease duration, cause of injury, and fracture classification, were compared between the two groups, and no significant difference was found (P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, accuracy of screw placement, maximum residual displacement postoperatively, quality of fracture reduction, incidence of complications, Majeed pelvic function score and classification at last follow-up were recorded and compared between the two groups. Results In the 5G group, 180 screws were implanted during surgery, while 213 screws were implanted in the control group. The 5G group demonstrated significantly reduced intraoperative blood loss and shorter incision length compared to the control group (P<0.05). No significant difference was observed between the two groups in terms of operation time or hospital stay (P>0.05). Radiographic evaluation revealed excellent and good reduction rates of 98.8% (79/80) in the 5G group and 97.5% (78/80) in the control group, while excellent and good screw placement accuracy rates were 98.3% (177/180) in the 5G group and 95.8% (204/213) in the control group. No significant difference was found between the two groups in maximum residual displacement, reduction quality, or screw placement accuracy (P>0.05). All patients were followed up 7-16 months (mean, 11.3 months), with no significant difference in follow-up duration between the groups (P>0.05). No perioperative or follow-up complication, such as wound infection, iatrogenic fractures, iatrogenic neurovascular injury, screw loosening or breakage, or nonunion, were observed in either group. The control group exhibited a worse degree of gait alteration compared to the 5G group (P<0.05), while no significant difference was found in incidences of squatting limitation or persistent pain (P>0.05). At last follow-up, no significant difference was observed between the groups in Majeed pelvic function scores or grading (P>0.05). Conclusion Compared with the local surgery group, 5G remote robotic surgery supported by remote expert technical guidance demonstrated smaller incision lengths, less intraoperative blood loss, and fewer postoperative complications, and was shown to be a precise, minimally invasive, safe, and reliable surgical method.
Objective To evaluate the effectiveness of lumbopelvic fixation using the combination of closed multi-axial screws (CMAS) iliosacral fixation system and the posterior segmental spinal fixation for unstable sacral fractures. Methods Between January 2013 and November 2014, 25 patients (39 sides) with unstable sacral fractures were treated with lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation. There were 17 males and 8 females, aged 19-55 years (mean, 33.9 years). The causes were traffic accident injury in 15 cases, falling injury from height in 8 cases, and crushing injury in 2 cases. The interval of injury and operation was 1-13 days (mean, 3.5 days). Fracture was classified as Denis type I in 2 sides, type II in 20 sides, and type III in 17 sides; nerve injury was rated as Gibbons grade I in 2 cases, grade II in 2 cases, grade III in 7 cases, and grade IV in 9 cases. The reduction quality was evaluated by Matta criterion, the clinical function outcome by Majeed, and nerve function by Gibbons criterion. Results The average operation time was 110 minutes (range, 80-150 minutes). The average blood loss was 570 mL (range, 250-1 400 mL). Superficial wound infection occurred in 2 patients, and was cured after debridement and antibiotic therapy. All patients were followed up for an average of 18 months (range, 15-22 months). Postoperative X-ray and CT examination showed clinical healing of sacral fractures at 8-12 weeks after operation (mean, 10 weeks). The mean removal time of internal fixation was 13 months (range, 12-20 months). No screw loosening and fracture, adhesion of internal fixation to surrounding tissue, and obvious electrolysis phenomenon occurred. According to Matta criterion, reduction was rated as excellent in 32 sides, good in 6 sides, fair in 1 side, and the excellent and good rate was 97.5%. According to Majeed functional scoring at last follow-up, the mean score was 84.7 (range, 64-98); the results were excellent in 18 cases, good in 5 cases, and fair in 2 cases, and the excellent and good rate was 92.0%. The nerve function was significantly improved when compared with preoperative one; nerve injury was rated as Gibbons grade I in 8 cases, grade II in 8 cases, grade III in 3 cases, and grade IV in 1 case. Conclusion Lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation is a relatively effective fixation for unstable sacral fractures. Not only is the fracture fixation rigid for early full weight-bearing, but also nerve decompression can be performed which facilitates nerve function recovery.
Objective To evaluated the application effect of reverse digital modeling combined with three-dimensional (3D)-printed disease models in the standardized training of orthopedic residents focusing on pelvic tumors. Methods From August 2022 to August 2023, 60 orthopedic residents from West China Hospital, Sichuan University were randomly assigned to a trial group (n=30) and a control group (n=30). The trial group received instruction using reverse digital modeling and 3D-printed pelvic tumor models, while the control group underwent traditional teaching methods. Teaching outcomes were evaluated and compared between groups through knowledge tests, practical skill assessments, and satisfaction surveys. Results Before training, there was no statistically significant difference in knowledge tests or practical skill assessments between the two groups (P>0.05). After training, the trial group showed significantly better performance than the control group in knowledge tests (90.5±5.2 vs. 78.4±6.8, P<0.05), skill assessments (92.7±4.9 vs. 81.3±6.2, P<0.05), and satisfaction surveys (9.40±1.10 vs. 7.60±1.20, P<0.05). One month after training, the trial group still showed significantly better performance than the control group in knowledge tests (88.1±6.4 vs. 72.3±7.1, P<0.05) and skill assessments (90.3±5.8 vs. 75.6±6.9, P<0.05). Conclusions Reverse digital modeling combined with 3D printing offers an intuitive and effective teaching approach that improves comprehension of pelvic tumor anatomy and strengthens clinical and technical competencies. This method significantly enhances learning outcomes in standardized residency training and holds promise for broader integration into medical education.
ObjectiveTo systematically review the efficacy and safety of laparoscopic pyeloplasty (LP) versus open pyeloplasty (OP) for patients with ureterpelvic junction obstruction (UPJO). MethodsWe electronically searched databases including PubMed, The Cochrane Library (Issue 11, 2015), Sciverse, VIP, WanFang Data and CNKI from inception to Dec., 2015, to collect randomized controlled trials (RCTs) and non-randomized clinical controlled trials (CCTs) about LP versus OP for UPJO patients. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 38 studies including 8 RCTs and 30 CCTs were included. The results of meta-analysis based on RCTs showed that, there were no significant differences in successful operation rate (OR=0.50, 95%CI 0.20 to 1.24, P=0.13) and the incidence of postoperative complications (OR=1.19, 95%CI 0.61 to 2.31, P=0.62) between the OP group and the LP group; The operation time of the OP group was shorter than that of the LP group (MD=62.07, 95%CI 3.94 to 120.19, P=0.04), but this difference was not found in subgroup analysis of retroperitoneal approach (MD=49.99, 95%CI -23.69 to 123.67, P=0.18); The hospital stay of the LP group was shorter than that of the OP group (MD=-3.96, 95%CI -4.92 to -2.99, P<0.0001). The results of meta-analysis based on CCTs showed that, there was no significant difference in successful operation rate between two groups (OR=1.34, 95%CI 0.84 to 2.16, P=0.22), and similar results were found in subgroup analysis of transperitoneal or retroperitoneal approaches; The incidence of postoperative complications of the LP group was shorter than that of the OP group (OR=0.51, 95%CI 0.37 to 0.69, P<0.0001); The hospital stay of the LP group was shorter than that of the OP group (MD=-3.87, 95%CI -4.90 to -2.83, P<0.00001) and similar result was found in subgroup analysis of transperitoneal approach (MD=-4.08, 95%CI -5.21 to -2.95, P<0.0001); There was no significant difference between two groups in operation time (MD=24.15, 95%CI -7.56 to 55.87, P=0.14). ConclusionCurrent evidence shows that, the successful operation rate between LP and OP operations is similar, but the LP operation has less incidence of postoperative complication and shorter hospital stay. Due to limited quality of the included studies, the above conclusion needs more high quality studies to verify.