Shetty Ajoy Prasad, Bosco Aju, Perumal Ramesh, Dheenadhayalan Jeyaramaraju, Rajasekaran Shanmuganathan
Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Medical Centre and Hospital, 313 Mettupalayam Road, Coimbatore - 641043, India.
J Clin Orthop Trauma. 2017 Jul-Sep;8(3):241-248. doi: 10.1016/j.jcot.2017.05.009. Epub 2017 Jun 10.
Anterior pelvic external fixation is associated with pin site infections, aseptic loosening with loss of reduction, frame bulkiness hindering patient mobilization and consequent difficulties in inpatient nursing. We performed a single-center prospective series to evaluate the feasibility, safety, limitations and midterm radiologic and functional outcomes of an alternative minimally invasive pelvic internal fixation technique using an anterior subcutaneous pelvic internal fixator (INFIX) and percutaneous iliosacral screws in unstable pelvic ring fractures.
Fifteen consecutive patients with vertically and/or rotationally unstable pelvic fractures, presenting to a Level-1 trauma center were treated with closed reduction, appropriate posterior stabilization with percutaneous iliosacral screws and anterior INFIX application. Outcomes were analyzed with respect to the quality of fracture reduction (Matta's radiologic criteria), ease of inpatient nursing, patient mobility and comfort, functional outcomes at final follow-up (Majeed score, SF-12 score), social reintegration and complications.
Most common injury pattern was AO/OTA type 61-C pelvic fracture in thirteen patients. Mean procedure time and intra-operative blood loss were, 57.1+/-4.9 min (range,51-68 min) and 115.3+/-26.7 ml (range,80-170 ml) respectively. Mean follow-up was 34.9+/-4.1 months (range,31-42 months). Fracture reduction was excellent in twelve and good in three patients (Matta's criteria). Functional outcomes were excellent in eight and good in seven patients (Majeed score). Mean SF-12 scores for physical and mental health were 48.58+/-5.61 and 50.89+/-3.97 respectively. Thirteen patients returned to their pre-injury jobs. All fifteen patients reintegrated into society without any restrictions. INFIX was removed at a mean post-operative period of 7.3+/-1.5 months (range,5.5-11 months). Complications included, lateral femoral cutaneous nerve irritation(n = 1), superficial wound infection(n = 1) and loss of reduction(n = 2).
Minimally invasive pelvic stabilization using INFIX and percutaneous iliosacral screws is easy to learn and apply, achieves good fracture reduction and definitive stabilization with minimum complications and offers excellent functional outcomes at a minimum follow-up of 31 months.
Level IV.
骨盆前路外固定术与针道感染、因复位丢失导致的无菌性松动、固定架臃肿妨碍患者活动以及随之而来的住院护理困难相关。我们开展了一项单中心前瞻性系列研究，以评估使用前路皮下骨盆内固定器（INFIX）和经皮骶髂螺钉治疗不稳定骨盆环骨折的另一种微创骨盆内固定技术的可行性、安全性、局限性以及中期影像学和功能结局。
连续15例垂直和/或旋转不稳定骨盆骨折患者就诊于一级创伤中心，接受闭合复位、经皮骶髂螺钉适当的后路稳定以及前路INFIX固定。根据骨折复位质量（Matta影像学标准）、住院护理的难易程度、患者活动能力和舒适度、最终随访时的功能结局（Majeed评分、SF - 12评分）、社会重新融入情况及并发症对结局进行分析。
最常见的损伤类型是13例患者的AO/OTA 61 - C型骨盆骨折。平均手术时间和术中失血量分别为57.1±4.9分钟（范围51 - 68分钟）和115.3±26.7毫升（范围80 - 170毫升）。平均随访时间为34.9±4.1个月（范围31 - 42个月）。12例患者骨折复位优秀，3例良好（Matta标准）。8例患者功能结局优秀，7例良好（Majeed评分）。身心健康的平均SF - 12评分分别为48.58±5.61和5’0.89±3.97。13例患者恢复了伤前工作。所有15例患者均无限制地重新融入社会。INFIX在术后平均7.3±1.5个月（范围5.5 - 11个月）取出。并发症包括股外侧皮神经刺激（n = 1）、浅表伤口感染（n = 1）和复位丢失（n = 2）。
使用INFIX和经皮骶髂螺钉进行微创骨盆稳定术易于学习和应用，能实现良好的骨折复位和确切的稳定，并发症最少，在最短31个月的随访中功能结局良好。
四级。
