Kumbhare Chetan, Meena Sanjay, Kamboj Kulbhushan, Trikha Vivek
Department of Orthopedics, Lady Hardinge Medical College and Associated Hospitals, N Delhi, India.
Department of Orthopedics, All India Institute of Medical Sciences and Associated JPN ApexTrauma Centre, New Delhi, India.
J Clin Orthop Trauma. 2020 Nov-Dec;11(6):970-975. doi: 10.1016/j.jcot.2020.06.039. Epub 2020 Jun 30.
Subcutaneous screw rod system which is popularly known as Pelvic internal fixator (INFIX) has emerged as an alternative to external fixators in management of unstable pelvic injuries. INFIX has shown various advantages over external fixation such as reduced infection rate and patient morbidity. However, it has its own set of complications such as lateral femoral cutaneous nerve injury, heterotopic ossification, femoral nerve palsy etc. We intended to conduct a systematic review of the current literature to assess outcomes and complications with INFIX technique of fixation.
A comprehensive search of literature was performed based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and online database of EMBASE, PubMed, Medline and Scopus was searched for all studies in English language till March 2020. Included studies were reviewed for demographic data, fracture type/classification, radiological outcome and functional outcomes. The inclusion criteria were: 1. Studies in English language 2. Clinical studies reporting use of INFIX technique in pelvis fracture where clinical and radiological outcomes were reported.
Twenty-two studies fulfilling inclusion and exclusion criteria were included in this systematic review with total of 619 patients. Radiographic parameters and outcome measures were infrequently reported. Fixation with INFIX in these fractures leads to 87% excellent to good radiological results and 84% excellent to good functional results. Complications include lateral femoral cutaneous nerve irritation (25.3%), heterotopic ossification (24.7%), infection (3%), and femoral nerve palsy (1.6%); which is likely related to placing the bar and screws too deep.
This analysis supports the use of INFIX in management of unstable pelvis fractures where anterior fixation is required.
皮下螺杆系统，即广为人知的骨盆内固定器（INFIX），已成为治疗不稳定骨盆损伤时外固定器的替代方法。与外固定相比，INFIX显示出多种优势，如感染率降低和患者发病率降低。然而，它也有一系列自身的并发症，如股外侧皮神经损伤、异位骨化、股神经麻痹等。我们旨在对当前文献进行系统综述，以评估INFIX固定技术的疗效和并发症。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南对文献进行全面检索，并在EMBASE、PubMed、Medline和Scopus在线数据库中搜索截至2020年3月的所有英文研究。对纳入研究的人口统计学数据、骨折类型/分类、影像学结果和功能结果进行综述。纳入标准为：1. 英文研究；2. 报告在骨盆骨折中使用INFIX技术并报告临床和影像学结果的临床研究。
本系统综述纳入了22项符合纳入和排除标准的研究，共619例患者。影像学参数和结果测量很少被报告。这些骨折采用INFIX固定后，影像学结果优良率为87%，功能结果优良率为84%。并发症包括股外侧皮神经刺激（25.3%）、异位骨化（24.7%）、感染（3%）和股神经麻痹（1.6%）；这可能与杆和螺钉放置过深有关。
该分析支持在需要前路固定的不稳定骨盆骨折治疗中使用INFIX。
