摘要
Abstract
BACKGROUND: There is no systematic classification method that can completely, accurately and directly reflect the characteristics of pelvic and acetabular fractures. Three-dimensional (3D) CT reconstruction technique provides more imaging evidences for the diagnosis of pelvic and acetabular fractures. OBJECTIVE: To introduce the "one trunk-three branches" classification for pelvic and acetabular fractures based on 3D CT reconstruction, and to evaluate its clinical effect. METHODS: Forty-seven cases of pelvic and acetabular fractures were enrolled, involving 18 cases of "single trunk or single branch" fracture, 18 cases of "one trunk-one branch", 7 cases of "one trunk-two branches", and 4 cases of "one trunk-three branches". Based on the "one trunk-three branches" classification, the surgical approaches included improved Stoppa, posterior iliac-lumbar, iliac fossa and K-L approaches, and one or combined approaches were recommended. The order of approach and fixation was as follows: trunk first followed by branch, and another approach was necessary when the conjoint branches did not achieve simultaneous reduction. The clinical efficacy was evaluated through postoperative follow up. RESULTS AND CONCLUSION: (1) The average operation time of the fractures of single trunk or one branch, one trunk-one, one trunk-two branches and one trunk-three branches was 75.2, 88.5, 97.4, and 115.8 minutes, respectively;the average blood loss was 321.2, 360.4, 450.5, and 650 mL, respectively. (2) According to the criteria described by Matta, 25 of the reductions were graded excellent, 20 were graded good, and 2 were poor, and the excellent and good rate was 96%. (3) All patients were followed up for 12-35 months, and the follow-up rate was 87%. The mean healing time was 2.9 months (2.7-4.2 months), and the mean weight bearing time was 3.8 months (2.5-5.6 months). (4) At the last follow up, the clinical outcomes (Majeed criteria) were 16 excellent, 25 good, 4 average and 2 poor, and the excellent and good rate was 87%; the clinical outcomes (Merle d'Aubigne-Postel) were 15 excellent, 24 good, 6 average, and 2 poor, and the excellent and good rate was 83%. None of complications occurred. (5) These results manifest that the "one trunk-three branches" classification for pelvic and acetabular fractures based on 3D CT reconstruction is helpful for designing an appropriate treatment scheme, and choosing optimal surgical approach and fixation order, thereby promoting the functional recovery of the pelvis and acetabulum.关键词
骨科植入物/骨植入物/三维重建CT/骨盆/髋臼/骨折/一干三枝分型分类
医药卫生
