The application of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in treatment of pubic branch fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Hai , YE Junjian , LIN Zhangxiong , WU Gui ,  XIE Yun

Department of Orthopedic Trauma & Ankle Surgery, Fujian Trauma Medical Center, First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350004, P.R.China;

Corresponding author：

XIE Yun, Email: xyxlr@126.com

Keywords：

Pelvic fracture; pubic branch fracture; hollow pedicle opener; percutaneous internal fixation; minimally invasive surgery

DOI：

10.7507/1002-1892.202002053

Video：

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Objective To evaluate the effectiveness of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in pubic branch fractures.Methods The clinical data of 42 patients with pubic branch fractures treated by hollow screw fixation between March 2008 and March 2019 were analyzed retrospectively. According to the operation method, they were divided into the traditional operation group (20 cases in group A, fixed with traditional retrograde pubic screws) and the modified operation group (22 cases in group B, fixed with percutaneous retrograde pubic screws assisted by hollow pedicle opener). There was no significant difference (P>0.05) between the two groups in terms of gender, age, cause of injury, fracture classification, comorbidity, and time from injury to operation. The operation time, blood loss, incision length, screw length, and complications were recorded and compared between the two groups. The fracture reduction was evaluated according to Matta standard on the next day after operation, and the function was evaluated by Majeed score at 12 months after operation.Results The operation was successfully completed in both groups. The operation time, blood loss, and incision length of group B were significantly less than those of group A (P<0.05); there was no significant difference in screw length between the two groups (t=0.793, P=0.437). All patients were followed up 8-24 months, with an average of 16.8 months. There was no complication in the two groups, such as injury of blood vessels and nerves, fracture of internal fixation, screw entering into joint cavity, and nonunion of fracture. There was no significant difference in the fracture healing time between the two groups (t=−1.068, P=0.299). There were 2 cases of incision infection, 1 case of incision fat liquefaction, 2 cases of lower extremity deep vein thrombosis in group A, the incidence of complications was 25.0%; there was only 1 case of lower extremity deep vein thrombosis in group B, the incidence of complication was 4.5%, which was lower than that in group A, but the difference was not significant (χ²=2.104, P=0.147). In group A, 1 case was found to be dislocated, but in group B, there was no dislocated fracture. There was no significant difference between the two groups in the evaluation of Matta imaging on the next day after operation and the evaluation of Majeed function at 12 months after operation (P>0.05).Conclusion Percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener is effect for the pubic branch fractures with the advantage of smaller incision, shorter operation time, and less bleeding compared with traditional methods.

Citation： WANG Hai, YE Junjian, LIN Zhangxiong, WU Gui, XIE Yun. The application of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in treatment of pubic branch fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1106-1113. doi: 10.7507/1002-1892.202002053 Copy

1.	Tachibana T, Yokoi H, Kirita M, et al. Instability of the pelvic ring and injury severity can be predictors of death in patients with pelvic ring fractures: A retrospective study. J Orthop Traumatol, 2009, 10(2): 79-82.
2.	陈龙. 微创内固定治疗骨盆前环骨折的研究进展. 中国矫形外科杂志, 2017, 25(6): 527-529.
3.	田维, 刘兆杰, 王宏川, 等. 微创内固定治疗骨盆前环损伤. 中华骨科杂志, 2018, 38(5): 264-270.
4.	孙换强, 孔建中, 郭晓山. 空心钉经皮微创内固定技术治疗骨盆环损伤的疗效评价. 中国骨伤, 2008, 21(7): 536-538.
5.	Archdeacon MT. Comparison of the ilioinguinal approach and the anterior intrapelvic approaches for open reduction and internal fixation of the acetabulum. J Orthop Trauma, 2015, 29(Suppl 2): S6-9.
6.	项舟, 段鑫, 王洪. 骨盆骨折三轴移位方式及复位原则. 中国修复重建外科杂志, 2017, 31(10): 1153-1160.
7.	黄淑明, 兰树华, 邢海林, 等. 钝头弹性敲击技术建立髋臼前柱逆行螺钉通道的应用研究. 中华创伤骨科杂志, 2019, 21(3): 218-225.
8.	Weatherby DJ, Chip Routt ML, Eastman JG. The retrograde-antegrade-retrograde technique for successful placement of a retrograde superior ramus screw. J Orthop Trauma, 2017, 31(7): e224-e229.
9.	Starr AJ, Nakatani T, Reinert CM, et al. Superior pubic ramus fractures fixed with percutaneous screws: What predicts fixation failure? J Orthop Trauma, 2008, 22(2): 81-87.
10.	陈华, 唐佩福. 骨盆髋臼骨折微创治疗. 郑州: 河南科学技术出版社, 2016: 56.
11.	Matta JM, Torneta 3rd P. Internal fixation of unstable pelvic ring injury. Clin Orthop Relat Res, 1996, (329): 129-140.
12.	Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
13.	Matta JM. Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res, 1996, (329): 88-96.
14.	郭晓山, 池永龙. 经皮闭合内固定治疗骨盆环损伤. 中华外科杂志, 2006, 44(4): 260-263.
15.	吴超, 邓佳燕, 谭伦, 等. 3D 打印技术辅助不稳定性骨盆骨折手术疗效分析. 中国修复重建外科杂志, 2019, 33(4): 455-461.
16.	陈华, 齐红哲, 王彬彬, 等. 机器人体外通道螺钉定位系统联合骨盆随意外架辅助复位微创治疗复杂骨盆骨折一例. 中国修复重建外科杂志, 2016, 30(7): 915-917.
17.	洪石, 吴征杰, 李雪, 等. 骨科机器人辅助下经皮螺钉内固定治疗骨盆与髋臼骨折. 中华创伤骨科杂志, 2019, 21(1): 16-21.
18.	赵春鹏, 王军强, 苏永刚, 等. 机器人辅助经皮螺钉内固定治疗骨盆和髋臼骨折. 北京大学学报 (医学版), 2017, 49(2): 274-280.
19.	张楠威, 于滨生. 经 S₂ 骶髂螺钉技术在脊柱骨盆稳定性重建中应用的研究进展. 中国修复重建外科杂志, 2018, 32(6): 764-767.
20.	Puchwein P, Enninghorst N, Sisak K, et al. Percutaneous fixation of acetabular fractures: computer-assisted determination of safe zones, angles and lengths for screw insertion. Arch Orthop Trauma Surg, 2012, 132(6): 805-811.
21.	Tosounidis TH, Giannoudis PV. ‘Reverse guide wire’ technique for placement of anterior column/superier pubic ramus screw in pelvis and acetabular surgery. Ann R Coll Surg Engl, 2018, 100(5): 418.
22.	项舟, 魏代清, 刘明, 等. 计算机辅助导航髋关节周围骨折及骨盆前后环骨折微创固定. 中国修复重建外科杂志, 2015, 29(1): 10-13.
23.	王钢. 骨盆与髋臼骨折的治疗进展及思考. 中华创伤骨科杂志, 2018, 20(3): 185-186.
24.	Mosheiff R, Liebergall M. Maneuvering the retrograde medullary screw in pubic ramus fractures. J Orthop Trauma, 2002, 16(8): 594-596.
25.	Rosenberger RE, Dolati B, Larndorfer R, et al. Accuracy of minimally invasive navigated acetabular and iliosacral fracture stabilization using a targeting and noninvasive registration device. Arch Orthop Trauma Surg, 2010, 130(2): 223-230.
26.	孟昊业, 汪爱媛, 许文静, 等. 逆行螺钉置入固定骨盆耻骨上支骨折的数字解剖学参数. 解放军医学院学报, 2018, 39(6): 520-522, 550.
27.	Mouhsine E, Garofalo R, Borens O, et al. Percutaneous retrograde screwing for stabilisation of acetabular fractures. Injury, 2005, 36(11): 1330-1336.

1. Tachibana T, Yokoi H, Kirita M, et al. Instability of the pelvic ring and injury severity can be predictors of death in patients with pelvic ring fractures: A retrospective study. J Orthop Traumatol, 2009, 10(2): 79-82.
2. 陈龙. 微创内固定治疗骨盆前环骨折的研究进展. 中国矫形外科杂志, 2017, 25(6): 527-529.
3. 田维, 刘兆杰, 王宏川, 等. 微创内固定治疗骨盆前环损伤. 中华骨科杂志, 2018, 38(5): 264-270.
4. 孙换强, 孔建中, 郭晓山. 空心钉经皮微创内固定技术治疗骨盆环损伤的疗效评价. 中国骨伤, 2008, 21(7): 536-538.
5. Archdeacon MT. Comparison of the ilioinguinal approach and the anterior intrapelvic approaches for open reduction and internal fixation of the acetabulum. J Orthop Trauma, 2015, 29(Suppl 2): S6-9.
6. 项舟, 段鑫, 王洪. 骨盆骨折三轴移位方式及复位原则. 中国修复重建外科杂志, 2017, 31(10): 1153-1160.
7. 黄淑明, 兰树华, 邢海林, 等. 钝头弹性敲击技术建立髋臼前柱逆行螺钉通道的应用研究. 中华创伤骨科杂志, 2019, 21(3): 218-225.
8. Weatherby DJ, Chip Routt ML, Eastman JG. The retrograde-antegrade-retrograde technique for successful placement of a retrograde superior ramus screw. J Orthop Trauma, 2017, 31(7): e224-e229.
9. Starr AJ, Nakatani T, Reinert CM, et al. Superior pubic ramus fractures fixed with percutaneous screws: What predicts fixation failure? J Orthop Trauma, 2008, 22(2): 81-87.
10. 陈华, 唐佩福. 骨盆髋臼骨折微创治疗. 郑州: 河南科学技术出版社, 2016: 56.
11. Matta JM, Torneta 3rd P. Internal fixation of unstable pelvic ring injury. Clin Orthop Relat Res, 1996, (329): 129-140.
12. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
13. Matta JM. Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res, 1996, (329): 88-96.
14. 郭晓山, 池永龙. 经皮闭合内固定治疗骨盆环损伤. 中华外科杂志, 2006, 44(4): 260-263.
15. 吴超, 邓佳燕, 谭伦, 等. 3D 打印技术辅助不稳定性骨盆骨折手术疗效分析. 中国修复重建外科杂志, 2019, 33(4): 455-461.
16. 陈华, 齐红哲, 王彬彬, 等. 机器人体外通道螺钉定位系统联合骨盆随意外架辅助复位微创治疗复杂骨盆骨折一例. 中国修复重建外科杂志, 2016, 30(7): 915-917.
17. 洪石, 吴征杰, 李雪, 等. 骨科机器人辅助下经皮螺钉内固定治疗骨盆与髋臼骨折. 中华创伤骨科杂志, 2019, 21(1): 16-21.
18. 赵春鹏, 王军强, 苏永刚, 等. 机器人辅助经皮螺钉内固定治疗骨盆和髋臼骨折. 北京大学学报 (医学版), 2017, 49(2): 274-280.
19. 张楠威, 于滨生. 经 S₂ 骶髂螺钉技术在脊柱骨盆稳定性重建中应用的研究进展. 中国修复重建外科杂志, 2018, 32(6): 764-767.
20. Puchwein P, Enninghorst N, Sisak K, et al. Percutaneous fixation of acetabular fractures: computer-assisted determination of safe zones, angles and lengths for screw insertion. Arch Orthop Trauma Surg, 2012, 132(6): 805-811.
21. Tosounidis TH, Giannoudis PV. ‘Reverse guide wire’ technique for placement of anterior column/superier pubic ramus screw in pelvis and acetabular surgery. Ann R Coll Surg Engl, 2018, 100(5): 418.
22. 项舟, 魏代清, 刘明, 等. 计算机辅助导航髋关节周围骨折及骨盆前后环骨折微创固定. 中国修复重建外科杂志, 2015, 29(1): 10-13.
23. 王钢. 骨盆与髋臼骨折的治疗进展及思考. 中华创伤骨科杂志, 2018, 20(3): 185-186.
24. Mosheiff R, Liebergall M. Maneuvering the retrograde medullary screw in pubic ramus fractures. J Orthop Trauma, 2002, 16(8): 594-596.
25. Rosenberger RE, Dolati B, Larndorfer R, et al. Accuracy of minimally invasive navigated acetabular and iliosacral fracture stabilization using a targeting and noninvasive registration device. Arch Orthop Trauma Surg, 2010, 130(2): 223-230.
26. 孟昊业, 汪爱媛, 许文静, 等. 逆行螺钉置入固定骨盆耻骨上支骨折的数字解剖学参数. 解放军医学院学报, 2018, 39(6): 520-522, 550.
27. Mouhsine E, Garofalo R, Borens O, et al. Percutaneous retrograde screwing for stabilisation of acetabular fractures. Injury, 2005, 36(11): 1330-1336.

Chinese Journal of Reparative and Reconstructive Surgery

The application of percutaneous retrograde pubic screw implantation assisted by hollow pedicle opener in treatment of pubic branch fracture

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