Effectiveness of three-dimensional visible technique without fluoroscopy versus two-dimensional fluoroscopy in reduction of unstable pelvic fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Jiaqi ^1,2 ,  CHEN Hua ^2,3 , ZHANG Wei ⁴ , QI Hongzhe ^1,5 , ZHU Zhengguo ^1,2 , CHANG Zuhao ^1,2 , QI Lin ^1,2 , ZHOU Feng ⁴ , LIU Haoyang ⁴ , TANG Peifu ^2,3

1. Chinese PLA General Medical School, Beijing, 100853, P. R. China;
2. Department of Orthopaedic Trauma, Chinese PLA General Hospital, Beijing, 100048, P. R. China;
3. National Clinical Research Center for Orthopaedics & Sports Rehabilitation in China, Beijing, 100048, P. R. China;
4. AI Sports Engineering Lab, School of Sports Engineering, Beijing Sport University, Beijing, 100084, P. R. China;
5. Chinese PLA Strategic Support Force Characteristic Medical Center, Beijing, 100101, P. R. China;

Corresponding author：

CHEN Hua, Email: chenhua0270@126.com

Keywords：

Pelvic fracture; unstable fracture; closed reduction; three-dimensional visible technique

DOI：

10.7507/1002-1892.202210073

Video：

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Objective To compare the reduction qualities of three-dimensional visible technique without fluoroscopy and two-dimensional fluoroscopy for unstable pelvic fractures during operations. Methods The clinical data of 40 patients with unstable pelvic fractures, who met the selection criteria in three clinical centers between June 2021 and September 2022, were retrospectively analyzed. According to the reduction methods, the patients were divided into two groups. Twenty patients in trial group were treated with unlocking closed reduction system combined with three-dimensional visible technique without fluoroscopy; 20 patients in control group with unlocking closed reduction system under two-dimensional fluoroscopy. There was no significant difference in the gender, age, injury mechanism, Tile type of fracture, Injury Severity Score (ISS), and the time between injury to operation between the two groups (P>0.05). The qualities of fracture reduction according to the Matta criteria, operative time, intraoperative blood loss, fracture reduction time, times of fluoroscopy, and System Usability Scale (SUS) score were recorded and compared. Results All operations were successfully completed in both groups. According to the Matta criteria, the qualities of fracture reduction were rated as excellent in 19 patients (95%) in trial group, which was better than that in the control group (13 cases, 65%), with a significant difference (χ²=3.906, P=0.048). The operative time and intraoperative blood loss had no significant differences between the two groups (P>0.05). The fracture reduction time and times of fluoroscopy were significantly less in trial group than in control group (P<0.05), and SUS score in trial group was significantly higher in trial group than in control group (P<0.05). Conclusion Compared to using unlocking closed reduction system under two-dimensional fluoroscopy, three-dimensional visible technique without fluoroscopy can significantly improve the reduction quality of unstable pelvic fractures without prolonging the operative time, and is valuable to reduce iatrogenic radiation exposure for patients and medical workers.

Citation： LI Jiaqi, CHEN Hua, ZHANG Wei, QI Hongzhe, ZHU Zhengguo, CHANG Zuhao, QI Lin, ZHOU Feng, LIU Haoyang, TANG Peifu. Effectiveness of three-dimensional visible technique without fluoroscopy versus two-dimensional fluoroscopy in reduction of unstable pelvic fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(2): 129-135. doi: 10.7507/1002-1892.202210073 Copy

1.	陈华, 白雪东, 易成腊, 等. 中国骨盆骨折微创手术治疗指南(2021). 中华创伤骨科杂志, 2021, 23(1): 4-14.
2.	Lindsay A, Tornetta P, Diwan A, et al. Is closed reduction and percutaneous fixation of unstable posterior ring injuries as accurate as open reduction and internal fixation? J Orthop Trauma, 2016, 30(1): 29-33.
3.	Tornetta P 3rd, Templeman DC. Expected outcomes after pelvic ring injury. Instr Course Lect, 2005, 54: 401-407.
4.	Templeman DC, Simpson T, Matta JM. Surgical management of pelvic ring injuries. Instr Course Lect, 2005, 54: 395-400.
5.	Lai CY, Lai PJ, Tseng IC, et al. Postoperative reduction quality may be the most important factor that causes worse functional outcomes in open and closed pelvic fractures. World J Surg, 2022, 46(3): 568-576.
6.	Chen H, Zhang Q, Wu Y, et al. Achieve closed reduction of irreducible, unilateral vertically displaced pelvic ring disruption with an unlocking closed reduction technique. Orthop Surg, 2021, 13(3): 942-948.
7.	Luo Y, Chen H, He L, et al. Displaced posterior pelvic ring fractures treated with an unlocking closed reduction technique: Prognostic factors associated with closed reduction failure, reduction quality, and fixation failure. Injury, 2022: S0020-1383(22)00001-8. doi: 10.1016/j.injury.2022.01.001.
8.	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.
9.	Wu Y, Chen H, Zhou X, et al. Lateral compression type 2 pelvic fractures-A clinical study of fracture displacement measurement and closed reduction. Orthop Surg, 2022, 14(10): 2545-2552.
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: 63-74, 119-140.
11.	陈华, 蒋斌, 张群, 等. 智能监视系统辅助闭合复位治疗复杂骨盆骨折一例. 中国修复重建外科杂志, 2020, 34(7): 874-877.
12.	Nana CT, Ngo-Yamben MA, Fokam P, et al. Functional outcome of unstable pelvic fractures treated in a level Ⅲ hospital in a developing country: a 10-year prospective observational study. J Orthop Surg Res, 2022, 17(1): 198. doi: 10.1186/s13018-022-03088-3.
13.	Halvorson JJ, Lamothe J, Martin CR, et al. Combined acetabulum and pelvic ring injuries. J Am Acad Orthop Surg, 2014, 22(5): 304-314.
14.	Hackenbroch C, Feilhuber M, Halt D, et al. Low-dose CT in pelvic imaging: Comparing dose and image quality in relation to clinical value in a phantom study. AJR Am J Roentgenol, 2021, 216(2): 453-463.
15.	Han R, Uneri A, Ketcha M, et al. Multi-body 3D-2D registration for image-guided reduction of pelvic dislocation in orthopaedic trauma surgery. Phys Med Biol, 2020, 65(13): 135009. doi: 10.1088/1361-6560/ab843c.
16.	Hüfner T, Pohlemann T, Tarte S, et al. Computer-assisted fracture reduction of pelvic ring fractures: an in vitro study. Clin Orthop Relat Res, 2002, (399): 231-239.
17.	Han R, Uneri A, Vijayan RC, et al. Fracture reduction planning and guidance in orthopaedic trauma surgery via multi-body image registration. Med Image Anal, 2021, 68: 101917. doi: 10.1016/j.media.2020.101917.
18.	Metzger MC, Rafii A, Holhweg-Majert B, et al. Comparison of 4 registration strategies for computer-aided maxillofacial surgery. Otolaryngol Head Neck Surg, 2007, 137(1): 93-99.
19.	Boddapati V, Lombardi JM, Urakawa H, et al. Intraoperative image guidance for the surgical treatment of adult spinal deformity. Ann Transl Med, 2021, 9(1): 91. doi: 10.21037/atm-20-2765.
20.	Kim HJ, Yang JH, Chang DG, et al. Adult spinal deformity: Current concepts and decision-making strategies for management. Asian Spine J, 2020, 14(6): 886-897.
21.	Kristin J, Burggraf M, Mucha D, et al. Automatic registration for navigation at the anterior and lateral skull base. Ann Otol Rhinol Laryngol, 2019, 128(10): 894-902.
22.	Nguyen NQ, Cardinell J, Ramjist JM, et al. An augmented reality system characterization of placement accuracy in neurosurgery. J Clin Neurosci, 2020, 72: 392-396.
23.	Liu H, Auvinet E, Giles J, et al. Augmented reality based navigation for computer assisted hip resurfacing: A proof of concept study. Ann Biomed Eng, 2018, 46(10): 1595-1605.
24.	Kiarostami P, Dennler C, Roner S, et al. Augmented reality-guided periacetabular osteotomy-proof of concept. J Orthop Surg Res, 2020, 15(1): 540. doi: 10.1186/s13018-020-02066-x.
25.	Maharjan N, Alsadoon A, Prasad PWC, et al. A novel visualization system of using augmented reality in knee replacement surgery: Enhanced bidirectional maximum correntropy algorithm. Int J Med Robot, 2021, 17(3): e2223. doi: 10.1002/rcs.2154.

1. 陈华, 白雪东, 易成腊, 等. 中国骨盆骨折微创手术治疗指南(2021). 中华创伤骨科杂志, 2021, 23(1): 4-14.
2. Lindsay A, Tornetta P, Diwan A, et al. Is closed reduction and percutaneous fixation of unstable posterior ring injuries as accurate as open reduction and internal fixation? J Orthop Trauma, 2016, 30(1): 29-33.
3. Tornetta P 3rd, Templeman DC. Expected outcomes after pelvic ring injury. Instr Course Lect, 2005, 54: 401-407.
4. Templeman DC, Simpson T, Matta JM. Surgical management of pelvic ring injuries. Instr Course Lect, 2005, 54: 395-400.
5. Lai CY, Lai PJ, Tseng IC, et al. Postoperative reduction quality may be the most important factor that causes worse functional outcomes in open and closed pelvic fractures. World J Surg, 2022, 46(3): 568-576.
6. Chen H, Zhang Q, Wu Y, et al. Achieve closed reduction of irreducible, unilateral vertically displaced pelvic ring disruption with an unlocking closed reduction technique. Orthop Surg, 2021, 13(3): 942-948.
7. Luo Y, Chen H, He L, et al. Displaced posterior pelvic ring fractures treated with an unlocking closed reduction technique: Prognostic factors associated with closed reduction failure, reduction quality, and fixation failure. Injury, 2022: S0020-1383(22)00001-8. doi: 10.1016/j.injury.2022.01.001.
8. 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.
9. Wu Y, Chen H, Zhou X, et al. Lateral compression type 2 pelvic fractures-A clinical study of fracture displacement measurement and closed reduction. Orthop Surg, 2022, 14(10): 2545-2552.
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: 63-74, 119-140.
11. 陈华, 蒋斌, 张群, 等. 智能监视系统辅助闭合复位治疗复杂骨盆骨折一例. 中国修复重建外科杂志, 2020, 34(7): 874-877.
12. Nana CT, Ngo-Yamben MA, Fokam P, et al. Functional outcome of unstable pelvic fractures treated in a level Ⅲ hospital in a developing country: a 10-year prospective observational study. J Orthop Surg Res, 2022, 17(1): 198. doi: 10.1186/s13018-022-03088-3.
13. Halvorson JJ, Lamothe J, Martin CR, et al. Combined acetabulum and pelvic ring injuries. J Am Acad Orthop Surg, 2014, 22(5): 304-314.
14. Hackenbroch C, Feilhuber M, Halt D, et al. Low-dose CT in pelvic imaging: Comparing dose and image quality in relation to clinical value in a phantom study. AJR Am J Roentgenol, 2021, 216(2): 453-463.
15. Han R, Uneri A, Ketcha M, et al. Multi-body 3D-2D registration for image-guided reduction of pelvic dislocation in orthopaedic trauma surgery. Phys Med Biol, 2020, 65(13): 135009. doi: 10.1088/1361-6560/ab843c.
16. Hüfner T, Pohlemann T, Tarte S, et al. Computer-assisted fracture reduction of pelvic ring fractures: an in vitro study. Clin Orthop Relat Res, 2002, (399): 231-239.
17. Han R, Uneri A, Vijayan RC, et al. Fracture reduction planning and guidance in orthopaedic trauma surgery via multi-body image registration. Med Image Anal, 2021, 68: 101917. doi: 10.1016/j.media.2020.101917.
18. Metzger MC, Rafii A, Holhweg-Majert B, et al. Comparison of 4 registration strategies for computer-aided maxillofacial surgery. Otolaryngol Head Neck Surg, 2007, 137(1): 93-99.
19. Boddapati V, Lombardi JM, Urakawa H, et al. Intraoperative image guidance for the surgical treatment of adult spinal deformity. Ann Transl Med, 2021, 9(1): 91. doi: 10.21037/atm-20-2765.
20. Kim HJ, Yang JH, Chang DG, et al. Adult spinal deformity: Current concepts and decision-making strategies for management. Asian Spine J, 2020, 14(6): 886-897.
21. Kristin J, Burggraf M, Mucha D, et al. Automatic registration for navigation at the anterior and lateral skull base. Ann Otol Rhinol Laryngol, 2019, 128(10): 894-902.
22. Nguyen NQ, Cardinell J, Ramjist JM, et al. An augmented reality system characterization of placement accuracy in neurosurgery. J Clin Neurosci, 2020, 72: 392-396.
23. Liu H, Auvinet E, Giles J, et al. Augmented reality based navigation for computer assisted hip resurfacing: A proof of concept study. Ann Biomed Eng, 2018, 46(10): 1595-1605.
24. Kiarostami P, Dennler C, Roner S, et al. Augmented reality-guided periacetabular osteotomy-proof of concept. J Orthop Surg Res, 2020, 15(1): 540. doi: 10.1186/s13018-020-02066-x.
25. Maharjan N, Alsadoon A, Prasad PWC, et al. A novel visualization system of using augmented reality in knee replacement surgery: Enhanced bidirectional maximum correntropy algorithm. Int J Med Robot, 2021, 17(3): e2223. doi: 10.1002/rcs.2154.

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Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of three-dimensional visible technique without fluoroscopy versus two-dimensional fluoroscopy in reduction of unstable pelvic fractures

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