ObjectiveTo investigate the effectiveness of percutaneous double-segment lengthened sacroiliac screws internal fixation assisted by three-dimensional (3D) navigation technology in treatment of Denis type Ⅱ and Ⅲ sacral fractures. Methods A clinical data of 45 patients with the Denis type Ⅱ and Ⅲ sacral fractures admitted between January 2017 and May 2020 was retrospectively analyzed. There were 31 males and 14 females, with an average age of 48.3 years (range, 30-65 years). The pelvic fractures were all high energy injuries. According to the Tile classification standard, there were 24 cases of type C1, 16 cases of type C2, and 5 cases of type C3. The sacral fractures were classified as Denis type Ⅱ in 31 cases and type Ⅲ in 14 cases. The interval between injury and operation was 5-12 days (mean, 7.5 days). The lengthened sacroiliac screws were implanted in S1 and S2 segments respectively under the assistance of 3D navigation technology. The implantation time of each screw, the intraoperative X-ray exposure time, and the occurrence of surgical complications were recorded. After operation, the imaging reexamination was used to evaluate the screw position according to Gras standard and the reduction quality of sacral fractures according to Matta standard. At last follow-up, the pelvic function was scored with Majeed scoring standard. Results The 101 lengthened sacroiliac screws were implanted with the assisting of 3D navigation technology. The implantation time of each screw was 37.3 minutes on average (range, 30-45 minutes), and the X-ray exposure time was 46.2 seconds on average (range, 40-55 seconds). All patients had no neurovascular or organ injury. All incisions healed by first intention. The quality of fracture reduction was evaluated according to Matta standard as excellent in 22 cases, good in 18 cases, and fair in 5 cases, and the excellent and good rate was 88.89%. The screw position was evaluated according to Gras standard as excellent in 77 screws, good in 22 screws, and poor in 2 screws, and the excellent and good rate was 98.02%. All patients were followed up 12-24 months (mean, 14.6 months). All fractures healed and the healing time was 12-16 weeks (mean, 13.5 weeks). Pelvic function was evaluated according to Majeed scoring standard as excellent in 27 cases, good in 16 cases, fair in 2 cases, and the excellent and good rate was 95.56%. Conclusion Percutaneous double-segment lengthened sacroiliac screws internal fixation for the treatment of Denis type Ⅱ and Ⅲ sacral fractures is minimally invasive and effective. With the assistance of 3D navigation technology, the screw implantation is accurate and safe.
ObjectiveTo analyze the recent clinical results of emergency conversion of transcatheter aortic valve replacement (TAVR) to surgery, and summarize the clinical experience. Methods The clinical data of patients who underwent TAVR emergency conversion surgery in the Department of Cardiovascular Surgery of the Second Hospital of Hebei Medical University from 2018 to 2023 were collected, and the results of 1-month follow-up after surgery were recorded. Results Totally 253 patients underwent TAVR, and 11 patients underwent emergency conversion to surgery, with an emergency conversion rate of 4.3%. Among the 11 patients, 7 were males and 4 were females, with an average age of 69.55±5.01 years. The causes of urgent conversion to surgery in TAVR were valve stent displacement (63.6%), left ventricular perforation and rupture (18.2%), and a large amount of perivalvular reflux (18.2%) after the insertion of the second valve. One patient died intraoperative, with a perioperative mortality rate of 9.1%. Among the 10 surviving patients, 8 had pulmonary infection, 7 severe pneumonia, 3 pleural effusion, 8 liver function injury, 3 renal function injury, 5 upper gastrointestinal bleeding, 1 cerebrovascular complications, 1 atrial fibrillation, 1 ventricular premature contraction, 1 atrioventricular block, and 3 complete left bundle branch block. After one month of postoperative follow-up, one patient died. The 30-day mortality rate after TAVR emergency conversion surgery was 18.2%, and the quality of life of 9 patients (81.8%) improved significantly compared to before surgery. There were no readmission patients with cardiovascular system diseases. Conclusion The incidence of emergency conversion to surgery in TAVR is low, but the incidence of surgical complications is high, and the 30-day postoperative mortality rate is also high. When severe complications occur during TAVR surgery, emergency conversion to surgical surgery can still bring good early clinical results for most patients.