MINIMALLY INVASIVE FIXATION UNDER COMPUTER-ASSISTED NAVIGATION FOR TREATMENT OF PERIACETABULAR FRACTURES, ANTERIOR AND POSTERIOR PELVIC RING FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 XIANGZhou , WEIDaiqing , LIUMing , DUANXin , MAJun , FANGYue , KONGQingquan , HUANGFuguo , CENShiqiang , ZHONGGang

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

XIANGZhou, Email: xiangzhou15@hotmail.com

Keywords：

Computer-assisted navigation; Periacetabular fractures; Anterior and posterior pelvic ring fracture; Internal fixation; Minimally invasive technique

DOI：

10.7507/1002-1892.20150003

Video：

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Objective To investigate the application and technical essentials of computer-assisted navigation in the surgical management of periacetabular fractures and pelvic fractures. Methods Between May 2010 and May 2011, 39 patients with periacetabular or anterior and posterior pelvic ring fractures were treated by minimally invasive fixation under computer-assisted navigation and were followed up more than 2 years, and the clinical data were analyzed retrospectively. There were 21 males and 18 females, aged 15-64 years (mean, 36 years). Fractures were caused by traffic accident in 23 cases, crush injury in 6 cases, and falling from height in 10 cases. Of them, 6 cases had acetabular fractures; 6 cases had femoral neck fractures; 18 cases had dislocation of sacroiliac joint; and 15 cases had anterior pelvic ring injuries. All patients were treated with closed or limited open reduction and screw fixations assisted with navigation. Results Eighty-nine screws were inserted during operation, including 8 in the acetabulum, 18 in the neck of the femur, 33 in the sacroiliac joint, and 30 in the symphysis pubis and pubic rami. The mean time of screw implanted was 20 minutes (range, 11-38 minutes), and the average blood loss volume was 20 mL (range, 10-50 mL). The postoperative pelvic X-ray and three dimensional CT scan showed good reduction of fractures and good position of the screws. No incision infection, neurovascular injury, or implant failure occurred. All patients were followed up 27-33 months with an average of 29.6 months. The patients could walk with full weight loading at 6-12 weeks after operation (mean, 8 weeks); at last follow-up, the patients could walk on the flat ground, stand with one leg, and squat down, and they recovered well enough to do their job and to live a normal life. Conclusion Minimally invasive fixation under computer-assisted navigation may be an excellent method to treat some specific types of periacetabular and anterior and posterior pelvic ring fractures because it has the advantages of less trauma and blood loss, lower complication incidence, and faster recovery.

Citation： XIANGZhou, WEIDaiqing, LIUMing, DUANXin, MAJun, FANGYue, KONGQingquan, HUANGFuguo, CENShiqiang, ZHONGGang. MINIMALLY INVASIVE FIXATION UNDER COMPUTER-ASSISTED NAVIGATION FOR TREATMENT OF PERIACETABULAR FRACTURES, ANTERIOR AND POSTERIOR PELVIC RING FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(1): 10-13. doi: 10.7507/1002-1892.20150003 Copy

1.	Milenkovic S, Saveski J, Radenkovic M, et al. Surgical treatment of displaced acetabular fractures. Srp Arh Celok Lek, 2011, 139(7-8):496-500.
2.	Starr AJ, Jones AL, Reinert CM, et al. Preliminary results and complications following limited open reduction and percutaneous screw fixation of displaced fractures of the acetabulum. Injury, 2001, 32 Suppl 1:A45-A50.
3.	Ochs BG, Gonser C, Shiozawa T, et al. Computer-assisted periacetabular screw placement:Comparison of different fluoroscopy-based navigation procedures with conventional technique. Injury, 2010, 41(12):1297-1305.
4.	Schweitzer D, Zylberberg A, Cordova M, et al. Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures. Injury, 2008, 39(8):869-874.
5.	楊光, 羅從風. 創傷患者靜脈血栓栓塞癥的發生與預防. 中華創傷骨科雜志, 2010, 12(12):1142-1146.
6.	朱仕文, 孫旭, 楊明輝, 等. 髖臼骨盆骨折患者術前深靜脈血栓形成的危險因素分析. 中華創傷骨科雜志, 2012, 14(8):675-678.
7.	Deitelzweig SB, Mckean SC, Amin AN, et al. Prevention of venous thromboembolism in the orthopedic surgery patient. Cleve Clin J Med, 2008, 75 Suppl 3:S27-S36.
8.	Kaempffe FA, Bone LB, Border JR. Open reduction and internal fixation of acetabular fractures:heterotopic ossification and other complications of treatment. J Orthop Trauma, 1991, 5(4):439-445.
9.	Mouhsine E, Garofalo R, Borens O, et al. Percutaneous retrograde screwing for stabilisation of acetabular fractures. Injury, 2005, 36(11):1330-1336.
10.	Hong G, Cong FL, Cheng FH, et al. Percutaneous screw fixation of acetabular fractures with 2D fluoroscopy-based computerized navigation. Arch Orthop Trauma Surg, 2010, 130(9):1177-1183.
11.	Mu WD, Wang H, Zhou DS, et al. Computer navigated percutaneous screw fixation for traumatic pubic symphysis diastasis of unstable pelvic ring injuries. Chin Med J (Engl), 2009, 122(14):1699-1703.
12.	Liebergall M, Ben-David D, Weil Y, et al. Computerized navigation for the internal fixation of femoral neck fractures. J Bone Joint Surg (Am), 2006, 88(8):1748-1754.
13.	Routt M J, Simonian PT, Mills WJ. Iliosacral screw fixation:early complications of the percutaneous technique. J Orthop Trauma, 1997, 11(8):584-589.
14.	Kraus MD, Krischak G, Keppler P, et al. Can computer-assisted surgery reduce the effective dose for spinal fusion and sacroiliac screw insertion? Clin Orthop Relat Res, 2010, 468(9):2419-2429.
15.	Altman DT, Jones CB, Routt MJ. Superior gluteal artery injury during iliosacral screw placement. J Orthop Trauma, 1999, 13(3):220-227.
16.	曾智敏, 羅從風, 胡承方. 透視導航引導下骨盆骨折的微創治療. 中國修復重建外科雜志, 2009, 23(11):1302-1305.
17.	Zwingmann J, Konrad G, Kotter E, et al. Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res, 2009, 467(7):1833-1838.
18.	Mosheiff R, Khoury A, Weil Y, et al. First generation computerized fluoroscopic navigation in percutaneous pelvic surgery. J Orthop Trauma, 2004, 18(2):106-111.
19.	Fulkerson EW, Egol KA. Timing issues in fracture management:a review of current concepts. Bull NYU Hosp Jt Dis, 2009, 67(1):58-67.
20.	李飛鵬, 李明, 華群, 等. 螺旋CT重建技術在骨盆環骨折中的診治價值. 中國骨傷, 2010, 23(3):204-207.

1. Milenkovic S, Saveski J, Radenkovic M, et al. Surgical treatment of displaced acetabular fractures. Srp Arh Celok Lek, 2011, 139(7-8):496-500.
2. Starr AJ, Jones AL, Reinert CM, et al. Preliminary results and complications following limited open reduction and percutaneous screw fixation of displaced fractures of the acetabulum. Injury, 2001, 32 Suppl 1:A45-A50.
3. Ochs BG, Gonser C, Shiozawa T, et al. Computer-assisted periacetabular screw placement:Comparison of different fluoroscopy-based navigation procedures with conventional technique. Injury, 2010, 41(12):1297-1305.
4. Schweitzer D, Zylberberg A, Cordova M, et al. Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures. Injury, 2008, 39(8):869-874.
5. 楊光, 羅從風. 創傷患者靜脈血栓栓塞癥的發生與預防. 中華創傷骨科雜志, 2010, 12(12):1142-1146.
6. 朱仕文, 孫旭, 楊明輝, 等. 髖臼骨盆骨折患者術前深靜脈血栓形成的危險因素分析. 中華創傷骨科雜志, 2012, 14(8):675-678.
7. Deitelzweig SB, Mckean SC, Amin AN, et al. Prevention of venous thromboembolism in the orthopedic surgery patient. Cleve Clin J Med, 2008, 75 Suppl 3:S27-S36.
8. Kaempffe FA, Bone LB, Border JR. Open reduction and internal fixation of acetabular fractures:heterotopic ossification and other complications of treatment. J Orthop Trauma, 1991, 5(4):439-445.
9. Mouhsine E, Garofalo R, Borens O, et al. Percutaneous retrograde screwing for stabilisation of acetabular fractures. Injury, 2005, 36(11):1330-1336.
10. Hong G, Cong FL, Cheng FH, et al. Percutaneous screw fixation of acetabular fractures with 2D fluoroscopy-based computerized navigation. Arch Orthop Trauma Surg, 2010, 130(9):1177-1183.
11. Mu WD, Wang H, Zhou DS, et al. Computer navigated percutaneous screw fixation for traumatic pubic symphysis diastasis of unstable pelvic ring injuries. Chin Med J (Engl), 2009, 122(14):1699-1703.
12. Liebergall M, Ben-David D, Weil Y, et al. Computerized navigation for the internal fixation of femoral neck fractures. J Bone Joint Surg (Am), 2006, 88(8):1748-1754.
13. Routt M J, Simonian PT, Mills WJ. Iliosacral screw fixation:early complications of the percutaneous technique. J Orthop Trauma, 1997, 11(8):584-589.
14. Kraus MD, Krischak G, Keppler P, et al. Can computer-assisted surgery reduce the effective dose for spinal fusion and sacroiliac screw insertion? Clin Orthop Relat Res, 2010, 468(9):2419-2429.
15. Altman DT, Jones CB, Routt MJ. Superior gluteal artery injury during iliosacral screw placement. J Orthop Trauma, 1999, 13(3):220-227.
16. 曾智敏, 羅從風, 胡承方. 透視導航引導下骨盆骨折的微創治療. 中國修復重建外科雜志, 2009, 23(11):1302-1305.
17. Zwingmann J, Konrad G, Kotter E, et al. Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res, 2009, 467(7):1833-1838.
18. Mosheiff R, Khoury A, Weil Y, et al. First generation computerized fluoroscopic navigation in percutaneous pelvic surgery. J Orthop Trauma, 2004, 18(2):106-111.
19. Fulkerson EW, Egol KA. Timing issues in fracture management:a review of current concepts. Bull NYU Hosp Jt Dis, 2009, 67(1):58-67.
20. 李飛鵬, 李明, 華群, 等. 螺旋CT重建技術在骨盆環骨折中的診治價值. 中國骨傷, 2010, 23(3):204-207.

Chinese Journal of Reparative and Reconstructive Surgery

MINIMALLY INVASIVE FIXATION UNDER COMPUTER-ASSISTED NAVIGATION FOR TREATMENT OF PERIACETABULAR FRACTURES, ANTERIOR AND POSTERIOR PELVIC RING FRACTURES

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