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1.
Objective
Presentation of our own experiences and results of an early clinical algorithm for treatment integrating emergency embolization (TAE) in cases of unstable pelvic ring fractures with arterial bleeding.Method
Consecutive patient series from April 2002 to December 2006 at a level 1 trauma center. The data of the online shock room documentation (Traumawatch®) of patients with a pelvic fracture and arterial bleeding detected on multislice computed tomography (MSCT) were examined for the following parameters: demographic data, injury mechanism, fracture classification according to Tile/AO and severity of the pelvic injury assessed with the Abbreviated Injury Score (AIS), accompanying injuries with elevation of the cumulative injury severity according to the Injury Severity Score (ISS), physiological admission parameters (circulatory parameters and initial Hb value) as well as transfusion requirement during treatment in the shock room, time until embolization, duration of embolization, and source of bleeding.Results
Of a total of 162 patients, arterial bleeding was detected in 21 patients by contrast medium extravasation on MSCT, 12 of whom were men and 9 women with an average age of 45 (14–80) years. The mechanism of injury was high energy trauma in all cases. In 33% it involved type B pelvic fractures and in 67% type C fractures with an average AIS pelvis of 4.4 points (3–5) and a total severity of injury with the ISS of 37 points (21–66). Upon admission 47.6% presented hemodynamic instability with an average Hb value of 7.8 g/dl (3.2–12.4) and an average transfusion requirement of 6 red blood cell units (4–13). The time until the TAE was started was on average 62 min (25–115) with a duration period of the TAE of 25 min (15–67). Branches of the internal iliac artery were identified as the sole source of bleeding. The success rate of TAE amounted to over 90%.Conclusion
Interventional TAE represents an effective as well as a fast procedure for hemostasis of arterial bleeding detected on MSCT in patients with pelvic fractures. If an experienced radiologist on 24-h stand-by is assured and the infrastructure is efficient, this can be performed shortly after hospital admission and therefore should be integrated into the early clinical treatment protocol. 相似文献2.
Jie Yang Xin-hua Zhang Yong-hui Huang Bin Chen Jian-bo Xu Chuang-qi Chen Shi-rong Cai Wen-hua Zhan Yu-long He Jin-ping Ma 《Journal of gastrointestinal surgery》2016,20(3):510-520
Background
Massive abdominal arterial bleeding is an uncommon yet life-threatening complication of radical gastrectomy. The exact incidence and standardized management of this lethal morbidity are not known.Methods
Between January 2003 and December 2013, data from 1875 patients undergoing radical gastrectomy with D2 or D2 plus lymphadenectomy were recorded in a prospectively designed database from a single institute. The clinical data and management of both early (within 24 h) and late (beyond 24 h) postoperative abdominal arterial hemorrhages were explored. For late bleeding patients, transcatheter arterial embolization (TAE) and re-laparotomy were compared to determine the better initial treatment option.Results
The overall prevalence of postoperative abdominal arterial bleeding was 1.92 % (n?=?36), and related mortality was 33.3 % (n?=?12). Early and late postoperative bleedings were found in 6 and 30 patients, respectively. The onset of massive arterial bleeding occurred on average postoperative day 19. The common hepatic artery and its branches were the most common bleeding source (13/36; 36.1 %). All the early bleeding patients were treated with immediate re-laparotomy. For late bleeding, patients from the TAE group had a significantly lower mortality rate than that of the patients from the surgery group (7.69 vs. 56.25 %, respectively, P?=?0.008) as well as a shorter procedure time for bleeding control (2.3?±?1.1 vs. 4.8?±?1.7 h, respectively, P?<?0.001). Four rescue reoperations were performed for TAE failures; the salvage rate was 50 % (2/4). Ten patients developed massive re-bleeding after initial successful hemostasis by either TAE (5/13) or open surgery (5/16). Three out of the 10 re-bleeding patients died of disseminated intravascular coagulation (DIC), while the other 7 recovered eventually by repeated TAE and/or surgery.Conclusion
Abdominal arterial bleeding following radical gastrectomy tends to occur during the later phase after surgery, with further complications such as abdominal infection and fistula(s). For late bleeding, TAE can be considered as the first-line treatment when possible.3.
Joon-Woo Kim Chang-Wug Oh Jong-Keon Oh Seung-Gil Baek Byoung-Joo Lee Han-Pyo Hong Woo-Kie Min 《Journal of orthopaedic science》2014,19(3):471-477
Background
Pelvic ring and acetabular fractures are the results of high energy trauma, but there is a paucity of information available regarding the incidence and risk factors of venous thromboembolism (VTE) after these injuries in Asians. This study was undertaken to evaluate the incidence of VTE after a pelvic or an acetabular fracture and to identify predictive factors.Methods
A prospective evaluation was performed by indirect computed tomography (CT) venography in patients with pelvic or acetabular fractures. Ninety-five patients were examined by indirect CT venography. Fifty-five patients suffered from a pelvic ring injury (anteroposterior compression 5, lateral compression 25, vertical shear 25), and the remaining 40 from acetabular fractures (simple 18, complex 22). Indirect CT venography was performed within 1–2 weeks of initial trauma. Relationships between VTE and sex, age, fracture pattern, body mass index, injury severity score, period of immobilization, and need for surgical treatment were analyzed. Deep vein thrombosis (DVT) in a more proximal to popliteal vein and the existence of PE were considered clinically significant.Results
Thirty-two patients (33.7 %) were found to have VTE at an average of 11 days after initial injury. Clinically significant DVT was found 20 cases (21.1 %). No statistical difference was found between pelvic ring injuries and acetabular fractures with respect to the development of VTE. For those with pelvic ring injury, the incidence of VTE in those with a vertical shear injury (52 %) was significantly greater than in others with a pelvic ring injury (p = 0.014). Patients with an age >50 were found to be at greater risk of VTE (p = 0.032).Conclusion
Our findings demonstrate that Korean patients with pelvic or acetabular fractures have a higher risk of VTE than is generally believed, and caution should be taken to prevent and treat VTE, especially in high energy pelvic ring injury and elderly patients. 相似文献4.
Prof. Dr. K.-P. Günther T. Wegner S. Kirschner A. Hartmann 《Operative Orthopadie und Traumatologie》2014,26(2):141-155
Objective
Restore primary center of rotation and reconstruct extensive bone defects in hip revision surgery with a modular off-label implant combined with antiprotrusion cage and metal augment, thus, achieving improved hip function.Indications
Large segmental acetabular defects with nonsupportive columns (Paprosky type 3a and 3b) in cup loosening or Girdlestone situation. In case of pelvic discontinuity posterior column-plating is possible.Contraindications
Persisting hip infection and severe systemic disorders impairing achievement of secondary stability through bony integration of metal augment.Surgical technique
Posterolateral (if dorsal column plating) or other approach. Remove loose implant and granulation tissue with sufficient exposure of bleeding bone. Size acetabular defect with trial components of augment and appropriate antiprotrusio cage. Fixation of selected metal augment with screws. Fill additional acetabular defects with morsellized bone graft. Open a slot into the ischium to fix the distal flange of the cage. If necessary, bend both flanges according to patient’s anatomy. Enter the ischium with distal flange and gradual impaction of the antiprotrusio ring. Final stabilization of the ring with several screws aiming at the posterior column or the acetabular dome. Inject cement between ring and augment to stabilize the construction and avoid metal wear. Final cement fixation of a polyethylene liner or a dual-mobility cup into the antiprotrusio ring. In pelvic discontinuity with major instability osteosynthesis of the dorsal column can be performed prior to cementation.Postoperative management
Prophylaxis of periprosthetic infection, DVT and heterotopic ossification. Physical therapy with partial weight bearing (20 kp) for 6 weeks; in discontinuity initial wheel chair mobilization.Results
Since 2008, 72 off-label implantations of a combined antiprotrusio cage and a Trabecular Metal? Augment were performed. A total of 44 patients (46 operations) were investigated at 38.8 (36–51) months postoperatively. In all, 36 patients had a bone defect according to Paprosky type 3a/b and in 3/4 patients with pelvic discontinuity additional osteosynthesis was performed. The WOMAC score increased from 39.8 (8.7–75) points preoperatively to 57.9 (16.7–97.9) points at follow-up. Migration or failure of implant components was not observed. In 11?% of dislocations and 11?% periprosthetic infections surgical revision was necessary. 相似文献5.
C.-P. Hsu S.-Y. Wang Y.-P. Hsu H.-W. Chen B.-C. Lin S.-C. Kang K.-C. Yuan E.-H. Liu I.-M. Kuo C.-H. Liao C.-H. Ouyang S.-J. Yang 《European journal of trauma and emergency surgery》2014,40(5):547-552
Purpose
To identify risk factors for liver abscess formation in patients with blunt hepatic injury who underwent non-operative management (NOM).Methods
From January 2004 to October 2008, retrospective data were collected from a single level I trauma center. Clinical data, hospital course, and outcome were all extracted from patient medical records for further analysis.Results
A total of 358 patients were enrolled for analysis. There were 13 patients with liver abscess after blunt hepatic injury. Patients with abscess had a significant increase in glutamic oxaloacetic transaminase (GOT, p = 0.006) and glutamic pyruvic transaminase (GPT, p < 0.0001), and a decrease in arterial blood pH (p = 0.023) compared to patients without abscess in the univariate analyses. In addition, high-grade hepatic injury and transarterial embolization (TAE, p < 0.001) were also risk factors for liver abscess formation. Five factors (GOT, GPT, pH level in the arterial blood sample, TAE, and high-grade hepatic injury) were included in the multivariate analysis. TAE, high-grade hepatic injury, and GPT level were statistically significant. The odds ratios of TAE and high-grade hepatic injury were 15.41 and 16.08, respectively. A receiver operating characteristic (ROC) analysis was used for GPT, and it suggested cutoff values of 372.5 U/L. A prediction model based on the ROC analysis had 100 % sensitivity and 86.7 % specificity to predict liver abscess formation in patients with two of the three independent risk factors.Conclusions
TAE, high-grade hepatic injury, and a high GPT level are independent risk factors for liver abscess formation. 相似文献6.
M. Burkhardt J. H. Holstein P. Moersdorf A. Kristen R. Lefering T. Pohlemann A. Pizanis 《European journal of trauma and emergency surgery》2014,40(4):473-479
Purpose
The Abbreviated Injury Scale (AIS) requires the estimation of the lost blood volume for some severity assignments. This study aimed to develop a rule of thumb for facilitating AIS coding by using objective clinical parameters as surrogate markers of blood loss.Methods
Using the example of pelvic ring fractures, a retrospective analysis of TraumaRegister DGU® data from 2002 to 2011 was performed. As potential surrogate markers of blood loss, we recorded the hemoglobin (Hb) level, systolic blood pressure (SBP), base excess (BE), Quick’s value, units of packed red blood cells (PRBCs) transfused before intensive care unit (ICU) admission, and mortality within 24 h.Results
We identified 11,574 patients with pelvic ring fractures (Tile/OTA classification: 39 % type A, 40 % type B, 21 % type C). Type C fractures were 73.1 % AISpelvis 4 and 26.9 % AISpelvis 5. Type B fractures were 47 % AISpelvis 3, 47 % AISpelvis 4, and 6 % AISpelvis 5. In type C fractures, cut-off values of <7 g/dL Hb, <90 mmHg SBP, 9 mmol/L BE, <35 % Quick’s value, >15 units PRBCs, and death within 24 h had a positive predictive value of 47 % and a sensitivity of 62 % for AISpelvis 5. In type B fractures, these cut-off values had poor sensitivity (48 %) and positive predictive value (11 %) for AISpelvis 5.Conclusions
We failed to develop a rule of thumb for facilitating a proper future AIS coding using the example of pelvic ring fractures. The estimation of blood loss for severity assignment still remains a noteworthy weakness in the AIS coding of traumatic injuries. 相似文献7.
Max J. Friedrich Jan Schmolders Robert D. Michel Thomas M. Randau Matthias D. Wimmer Hendrik Kohlhof Dieter C. Wirtz Sascha Gravius 《International orthopaedics》2014,38(12):2455-2461
Purpose
Revision of failed total hip arthroplasty with massive acetabular bone loss resulting in pelvic discontinuity represents a rare but challenging problem. The objective of this study was to present short to mid-term results of revision total hip arthroplasty with a custom-made acetabular implant in a consecutive series of patients with pelvic discontinuity.Methods
We retrospectively reviewed 18 consecutive patients with massive acetabular bone loss (Paprosky Type 3B) resulting in pelvic discontinuity reconstructed with revision total hip arthroplasty using a custom-made acetabular component. The prosthesis was created on the basis of a thin-cut 1-mm computed tomography (CT) scan of the pelvis. Initial stability of the implant was obtained by screw fixation. Harris hip score and sequential radiographs were used to evaluate the clinical and radiographic results.Results
At an average follow up of 30 months (range 17–62 months) 16 of 18 (88.9 %) custom-made implants were considered radiographically stable without signs of acetabular migration of more than 2 mm in the horizontal or vertical direction, implant rotation or screw breakage. Complications included two periprosthetic joint infections treated with explantation of the implant. Three patients had recurrent dislocations postoperatively. The mean Harris hip score improved from 28?±?12 points preoperatively to 69?±?13 points at the time of last follow up.Conclusion
Treatment of acetabular bone loss and pelvic discontinuity with a custom-made acetabular component can provide a durable solution with good clinical and radiographic results. 相似文献8.
William S. Murphy Greg Klingenstein MD Stephen B. Murphy MD Guoyan Zheng PhD 《Clinical orthopaedics and related research》2013,471(2):417-421
Background
While surgical navigation offers the opportunity to accurately place an acetabular component, questions remain as to the best goal for acetabular component positioning in individual patients. Overall functional orientation of the pelvis after surgery is one of the most important variables for the surgeon to consider when determining the proper goal for acetabular component orientation.Questions/Purposes
We measured the variation in pelvic tilt in 30 patients before THA and the effect of THA on pelvic tilt in the same patients more than a year after THA.Methods
Each patient had a CT study for CT-based surgical navigation and standing and supine radiographs before and after surgery. Pelvic tilt was calculated for each of the radiographs using a novel and validated two-dimensional/three-dimensional matching technique.Results
Mean supine pelvic tilt changed less than 2°, from 4.4° ± 6.4° (range, ?7.7° to 20.8°) before THA to 6.3° ± 6.6° (range, ?5.7° to 19.6°) after THA. Mean standing pelvic tilt changed less than 1°, from 1.5° ± 7.2° (range, ?13.1° to 12.8°) before THA to 2.0° ± 8.3° (range, ?12.3° to 16.8°) after THA. Preoperative pelvic tilt correlated with postoperative tilt in both the supine (r2 = 0.75) and standing (r2 = 0.87) positions.Conclusions
In this population, pelvic tilt had a small and predictable change after surgery. However, intersubject variability of pelvic tilt was high, suggesting preoperative pelvic tilt should be considered when determining desired acetabular component positioning on a patient-specific basis. 相似文献9.
Control of severe hemorrhage using C-clamp and arterial embolization in hemodynamically unstable patients with pelvic ring disruption 总被引:1,自引:0,他引:1
Sadri H Nguyen-Tang T Stern R Hoffmeyer P Peter R 《Archives of orthopaedic and trauma surgery》2005,125(7):443-447
Introduction
Hemorrhage is the leading cause of death in patients with a pelvic fracture. The majority of blood loss derives from injured retroperitoneal veins and broad cancellous bone surfaces. The emergency management of multiply injured patients with pelvic ring disruption and severe hemorrhage remains controversial. Although it is well accepted that the displaced pelvic ring injury must be rapidly reduced and stabilized, the methods by which control of hemorrhagic shock is achieved remain under discussion. It has been proposed to exclusively use external pelvic ring stabilization for control of hemorrhage by producing a ‘tamponade effect’ of the pelvis. However, the frequency of clinically important arterial bleeding after external fixation of the pelvic ring remains unclear. We therefore undertook this retrospective review to attempt to answer this one important question: How frequently is arterial embolization necessary to control hemorrhage and restore hemodynamic stability after external pelvic ring fixation?Materials and methods
We performed a retrospective review of 55 consecutive patients who presented with unstable types B and C pelvic ring fractures. Those patients designated as being in hemorrhagic shock (defined as a systolic blood pressure less than 90 mmHg after receiving 2 L of intravenous crystalloid) were treated by application of the pelvic C-clamp. Patients who remained in hemorrhagic shock, or were determined to be in severe shock (defined as mandatory catecholamines or more than 12 blood transfusions over 2 h), underwent therapeutic angiography within 24 h in order to control bleeding.Results
Fourteen patients were identified as being hemodynamically unstable (ISS 30.1±11.3 points) and were treated with a C-clamp. In those patients with persistent hemodynamic instability, arterial embolization was performed. After C-clamp application, 5 of 14 patients required therapeutic angiography to control bleeding. Two patients died, one from multiple sources of bleeding and the other from an open pelvic fracture (total mortality 2/14, 14%).Conclusions
Although the C-clamp is effective in controlling hemorrhage, one must be aware of the need for arterial embolization to restore hemodynamic stability in a select subgroup of patients.10.
N.J. Lee J.H. Shin S.S. Lee D.H. Park S.K. Lee H.-K. Yoon 《Diagnostic and interventional imaging》2018,99(11):717-724
Purpose
The purpose of this study was to report the incidence of massive bleeding after endoscopic ultrasound-guided transmural pancreaticobiliary drainage (EUS-TPBD) and the clinical outcomes in patients with this condition treated with transcatheter arterial embolization (TAE).Patients and methods
We performed a 9-year retrospective analysis of 797 EUS-TPBD procedures (excluding gallbladder or pseudocysts) in 729 patients. Among them, twelve (12/729, 1.65%) patients were referred for TAE to manage active bleeding adjacent to the TPBD sites. There were 8 men and 4 women with a mean age of 66.1 years ± 13.4 (SD) (range: 45–89 years). The clinical and procedure data of these 12 patients were reviewed.Results
Thirteen TAE procedures in 12 patients were performed. The bleeding sites were the left hepatic artery (n = 7), the right hepatic artery (n = 3), the left gastric artery (n = 1), the left accessory gastric artery (n = 1) and gastroduodenal artery (n = 1). TAE was performed with gelatin sponge particles (n = 1), coil (n = 1) and n-butyl-2 cyanoacrylate with/without coils (n = 11), with technical and clinical success rates of 100% (13/13) and 85% (11/13), respectively. Re-bleeding following embolization with gelatin sponge particles occurred in one patient. Procedure-related ischemic hepatitis was observed in another patient with pancreatic cancer with portal vein involvement.Conclusion
On the basis of our results, TAE using n-butyl-2 cyanoacrylate seems safe and effective for the treatment of bleeding after EUS-TPBD procedures. When the portal vein is compromised, TAE of the hepatic artery can cause ischemic liver damage. 相似文献11.
Nicholas J. Shaheen Hannah P. Kim William J. Bulsiewicz William D. Lyday George Triadafilopoulos Herbert C. Wolfsen Srinadh Komanduri Gary W. Chmielewski Atilla Ertan F. Scott Corbett Daniel S. Camara Richard I. Rothstein Bergein F. Overholt 《Journal of gastrointestinal surgery》2013,17(1):21-29
Background
Ongoing gastroesophageal reflux may impair healing and re-epithelialization after radiofrequency ablation (RFA) of Barrett’s esophagus (BE). Because prior fundoplication may improve reflux control, our aim was to assess the relationship between prior fundoplication and the safety/efficacy of RFA.Methods
We assessed the U.S. RFA Registry, a nationwide registry of BE patients receiving RFA at 148 institutions, to compare the safety and efficacy of ablation between those with prior fundoplication and those with medical management (proton pump inhibition).Results
Among 5,537 patients receiving RFA, 301 (5.4 %) had prior fundoplication. Of fundoplication subjects, 1.0 % developed stricture and 1.0 % were hospitalized after RFA. Rates of stricture, bleeding, and hospitalization were not statistically different (p?=?ns) between patients with and without prior fundoplication. Complete eradication of intestinal metaplasia and complete eradication of dysplasia were achieved in 71 % and 87 % of fundoplication patients, and 73 % and 87 % of patients without fundoplication, respectively (p?=?ns for both). Patients with prior fundoplication needed similar numbers of RFA sessions for eradication compared with those without fundoplication.Conclusions
Radiofrequency ablation, with or without prior fundoplication, is safe and effective in eradicating BE. Prior fundoplication was associated with similar adverse event and efficacy rates when compared with medical management. 相似文献12.
Onur Hapa Halil Yalçın Yüksel Hasan Hilmi Muratlı Ertuğrul Akşahin Serap Gülçek Levent Çelebi Ali Biçimoğlu 《Archives of orthopaedic and trauma surgery》2010,130(10):1305-1310
Introduction
Mechanical factors play a role in pathogenesis of primary osteoarthritis of the hip. Torsion measures were made to detect whether there is a causal relationship between increase or decrease of femoral anteversion, acetabular anteversion, and osteoarthritis. There are no studies in the literature indicating a relationship between axial plane coverage and osteoarthritis of the hip. Deficient axial plane coverage of femoral head may also play a role in pathogenesis of osteoarthritis.Materials and methods
Thirty patients with primary osteoarthritis of the hip and 29 control cases were included in the study. We used the method of Anda et al. (Acta Radiol Diagn 27:443–447, 1986; Comput Assist Tomogr 15:115–120, 1991) to measure axial plane anterior, posterior coverages in patients with primary osteoarthritis of the hip. The computerized tomography sections and pelvic radiographs indicated good frontal plane coverage and spherical femoral head. In addition to anterior acetabular sector angle, posterior acetabular sector angle, horizontal acetabular sector angles for axial plane coverage detection, femoral anteversion, acetabular anteversion, and McKibbin instability index were also measured.Results
Posterior coverage was lower at osteoarthritic hips than the control group’s hips (96.0 ± 16.7, 104.2 ± 10.6) (p < 0.05).Conclusion
The results may indicate that in addition to other mechanical factors, axial plane coverage, especially the posterior coverage deficiency, may play a role in the pathogenesis of hip osteoarthritis. 相似文献13.
Background
Traditionally, operative fixation of pelvic and acetabular injuries involves complex approaches and significant complications. Accelerated rehabilitation, decreased soft tissue stripping and decreased wound complications are several benefits driving a recent interest in percutaneous fixation. We describe a new fluoroscopic view to guide the placement of screws within the anterior pelvic ring.Methods
Twenty retrograde anterior pelvic ring screws were percutaneously placed in ten cadaveric specimens. Arranging a standard C-arm in a position similar to obtaining a lateral hip image, with angles of 54° ± 2° beam to body, 75° ± 5° of reverse cantilever and 14° ± 6° of outlet, a gun barrel view of the anterior pelvic ring is identified. Fluoroscopic images were taken, and the hemipelvi were harvested to examine the dimensions of the anterior pelvic ring and inspected for any cortical or articular perforation.Results
The minimum cranial-to-caudal distance in the anterior pelvic ring was 9 mm (range 6.5–12 mm), and the minimum anterior-to-posterior dimension was 9 mm (range 5–15 mm). All but 2 screws were completely confined within the osseous corridors. Identifiable on final fluoroscopic evaluation, one screw perforated the psoas groove and a second perforated the acetabular dome. Overall, 90 % of our screws were accurately and safely placed, upon the first attempt, within the anterior pelvic ring using the described gun barrel view.Conclusion
Employing either open reduction, or following a closed or percutaneous reduction, the anterior pelvic ring gun barrel view can reproducibly guide safe placement of anterior pelvic ring screw fixation.Level of evidence
IV.14.
E. Hoffmann T. Lenoir E. Morel N. Levassor L. Rillardon P. Guigui 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2008,18(1):47-53
Objective
To evaluate the long-term clinical and radiographic results in patients treated for 61C3-2 (OTA class) pelvic ring disruption with a posterior bridging sacroiliac fixation.Design
Retrospective clinical and radiological study.Setting
University Hospital.Patients/participants
Between May 2002 and March 2003, seven patients with sacroiliac dislocation were treated with a technique developed for the treatment of pelvic injuries with vertical and horizontal instability.Intervention
We applied spino-pelvic fixation techniques, using spine instrumentation, to stabilize an SI dislocation. This technique consists of two 5 mm diameter screws inserted into the S1 pedicle and S2 ala. A 5.5 mm rod joins the 2 sacral screws to two 7 mm screws placed into the posterior iliac crest and secured into the cancellous mass of the posterior ilium . The described technique stabilizes the SI-joint by performing a bridging osteosynthesis instead of the commonly performed iliosacral screw osteosynthesis passing the SI-joint. Symphyseal platting is performed to reduce and stabilize the anterior ring if necessary.Main outcome measurements
Data were analyzed as follows: pelvic fracture classification; functional outcome; radiographic outcome; Leg length discrapency; and CT scan aspect of the sacroiliac joint.Results
Associated pelvic injuries were present in all the patients and include symphysis rupture and acetabular fractures. Four of the seven patients had fractures of the lower extremities. Follow-up was available for all patients at an average of 27 months (range, 32–24 months). Neither septic nor cutaneous complications were reported. No loss of post-op reduction and no fixation failure were observed. The functional results noted at the last examination were satisfactory with a mean Majeed score of 93.Conclusion
In our opinion, this surgical technique may be indicated in Tile type C1.2 (61C3-2 OTA class) pelvic ring disruption. It obviously reaches its limits in sacral fractures. The technique described provides effective control of vertical displacement while providing a certain degree of horizontal mobility to facilitate reduction and osteosynthesis of anterior lesions. The quality of the fixation allowed early weight bearing. 相似文献15.
P. Maxwell Courtney Ryan Taylor John Scolaro Derek Donegan Samir Mehta 《Archives of orthopaedic and trauma surgery》2014,134(7):935-939
Introduction
Injuries to the anterior or posterior pelvic ring rarely occur in isolation. Disruption to the anterior pelvic ring, indicated by a fracture of the superior or inferior pubic ramus, or injury to the pubic symphysis, may be indicative of additional pelvic ring disruption. The purpose of this retrospective study was to determine whether displaced inferior pubic ramus fractures warrant a more detailed investigation of the posterior ring in an effort to predict unstable posterior pelvic ring injuries.Materials and methods
All patients with a displaced inferior ramus fracture on AP pelvic radiograph were identified at a single level I trauma center over a 5-year period. Complete pelvic radiographs and computed tomography scans were then evaluated for additional pelvic ring injuries. The data were analyzed using the chi-square test to determine the association between inferior ramus fractures and posterior pelvic ring injury.Results
Sixty-three of the 93 patients with a fracture of the inferior ramus (68 %) were found to have a posterior ring injury; 60 % of these injuries were unstable. Patients with concurrent superior ramus fractures were more likely to have a posterior ring injury (p < 0.001) and an unstable pelvis (p = 0.018). Of those with a displaced unilateral inferior ramus fracture, parasymphyseal involvement was associated with higher incidence of posterior ring injury (p = 0.047) and pelvic instability (p = 0.028).Conclusion
The anterior pelvic ring can be used to help identify unstable injuries to the posterior pelvis. Patients with displaced inferior pubic ramus fractures warrant a detailed examination of their posterior ring to identify additional injuries and instability. 相似文献16.
Michael Oberst Gerhard Konrad Georg W. Herget Abdelrehim El Tayeh Norbert P. Suedkamp 《Archives of orthopaedic and trauma surgery》2014,134(11):1557-1560
Objective
We report in the following on our technique of endoscopic sacroiliacal screw removal as a new extra-articular endoscopic method in soft tissue surgery, aimed at the reduction of radiation exposure for both the patient and the surgical teams.Summary of background data
Patients who underwent endoscopic implant removal from the dorsal pelvic ring (Group A) were retrospectively compared with a control group, in which the screws were removed via the conventional approach (Group B). The parameters of interest were the extent of x-ray exposure in seconds and surgical duration in minutes as well as approach related peri- and postoperative complications.Results
34 screws were removed endoscopically from 28 patients in group A and 35 screws from 29 patients in group B. The mean skin-to-skin time in group A was 36.1 (15–111) min and 32.7 (12–114) min in group B. The difference was not statistically significant (p > 0.05). The average radiation time in group A was 5.7 ± 3.2 s (range, 0–101 s), while in group B the radiation time was significantly longer (52.6 ± 23 s (range, 0–239 s); p = 0.005).Conclusions
Endoscopic screw removal from the posterior pelvic ring reduces the intraoperative radiation time whereas the skin-to-skin times do not differ from the conventional procedure.Level of evidence
Case–control study, Level III. 相似文献17.
James Shi Antoinette Gomes Edward Lee Stephen Kee John Moriarty Henry Cryer Justin McWilliams 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(8):877-883
Purpose
Transcatheter arterial embolization (TAE) is commonly used to control hemorrhage after pelvic trauma. Despite the procedures reported safety, there can be severe complications, mostly related to ischemia of embolized tissues. Our purpose was to examine the complications of trauma patients resulting from the embolization techniques utilized at our level 1 trauma center.Materials and methods
A retrospective chart review was conducted. One hundred and seven patients who underwent pelvic embolization between January 2003 and December 2013 were included. Patient demographics, ISS, angiography techniques, and major complications including gluteal and skin necrosis, wound breakdown, and deep infection were compared.Results
Nine patients (8.4 %) developed major complications after undergoing TAE. This rate dropped to 5.1 % after exclusion of patients with Morel-Lavallee lesions. Nonselective embolization trended toward a higher complication rate compared to superselective embolization. Patients who developed complications were more likely to have undergone pelvic surgery.Conclusion
The majority of patients who developed complications had nonselective TAE. Morel-Lavallee lesions are a confounding factor, but TAE may impose an additional risk. Pelvic surgery after TAE may further predispose patients to complications. We recommend superselective embolization as first-line treatment and caution the use of prophylactic embolization, especially in patients with substantial pelvic soft tissue injuries.18.
Shigeru Marubashi Shogo Kobayashi Hiroshi Wada Koichi Kawamoto Hidetoshi Eguchi Yuichiro Doki Masaki Mori Hiroaki Nagano 《World journal of surgery》2013,37(11):2671-2677
Background
In partial liver transplantation, reconstruction of the hepatic artery is technically highly demanding and the incidence of arterial complications is high. We attempted to identify the risk factors for anastomotic complications after hepatic artery reconstruction and examined the role of multidetector-row computed tomography (MDCT) in the evaluation of the reconstructed hepatic artery in liver transplant recipients.Methods
A total of 109 adult-to-adult living donor liver transplantations (LDLT) were performed at our institute between 1999 and July 2011. Hepatic artery reconstruction was performed under a surgical microscope (MS group, n = 84), until we began to adopt surgical loupes (4.5×) for arterial reconstructions in all cases after January 2009 (SL group, n = 25). A dynamic MDCT study was prospectively carried out on postoperative days 7, 14, and 28, and at postoperative month 3, 6, and 12 after April 2005 (n = 60).Results
There were no cases of hepatic artery thrombosis and six cases (5.5 %) of interventional radiology-confirmed hepatic artery stenosis (HAS). Risk factor analysis for HAS showed that ABO-incompatible LDLT was associated with HAS. Use of surgical loupes provided superior results as compared to anastomosis under a surgical microscope, and it also provided the advantage of reduced operative time. The MDCT procedure was useful for detecting HAS; however, the false positive rate was relatively high until 3 months after the LDLT (100 % sensitivity and 72.8 % specificity at 3 months).Conclusions
Hepatic arterial anastomosis using surgical loupes tended to be time-saving and to yield similar or better results than traditional microscope-anastomosis. The use of MDCT aided the diagnosis of HAS, although the substantial false positive rate should be borne in mind in clinical practice. 相似文献19.
Franz Josef Müller Wolfgang Stosiek Michael Zellner Rainer Neugebauer Bernd Füchtmeier 《International orthopaedics》2013,37(11):2239-2245
Purpose
The purpose of this study was to determine the outcome of unstable type C pelvic fractures treated with posterior stabilisation and the anterior subcutaneous internal fixator (ASIF).Methods
Altogether, 36 consecutive patients were treated for unstable type C pelvic ring fractures using posterior stabilisation and ASIF. After a minimum of 18 months, the clinical and radiological outcome was retrospectively investigated.Results
Overall, three patients (8.3 %) died, and 31 patients (86 %) were available for follow-up after a mean of 4.5 years. Thirty of 31 patients (97 %) showed radiographic bone consolidation of both the posterior and anterior pelvic ring. Only one non-union and two infections due to the anterior device were observed. The total German pelvic outcome score showed an excellent or good rating for 64.5 % of the patients, and a fair or poor for 35.5 %. The SF-12 questionnaire showed a significantly reduced total score for physical and mental health compared to a general reference population.Conclusions
The ASIF represents an innovative surgical procedure for the treatment of type C pelvic ring fractures. In the medium term, patient satisfaction was high and the complication rate was low, despite the small number of patients. More cases must be investigated before the procedure can be recommended in general, possibly replacing the external fixator for the treatment of pelvic ring fractures in the future. 相似文献20.
Richard Martin Sellei MD Peter Schandelmaier MD Philipp Kobbe MD Matthias Knobe MD Hans-Christoph Pape MD FACS 《Clinical orthopaedics and related research》2013,471(9):2862-2868