Application of the “one trunk-three branches” classification based on three-dimensional CT reconstruction in the treatment of pelvic and acetabular fractures

doi:10.3969/j.issn.2095-4344.2017.35.022

Abstract

Abstract:

BACKGROUND: There is no systematic classification method that can completely, accurately and directly reflect the characteristics of pelvic and acetabular fractures. Three-dimensional (3D) CT reconstruction technique provides more imaging evidences for the diagnosis of pelvic and acetabular fractures.

OBJECTIVE: To introduce the “one trunk-three branches” classification for pelvic and acetabular fractures based on 3D CT reconstruction, and to evaluate its clinical effect.

METHODS: Forty-seven cases of pelvic and acetabular fractures were enrolled, involving 18 cases of “single trunk or single branch” fracture, 18 cases of “one trunk-one branch”, 7 cases of “one trunk-two branches”, and 4 cases of “one trunk-three branches”. Based on the “one trunk-three branches” classification, the surgical approaches included improved Stoppa, posterior iliac-lumbar, iliac fossa and K-L approaches, and one or combined approaches were recommended. The order of approach and fixation was as follows: trunk first followed by branch, and another approach was necessary when the conjoint branches did not achieve simultaneous reduction. The clinical efficacy was evaluated through postoperative follow up.

RESULTS AND CONCLUSION: (1) The average operation time of the fractures of single trunk or one branch, one trunk-one, one trunk-two branches and one trunk-three branches was 75.2, 88.5, 97.4, and 115.8 minutes, respectively; the average blood loss was 321.2, 360.4, 450.5, and 650 mL, respectively. (2) According to the criteria described by Matta, 25 of the reductions were graded excellent, 20 were graded good, and 2 were poor, and the excellent and good rate was 96%. (3) All patients were followed up for 12-35 months, and the follow-up rate was 87%. The mean healing time was 2.9 months (2.7-4.2 months), and the mean weight bearing time was 3.8 months (2.5-5.6 months). (4) At the last follow up, the clinical outcomes (Majeed criteria) were 16 excellent, 25 good, 4 average and 2 poor, and the excellent and good rate was 87%; the clinical outcomes (Merle d’Aubigne-Postel) were 15 excellent, 24 good, 6 average, and 2 poor, and the excellent and good rate was 83%. None of complications occurred. (5) These results manifest that the “one trunk-three branches” classification for pelvic and acetabular fractures based on 3D CT reconstruction is helpful for designing an appropriate treatment scheme, and choosing optimal surgical approach and fixation order, thereby promoting the functional recovery of the pelvis and acetabulum.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Pelvis, Acetabulum, Fractures, Bone, Tissue Engineering

CLC Number:

R318

Chen Hua, Li Feng, Xu Yang-ping. Application of the “one trunk-three branches” classification based on three-dimensional CT reconstruction in the treatment of pelvic and acetabular fractures[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(35): 5709-5714.

Figures/Tables 2

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