MINIMALLY INVASIVE LUMBAR-PELVIC STABILIZATION FOR UNSTABLE PELVIC RING INJURIES
- Authors: Dulaev A.K.1,2, Kazhanov I.V.1, Manukovsky V.A.1,3, Mikityuk S.I.1,3, Presnov R.A.1, Gavrishchyuk Y.V.1
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Affiliations:
- Dzhanelidze St. Petersburg Research Institute of Emergency Medicine
- Pavlov First St. Petersburg State Medical University
- Kirov Military Medical Academy of the Ministry of Defense of Russian Federation
- Issue: Vol 23, No 2 (2017)
- Pages: 49-58
- Section: Modern technologies in traumatology and orthopedics
- Submitted: 01.07.2017
- Accepted: 01.07.2017
- Published: 01.07.2017
- URL: https://journal.rniito.org/jour/article/view/725
- DOI: https://doi.org/10.21823/2311-2905-2017-23-2-49-58
- ID: 725
Cite item
Full Text
Abstract
Reconstructive operations for unstable pelvic ring injuries in most cases are performed at later date after trauma (period of complete stabilization of the vital functions). The paper presents treatment outcomes of three patients with vertically unstable pelvic ring injuries where minimally invasive lumbar-pelvic fixation with pedicle screws was applied. The morphology of sacrum injury determined a configuration of the lumbar-pelvic transpedicular system. In all cases the final surgery was performed in the early period of traumatic disease, which made it possible to restore the anatomy of the pelvic ring and obtain good functional outcomes.
About the authors
A. K. Dulaev
Dzhanelidze St. Petersburg Research Institute of Emergency Medicine; Pavlov First St. Petersburg State Medical University
Email: fake@neicon.ru
Alexander K. Dulaev – Dr. Sci (Med.), Professor, Head of the Department of Traumatology, Orthopedics and Vertebrology SPRIEM; the Head of Department of Traumatology and Orthopedics of FSPSMU
3, Budapeshtskaya ul., St. Petersburg, 192242; 6-8, ul. L’va Tolstogo, St. Petersburg, 197022
РоссияI. V. Kazhanov
Dzhanelidze St. Petersburg Research Institute of Emergency Medicine
Author for correspondence.
Email: carta400@rambler.ru
Igor V. Kazhanov – Cand. Sci (Med.), Leading Researcher of Department of the Combined Trauma S PRIEM; Head of Department of Military Field Surgery Clinic MMA
3, Budapeshtskaya ul., St. Petersburg, 192242
РоссияV. A. Manukovsky
Dzhanelidze St. Petersburg Research Institute of Emergency Medicine; Kirov Military Medical Academy of the Ministry of Defense of Russian Federation
Email: fake@neicon.ru
Vadim A. Manukovsky – Dr. Sci (Med.), Professor, Deputy Director for Clinical work S PRIEM; Professor of Military Field Surgery Clinic MMA
3, Budapeshtskaya ul., St. Petersburg, 192242; 6, ul. Akad. Lebedeva, St. Petersburg, 194044
РоссияS. I. Mikityuk
Dzhanelidze St. Petersburg Research Institute of Emergency Medicine; Kirov Military Medical Academy of the Ministry of Defense of Russian Federation
Email: fake@neicon.ru
Sergey I. Mikityuk – Cand. Sci (Med.), Senior Lecturer of Educational Center o SPRIEM; Head of Department of Military Field Surgery Clinic MMA
3, Budapeshtskaya ul., St. Petersburg, 192242; 6, ul. Akad. Lebedeva, St. Petersburg, 194044
РоссияR. A. Presnov
Dzhanelidze St. Petersburg Research Institute of Emergency Medicine
Email: fake@neicon.ru
Roman A. Presnov – Orthopedic Surgeon of Department of Traumatology and Orthopedics SPRIEM
3, Budapeshtskaya ul., St. Petersburg, 192242
РоссияY. V. Gavrishchyuk
Dzhanelidze St. Petersburg Research Institute of Emergency Medicine
Email: fake@neicon.ru
Yaroslav V. Gavrishuk – Cand. Sci (Med.), Head of Operating Department SPRIEM
3, Budapeshtskaya ul., St. Petersburg, 192242
РоссияReferences
- Донченко С.В., Дубров В.Э., Слиняков Л.Ю., Черняев А.В., Лебедев А.Ф., Алексеев Д.В. Алгоритм хирургического лечения нестабильных повреждений тазового кольца. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2013;(4):9-16.
- Ключевский В.В., Даниляк В.В., Гильфанов С.И. Семилетний опыт в лечении пациентов с нестабильными повреждениями тазового кольца. Margo Anterior. 2009;(1):3-11.
- Самохвалов И.М., Кажанов И.В., Тюрин М.В., Ганин В.Н., Денисов А.В. Особенности хирургического лечения переломов крестца. Травматология и ортопедия России. 2012;(2):16-21. doi: 10.21823/2311-2905-2012--2-16-21.
- Шаповалов В.М., Дулаев А.К., Дыдыкин А.В. экспериментальная разработка и клиническое применение минимально инвазивной внутренней стержневой фиксации тазового кольца. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2001;(4):33-37.
- Швец А.И., Ивченко Д.В., Ивченко В.К., Лубенец А.А., Ивченко А.В. Повреждения поясничного отдела позвоночника в сочетании с переломами крестца. Травма. 2014;15(2):55-59.
- Ayoub М.A. Displaced spinopelvic dissociation with sacral cauda equina syndrome: outcome of surgical decompression with a preliminary management algorithm. J Eur Spine. 2012; 21(9):1815-1825. doi: 10.1007/s00586-012-2406-9.
- Bellabarba C., Schildhauer T.A., Vaccaro A.R., Chapman J.R. Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability. Spine (Phila Pa 1976). 2006;(31):80-88. doi: 10.1097/01.brs.0000217949.31762.be.
- Denis F., Davis S., Comfort T. Sacral fractures: an important problem, retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;(227):67-81.
- gibbons K.J., Soloniuk D.S., Razack N. Neurological injury and patterns of sacral fractures. J Neurosurg. 1990;72(6):889-993. doi: 10.3171/jns.1990.72.6.0889.
- Gribnau A.J., Hensbroek P.B., Haverlag R., Ponsen K.J. et al. U-shaped sacral fractures: surgical treatment and quality of life. Injury. 2009;40(10):1040-1048. doi: 10.1016/j.injury.2008.11.027.
- Griffin D.R., Starr A.J., Reinert C.M., Jones A.L., Whitlock S. Vertically unstable pelvic fractures fixed with percutaneous iliosacralscrews: does posterior injury pattern predict fixation failure. J Orthop Trauma. 2003;(17):399-405.
- Iorio J.A., Jakoi A.M., Rehman S. Percutaneous sacroiliac screw fixation of the posterior pelvic ring. Orthop Clin N Am. 2015; 46 (4): 511-521. doi: 10.1016/j.ocl.2015.06.005.
- Isler B. Lumbosacral lesions associated with pelvic ring injuries. J Orthop Trauma. 1990;4(1):1-6.
- Käch K., Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg. 1994;(97):28-38.
- Keel M.J., Benneker L.M., Siebenrock K.A., Bastian J.D. Less invasive lumbopelvic stabilization of posterior pelvic ring instability: technique and preliminary results. J Trauma. 2011;71(3):62-70. doi: 10.1097/TA.0b013e3182092e66.
- Kleweno C., Bellabarba C. Lumbopelvic fixation for pelvic fractures. Oper Tech Orthop. 2015;25(4):270-281. doi: 10.1053/j.oto.2015.09.001.
- Lindahl J., Hirvensalo E., Böstman O. Santavirta S. Failure of reduction with an external fixator in the management of injuries of the pelvic ring. Long-term evaluation of 110 patients. J Bone Joint Surg Br. 1999;(81):955-962.
- Majeed S.A. Grading the outcome of pelvic fracture. J Bone Joint Surg Br. 1989;71(2):304-306.
- Park Y.S., Baek S.W., Hong-Sik Kim H.S., Park K.C. Management of sacral fractures associated with spinal or pelvic ring injury. J Trauma Acute Care Surg. 2012;1(73): 239-242. doi: 10.1097/TA.0b013e31825a79d2.
- Papakostidis C., Kanakaris N.K., Kontakis G., Giannoudis P.V. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop. 2009;33(2):329-338. doi: 10.1007/s00264-008-0555-6.
- Pape H.C., Giannoudis P.V., Krettek C., Trentz O. Timing of fixation of major fractures in blunt polytrauma: Role of conventional indicators in clinical decision making. J Orthop Trauma. 2005;(19):551-562.
- Roy-Camille R., Saillant G., Gagna G., Mazel C. Transverse fractures of the upper sacrum: Suicidal jumper’s fractures. Spine. 1985;10(9):838-845.
- Sagi H.C. Technical aspects and recommended treatment algorithms in triangular osteosynthesis and spinopelvic fixation for vertical shear transforaminal sacral fractures. J Orthop Trauma. 2009;23(5):354-360. doi: 10.1097/BOT.0b013e3181a1143a.
- Schildhauer T.A., Ledoux W.R., Chapman J.R., Henley M.B., Tencer A.F., Routt M.L. Jr. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma. 2003;(17):22-31.
- Schildhauer T., Bellabarba С., Nork S.E. Barei D.P., Routt M.L. Jr., Chapman J.R. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma. 2006;20(7):447-457.
- Solomin L.N. The basic principles of external skeletal fixation using the Ilizarov and other devices. 2nd ed. Milan : Springer, 2012. р. 933-967.
- Tan G.Q., He J.L., Fu B.S., Li L.X. Wang B.M., Zhou D.S. Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability. Injury. 2012;43(8):1318-1325. doi: 10.1016/j.injury.2012.05.003.
- Tonetti J. Management of recent unstable fractures of the pelvic ring. An update conference supported by the Club BassinCotyle (Pelvis-Acetabulum Club). Orthop Traumatol Surg Res. 2013;99(1):77-86. doi: 10.1016/j.otsr.2012.11.013.
- Vigdorchik J.M., Jin X., Sethi A., Herzog D.T., Oliphant B.W., Yang K.H., Vaidya R. A biomechanical study of standard posterior pelvic ring fixation versus a posterior pedicle screw construct. Injury. 2015;46(8):1491-1496. doi: 10.1016/j.injury.2015.04.038.
- Williams S.K., Quinnan S.M. Percutaneous lumbopelvic fixation for reduction and stabilization of sacral fractures with spinopelvic dissociation patterns. J Orthop Trauma. 2016;30(9):318-324. doi: 10.1097/BOT.0000000000000559.
- Zamzam M.M. Unstable pelvic ring injuries. _Outcome and timing of surgical treatment by internal fixation. Saudi Med J. 2004; 25(11):1670-1674.