[Internal fixation for pelvic posterior ring lesions].

OBJECTIVE: To explore the choice for the internal fixation in treatment of pelvic posterior lesions.

METHODS: From May 2000 to June 2005, the treatment was given to 40 patients (28 males, 12 females, aged 21-58 years) with pelvic posterior ring fracture and dislocation. Of the patients, 23 had a traffic accident, 11 had a crush injury and 6 had a fall. As for the state of an injury to the pelvic posterior ring, 22 patients had dislocation of the sacroiliac joint, 12 had a sacrum fracture dislocation, and 6 had an ala iliac fracture and dislocation of the sacroiliac joint. According to the Denis (1988) classification, fracture of the (sacral region I was found in 6 cases, fracture of the sacral) region II in 3 cases, and fracture of the sacral region III in 3 cases. As for the complication of the pelvic front ring fracture: separation of the symphysis pubis was found in 14 cases, fracture of the superior ramus and inferior ramus of the pubis on one side in 10 cases. The two-side superior ramus of public and inferior ramus of pubis in 8 cases, homopleural acetabular fracture on one side in 4 cases, acetabular fracture on one side and contralateral superior ramus and inferior ramus fracture of the pubis in 3 cases, and acetabular fracture on the opposite side in 1 case. As for the operation, 28 patients underwent the still-plate internal fixation of the sacroiliac joint from anterior at 24 h to 15 days after the injury, 2 underwent the screw internal fixation of the sacroiliac joint from posterior, and remaining 10 underwent the internal fixation by the Galveston Technique associated with the ISOLA system. The therapeutic results were analyzed.

RESULTS: The follow-up of the 40 patients for 6 months to 3 years revealed that before operation 3 had a sacral plexus nerve injury, and after operation 1 patient developed perineum numbness and urinary incontinence, 1 developed claudication,3 developed posterior urethral fragmentation, and 2 developed urinary bladder rupture; however, they had a complete recovery after the reparative surgery.

CONCLUSION: In treatment of the pelvic posterior ring lesions, an appropriate internal fixation can be chosen according to the type of the pelvic fracture, applicability of internal fixation, condition of the patient,equipment available, and the doctor's experience.