Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2022; 10(14): 4470-4479
Published online May 16, 2022. doi: 10.12998/wjcc.v10.i14.4470
Multi-slice spiral computed tomography in diagnosing unstable pelvic fractures in elderly and effect of less invasive stabilization
Jian-Guo Huang, Zhi-Yuan Zhang, Liang Li, Guang-Bao Liu, Xiong Li
Jian-Guo Huang, Zhi-Yuan Zhang, Department of Orthopedics, Sanya Hospital of Traditional Chinese Medicine, Sanya 572000, Hainan Province, China
Liang Li, Department of Orthopedics, Xi’an Honghui Hospital, Xi’an 710024, Shaanxi Province, China
Guang-Bao Liu, Department of Radiology, Sanya Hospital of Traditional Chinese Medicine, Sanya 572000, Hainan Province, China
Xiong Li, Department of Traumatic Orthopedics Sports Medicine, Yan’an Hospital of Traditional Chinese Medicine, Yan’an 716000, Shaanxi Province, China
Author contributions: Huang JG designs topics and writes articles; Zhang ZY collects patient case information; Li L organizes examination results; Liu GB statistically analyzes experimental results; Li X is responsible for research progress, article writing and revision.
Institutional review board statement: This study was approved by the Institutional Review Board of Sanya Hospital of Traditional Chinese Medicine.
Informed consent statement: All patients provided informed consent.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: The date that support the findings of this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiong Li, MBChB, Attending Doctor, Department of Traumatic Orthopedics Sports Medicine, Yan’an Hospital of Traditional Chinese Medicine, No. 26 Xuanyuan Avenue, New District, Yan’an 716000, Shaanxi Province, China. lixiongdr@163.com
Received: December 15, 2021
Peer-review started: December 15, 2021
First decision: January 26, 2022
Revised: February 17, 2022
Accepted: March 27, 2022
Article in press: March 27, 2022
Published online: May 16, 2022
Processing time: 148 Days and 22.1 Hours
Abstract
BACKGROUND

Older people are more likely to experience pelvic fractures than younger people. Multi-slice spiral computed tomography (CT) uses three-dimensional (3D) reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.

AIM

To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.

METHODS

A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery. Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable. Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis. After basic or complete reduction, minimally invasive internal fixation using hollow lag screws was performed. The detection rates of fracture location and classification by X-ray and CT reconstruction were compared. Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction, wound healing time, fracture healing time, hospitalization time, visual analog scale (VAS) score, poor internal fixation, and functional recovery.

RESULTS

The diagnostic coincidence rates of X-rays for pubic symphysis, ilium wing, sacroiliac periarticular, and sacral fractures were lower than those of CT reconstruction. The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%, whereas 11 cases were misdiagnosed by X-ray; the total coincidence rate was 87.21%. The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group (P < 0.05). The wound healing, fracture healing, and hospitalization times were significantly shorter in the study group than in the control group (P < 0.05). The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group (P < 0.05). The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group (P < 0.05). The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group (P < 0.05).

CONCLUSION

Multi-slice spiral CT has high guiding significance for the diagnosis, classification, and treatment of unstable pelvic fractures in the elderly. Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing, while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites, making it worthy of clinical application.

Keywords: Multi-slice spiral computed tomography; Three-dimensional reconstruction; Unstable pelvic fracture; Minimally invasive internal fixation; Diagnostic value

Core Tip: Multi-slice spiral computed tomography has high guiding significance for the diagnosis, classification, and treatment of unstable pelvic fractures in elderly individuals. Preoperative three-dimensional reconstruction can effectively shorten the operation time and promote fracture healing, and minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites, making it worthy of clinical application.