Mr. Huang from Fuzhou accidentally fell from a height and suffered multiple fractures throughout his body, and was paraplegic for more than 4 months, and came to Nanchang Hongdu Hospital of Traditional Chinese Medicine on March 4, 2024 for treatment of pelvic fractures.
Paraplegia caused by a fall from a height
Paraplegic for more than 4 months, why did Mr. Huang come to the hospital for treatment of pelvic fracture for so long?
According to Mr. Huang's own complaint, he is 31 years old and works in Xiamen. On October 27, 2023, he accidentally fell from a building about 6 floors high, causing multiple swelling, pain, bleeding and unfavorable activities all over his body, and was immediately sent to the ICU of a hospital in Xiamen for rescue after the injury, and was treated with fluid rehydration, blood transfusion, anti-shock, bilateral pleural fluid puncture, abdominal puncture and aspiration, bedside debridement and suturing of the right calf open injury. After his condition was stabilized, the orthopedic surgeon of the hospital performed open reduction and internal fixation of lumbar vertebra fracture + debridement of open fracture site of right calf + open reduction and internal fixation of right tibia and fibula fracture + external fixation of right tibia and fibula + external fixation of right tibia on November 10. Treatment continues in orthopedics after surgery. On November 20, Mr. Huang suddenly developed symptoms such as cough, fever, oligouria, and rash all over his body, and was transferred back to the ICU for treatment. After his condition stabilized, he was transferred back to orthopedic treatment on December 8 and was discharged from the hospital on December 18, and was treated in the ICU for more than 40 days throughout the treatment process.
Preoperative external fixator of the right tibia and fibula
The right limb was more than 2.5 cm shorter than the contralateral side before surgery
Anamnesis: history of blood transfusion, history of albumin drug allergy, denial of chronic disease history such as hypertension, diabetes, coronary heart disease, denial of hepatitis, tuberculosis and other infectious diseases.
Discharge diagnosis from a hospital in Xiamen:
1. Paraplegia (paralysis of the lower limbs); 2. Multiple fractures [L1 vertebral fracture, L2 vertebral burst fracture, T6 vertebral burst fracture, bilateral fifth lumbar vertebral transverse process fracture, right fourth lumbar vertebra transverse process fracture, sternal fracture, rib fracture, pulmonary contusion pneumothorax, multiple pelvic fractures (right acetabular fracture, iliac fracture, right pubic upper and lower branch fracture, bilateral sacrum comminuted fracture, right sacroiliac joint dislocation), right open lower tibia and fibula fracture, etc.];3. Shock;4.Sequelae of lumbar plexus nerve injury;5.Sequelae of sacral plexus nerve injury;6.Cauda equina nerve injury;7.Multiple soft tissue contusions;8.Hepatic insufficiency;9.Pleural effusion;10.Allergic reaction to drugs;11.Cardiac insufficiency;12.Renal insufficiency;13.Ascites effusion;14.Hypoproteinemia;15.Liver contusion;16.Neurogenic bladder.
Seek medical treatment everywhere and go to Hongzhong
Mr. Huang sought medical treatment all over the country, but almost all the hospitals he went to recommended conservative treatment, and when he felt hopeless, someone suggested that he go to Nanchang Hongdu Hospital of Traditional Chinese Medicine. So, on March 4, 2024, Mr. Huang came to the Department of Intelligent Minimally Invasive Orthopedics and Interventional Medicine of Nanchang Hongdu Hospital of Traditional Chinese Medicine for treatment.
Huang Haiming, deputy chief physician of the Department of Minimally Invasive Orthopedics and Interventional Surgery, received Mr. Huang, and after careful examination, it was found that the abdominal wall reflex was normal, the right cremaster reflex was present, the left cremaster reflex was weak, the Achilles tendon reflex left (+) right (-), the knee reflex left (+) right (-), and the pathological signs were not elicited. The patient's right gastrocnemius muscle, tibialis anterior, extensor digitorum muscle, and toe flexor muscle strength are only I. muscles. Weak left cremaster, positive left Achilles tendon reflex, positive left knee reflex, positive right cremaster reflex, right Achilles tendon reflex negative, left knee reflex negative.
Preoperative CT sagittal x-ray showed sacral duct fracture dislocation + sacral mass occupancy
After carefully studying Mr. Huang's fracture and treatment requirements, Director Huang Haiming believed that there was still hope for recovery, and admitted Mr. Huang to the hospital under great pressure.
Preoperative pelvic CT + 3D reconstruction
Preoperative multidisciplinary consultation of the whole hospital
Considering that the patient's condition is quite complex, a slight carelessness will inevitably lead to the occurrence of medical accidents and even the risk of death. Because it involves many departments such as spine surgery, traumatology, blood transfusion, laboratory department, anesthesiology department, internal medicine, intensive care department, nursing department, etc., on March 8, under the organization of the medical department, the Department of Wisdom Orthopedics and multidisciplinary experts held a consultation to discuss the best surgical treatment plan, and Vice President Fan Shaoyong also participated in the discussion.
Multidisciplinary consultation and discussion
At present, Mr. Huang's main treatment requirements are: first, to alleviate paralysis and solve the problem of incontinence, second, to solve the problem of getting off the ground, that is, to restore the length of the right lower limb, which is 3.8cm shorter than the left lower limb, and third, to solve the problem of difficulty in sitting up and lying flat caused by sacral fracture and pelvic tilt.
During the discussion, Dean Fan put forward key suggestions on many technical problems such as intraoperative pelvic osteotomy reduction and spinal canal nerve decompression, the directors of the Department of Orthopedics and Traumatology and the Department of Surgery contributed useful insights on the difficulties and solutions that may be encountered during the operation, and the directors of the Department of Medical Affairs, the Department of Emergency Medicine, and the Department of Laboratory Medicine put forward valuable opinions on the notification of surgical risks, postoperative rehabilitation, and blood transfusion guarantee. After discussion, a thorough surgical plan was finally formulated.
Repeated drills and successful treatment
Although the treatment plan has been repeatedly demonstrated, in order to ensure the safety of the operation, intelligent minimally invasive orthopedic experts printed a 3D model of pelvic fracture before surgery, and repeatedly rehearsed the problems and treatment methods that may be encountered during the operation, so as to have a clear idea of it.
Preoperative pelvis 3D printed anterior and dorsal
On the morning of March 12, with the cooperation of the Department of Minimally Invasive Orthopedics and Interventional Surgery, the Third Department of Spine Surgery, and the Second Department of Anesthesiology, experts performed multiple old pelvic fractures + osteotomy and orthopedic open reduction and internal fixation of the right acetabular old fracture after general anesthesia, internal fixation and removal after lumbar fracture + lumbar reduction and internal fixation, sacral old comminuted fracture and spinal canal mass bone removal + nerve exploration and decompression + fracture reduction and internal fixation + iliac bone retrieval + bone grafting, and postoperative internal fixation and removal of right tibial fracture +Re-reduction and internal fixation. The operation lasted 18 hours and ended at 4:30 a.m. the next day, with about 3500ml of intraoperative bleeding, 18 U of homotypic suspension red blood cells, 1810 ml of frozen plasma, 10 U of cryoprecipitate, 18 U of platelets of apheresis, and 750 ml of autologous blood recovery. Due to factors such as large trauma, heavy bleeding and long operation time, Mr. Huang was transferred to the ICU ward for observation after the operation.
Intraoperative diagram
Intraoperative image fixation
Both lower limbs were recovered to be equal in length after surgery
After careful treatment by the ICU medical staff, Mr. Huang returned to the general ward in only two days. After surgery and postoperative exercise, Mr. Huang's condition was stable, his skin felt significantly better, his muscle strength gradually recovered, the function of the affected limb gradually recovered, the numbness disappeared, and the urine bag was removed, and he was able to defecate and defecate spontaneously. At present, Mr. Huang has improved in lying down and sitting up, and can try walking on the ground after the muscle strength of both lower limbs has recovered.
The surgery was a great success, and Mr. Huang rekindled his hope for his future life and always smiled with satisfaction in the face of the medical staff.
Postoperative anterolateral view of the right tibia and fibula
Postoperative postoperative lumbar iliac fixation in anterolateral x-ray
Postoperatively, pelvic x-rays are repeated, and the anterior and lateral views are examined
A pelvic fracture is a serious traumatic injury that accounts for 1% to 3% of total body fractures. It is mostly caused by high-energy direct violence, and the disability rate is as high as 50%~60%. The pelvic position is deep, the internal organ structure is complex, and the vascular nerves are abundant, once the injury occurs, it often leads to the corresponding vascular nerve damage and massive bleeding, and there is a high mortality rate if the treatment is improper. Clinically, pelvic fracture surgery has been considered one of the most severe, complex, and lethal surgeries in the field of orthopedic trauma.
If pelvic fracture surgery is the "crown" in trauma orthopedics, then complex pelvic fracture surgery is the "crown jewel", and multiple old and complex pelvic fracture surgery is the ceiling in the orthopedic world.
Complex pelvic fractures are mostly caused by severe high-energy trauma, and the mortality rate and disability rate are high. In clinical treatment, surgery is difficult, bleeding is large, and surgical risks are high, so even highly skilled surgeons need to think in detail about how to carry out reduction and surgical approach, how to reduce surgical risks, and avoid damage to important tissue structures before the operation begins. In this operation, the intelligent minimally invasive orthopedic and interventional team challenged a number of orthopedic problems, successfully carried out the four-month old complex pelvic fracture surgery for the first time, and successfully carried out the "Everest-style" surgery such as sacral comminuted fracture sacral mass decompression and nerve release for the first time in paraplegic patients.
In recent years, the volume and difficulty of pelvic fracture surgery in Nanchang Hongdu Hospital of Traditional Chinese Medicine have ranked first in the province.
The smooth development of this operation marks a new step in the treatment of pelvic fracture in Hongdu Bone Injury. In the future, the team of smart minimally invasive orthopedics and interventional departments will continue to work hard to learn, keep improving, and be brave in innovation to escort the health of the people.
Department
Intelligent minimally invasive orthopedics and interventional medicine
The Department of Intelligent Minimally Invasive Orthopedics and Interventional Medicine is the first orthopedic department deeply integrated with artificial intelligence in Nanchang Hongdu Hospital of Traditional Chinese Medicine, which adheres to the patient-centered service concept, strives for excellence in medical technology, and is committed to providing high-quality, efficient and convenient medical services for the majority of orthopedic patients. The department adheres to the equal emphasis on traditional Chinese and Western medicine technology, inherits the traditional Chinese medicine concept of orthopedic injury to escort the health of orthopedic patients, and keeps up with the academic frontier, scientifically uses the essence of modern medical diagnosis and treatment technology, and has unique treatment methods for common and frequent diseases in orthopedics and traumatology, and can skillfully use orthopedic surgical robots to carry out conservative and minimally invasive surgical treatment of limb trauma fractures, complex pelvic acetabular fractures, and interventional treatment of peripheral vascular diseases. The department has a vibrant, skilled, noble medical ethics, united and cooperative medical team. At present, there are 2 senior titles, 1 intermediate title, 1 junior title and 4 master's titles.
Outpatient Arrangement:
Orthopedic Outpatient Room 7, 1st Floor, North Hospital (Monday to Sunday)
Recommend an expert
Huang Haiming: Deputy Chief Physician, Head of the Department of Minimally Invasive Orthopedics and Interventional Medicine.
Under the tutelage of Professor Li Xiaolin, a famous orthopedic expert from Shanghai Sixth Hospital, he has been engaged in clinical work in trauma orthopedics for more than 10 years, with a solid theoretical foundation and rich clinical experience. He is good at using traditional Chinese medicine characteristics and minimally invasive surgical techniques to treat limb fractures and dislocations caused by trauma, and is good at surgical treatment with the assistance of orthopedic robots, especially the treatment of various complex pelvic acetabular fractures, hip, knee and ankle joints and intra-articular fractures, fracture non-union and deformity healing, and interventional treatment of peripheral vascular diseases. He has in-depth research on various complex pelvic acetabular fractures and osteoporotic fractures, and has rich clinical experience. He has presided over 1 scientific research project of the Provincial Health Commission, published 2 SCI articles, and published more than 10 articles in domestic core journals such as the Chinese Journal of Orthopedics, the Chinese Journal of Osteoporosis, and the Chinese Journal of Rehabilitation.
Guo Jian: Deputy Chief Physician of Traditional Chinese Medicine, Associate Professor, Department of Minimally Invasive Orthopedics and Interventional Medicine.
Graduate. He is a member of the first Standing Council of the Orthopedic Branch of the Chinese Society of Traditional Chinese Medicine, a member of the Traumatology Group of the Orthopedic Professional Committee of the Jiangxi Association of Traditional Chinese Medicine, and a member of the Spine Group of the Second Orthopedic Minimally Invasive Professional Committee of the Jiangxi Association of Integrative Traditional and Western Medicine.
He studied under Professor Chen Weiliang, a national-level veteran Chinese medicine practitioner, and experienced orthopedic doctors Chen Xunwen, Liu Shangli and other experts. He is good at pelvic fractures, limb trauma, foot and ankle orthopedics and other surgeries, and has unique experience in the treatment of osteoarthritis, bone defects, bone infections and other methods using the combination of traditional Chinese medicine and Western medicine, especially in the treatment of difficult and miscellaneous orthopedic diseases such as osteoporosis, nonunion, osteomyelitis, arthritis and other orthopedic diseases, and is good at using orthopedic robots to treat orthopedic diseases with minimally invasive treatment, and is good at open surgery and interventional treatment of peripheral vascular diseases. He presided over 1 provincial industry standard project, participated in 1 project of the Provincial Department of Science and Technology, presided over 8 projects of the Provincial Health Commission, and participated in 5 projects of the Provincial Health Commission. He has published nearly 20 papers in domestic journals and 2 SCI papers. He has won the title of "Excellent Physician" many times.
Liang Xu: Attending TCM physician, intelligent minimally invasive orthopedics and interventional medicine.
He has been engaged in clinical orthopedic medical work for more than ten years, actively absorbing advanced experience at home and abroad, applying new technologies, striving for excellence, with a solid theoretical foundation and rich practical experience, and strong ability to deal with various difficult and complex cases. He is proficient in the diagnosis and treatment of common diseases such as fractures, dislocations, acute soft tissue injuries and chronic sports injuries in clinical orthopedics, and is good at using traditional Chinese medicine to treat and surgical treatment of various injuries of shoulder, elbow, wrist, knee, ankle and other joints. He has published many papers in national journals such as "Chinese Orthopedics" and "Traditional Chinese Medicine Orthopedics".
Yuan Ning: Resident, Department of Minimally Invasive Orthopedics and Interventional Medicine.
He studied under Professor Chen Feng, the instructor of the seventh batch of national experts in the inheritance of academic experience of old Chinese medicine experts and the chairman of the World Federation of Manipulative Medicine. He is good at minimally invasive surgery for orthopedic diseases such as elderly hip fractures, pelvic fractures, and limb fractures and dislocations, and is also good at using traditional Chinese medicine to treat common orthopedic diseases. He has participated in a number of provincial and municipal research projects and published 5 academic papers.
Author: Guo Jian, Department of Intelligent Minimally Invasive Orthopedics and Interventional Medicine, Nanchang Hongdu Hospital of Traditional Chinese Medicine
Correspondents: Qiu Peijun Zeng Huilan
Editor: Huang Menglin
Reviewer: Xie Tao
Issued: Daley Red
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