Clinical efficacy and psychological influence of lateral rectus approach for treating pelvic fracture with lumbosacral plexus injury.

Background: The surgical treatment of pelvic fractures is challenging, particularly after lumbosacral plexus injuries. Such impairments affect a patient's physiological function and can cause significant mental health problems. In recent years, the new transrectus lateral approach has favorably treated pelvic fractures and possibly preserved patients' physiological and psychological conditions. Therefore, investigating its clinical efficacy for treating pelvic fractures plus lumbosacral plexus injuries is of great clinical significance.

Aim: To investigate the clinical effect of the transrectus lateral approach on pelvic fractures complicated by lumbosacral plexus injuries as well as anxiety and depression.

Methods: Data of 136 patients with pelvic fractures complicated by lumbosacral plexus injuries treated by the transrectus lateral approach (January 2011 to May 2024) were retrospectively analyzed. The patients' general data were collected via questionnaire. The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess anxiety and depression, respectively. We adopted a numerical rating scale (NRS) to evaluate pain degree, the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality, and Medical Research Council (MRC) Scale for Muscle Strength to evaluate treatment efficacy and complications.

Results: The 136 included patients (92 male, 44 female) were a mean 48.02 ± 15.72 years old. The mean SAS score was 66.36 ± 5.15 preoperatively vs 42.15 ± 4.36 postoperatively, while the mean SDS score was 65.61 ± 5.02 preoperatively vs 43.83 ± 4.54 postoperatively, showing statistically significant differences (P < 0.05). The mean NRS and PSQI scores were significantly lower pre- vs postoperatively (P < 0.05). Postoperatively, 67 patients with fresh pelvic fractures plus nerve injuries achieved an MRC of M5, 22 achieved an M1-M4, and four achieved an M0. Postoperative motor function improved by a mean 4.20 grades (scale, 0-5). Among the patients with old pelvic fractures and nerve injuries, 19 achieved an M5, 16 achieved an M1-M4, and eight achieved an M0. Motor function improved significantly by a mean 3.30 grades (scale, 0-5; P < 0.05). No serious postoperative complications occurred.

Conclusion: The transrectus lateral approach to treating pelvic fractures plus lumbosacral plexus injuries can safely alleviate anxiety and depression, relieve pain, improve sleep quality, reduce intraoperative blood loss, and improve postoperative recovery.