Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications
Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications
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DOI：
10.1007/s00402-010-1230-0
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发表时间：
2011-06-01
影响因子：
2.3
通讯作者：
Werner, Clement M. L.
中科院分区：
文献类型：
--
作者：
Osterhoff, Georg;Ossendorf, Christian;Werner, Clement M. L.
经皮髂骶螺钉置入允许微创固定骨盆后环不稳定。本研究的目的是描述使用传统C形臂在S1和S2进行螺钉固定的技术，并评估围手术期并发症。术后和定期随访检查评估螺钉放置的准确性、神经损伤、二次手术的需要、手术时间和完全负重的时间。21例患者接受单侧螺钉固定，17例患者接受双侧螺钉固定。共置入83枚螺钉。患者的平均年龄为52 ± 19岁。平均手术时间为16 +/- A 7 min/螺钉。平均随访5 +/-A3个月。28例患者完全负重时间为9 +/-A4周。8名患者仍然不能完全承重，部分原因是伴随损伤。没有影响行走的伴随损伤的患者在8 +/- A 4周后能够承受全部重量（n = 17）。2例患者术后持续感觉减退。没有明显的运动无力，也没有观察到术后出血。4例患者因螺钉错位或松动而不得不进行二次手术。经皮髂骶螺钉内固定术是治疗骨盆后环损伤的一种快速而明确的治疗方法，在骨盆后稳定过程中继发出血的风险较低。还发现使用标准C形臂荧光镜检查的技术对于S2中放置的螺钉是安全的。
Percutaneous iliosacral screw placement allows for minimally invasive fixation of posterior pelvic ring instabilities. The objective of this study was to describe the technique for screws in S1 and S2 using conventional C-arm and to evaluate perioperative complications.Thirty-eight consecutive patients after percutaneous pelvic ring fixation with cannulated screws in S1 and S2 using conventional C-arm fluoroscopy were analysed. Accuracy of screw placement, nerval lesions, need for second surgery, operation time, and time to full weight bearing were assessed postoperatively and during regular follow-up examinations.Twenty-one patients underwent unilateral screw fixation and 17 patients underwent bilateral screw fixation. In total, 83 screws were placed. Mean age of the patients was 52 +/- A 19 years. Mean operation time was 16 +/- A 7 min/screw. Mean follow-up was 5 +/- A 3 months. Time to full weight bearing in 28 patients was 9 +/- A 4 weeks. Eight patients were still not able to support full weight bearing, partially due to concomitant injuries. Patients without concomitant injuries that affected walking were able to bear full weight after 8 +/- A 4 weeks (n = 17). Two patients had persistent postoperative hypaesthesia. No motor weakness was apparent and no postoperative bleeding was observed. Secondary surgery due to screw malpositioning or loosening had to be performed in four patients. The presence of a screw in S2 was not indicated for perioperative complications.Percutaneous iliosacral screw fixation is a rapid and definitive treatment for posterior pelvic ring injuries with a low risk of secondary bleeding during posterior pelvic stabilization. The technique using standard C-arm fluoroscopy was also found to be safe for screws placed in S2.