Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: Does posterior injury pattern predict fixation failure?
Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: Does posterior injury pattern predict fixation failure?
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DOI：
10.1097/00005131-200307000-00001
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发表时间：
2003-07-01
影响因子：
2.3
通讯作者：
Whitlock, S
中科院分区：
文献类型：
--
作者：
Griffin, DR;Starr, AJ;Whitlock, S
目的：测量垂直不稳定骨盆骨折经皮髂骶螺钉固定的失败率，特别是检验以下假设：后部损伤为骶骨垂直骨折的固定比骶髂关节脱位或骨折脱位的固定更容易失败。设计：回顾性分析。地点：1级创伤中心。方法：1993年1月1日至1998年12月31日期间收治的所有骨盆骨折患者均来自创伤登记处。使用医院记录识别接受髂骶螺钉治疗的患者。通过影像学检查明确诊断垂直不稳定骨盆骨折的患者。检查术后即刻和至少12个月的随访前后位、入口和出口X线片。记录髂骶螺钉的位置、长度和数量以及螺钉失效的任何证据（例如，弯曲或断裂）。测量术后残余位移和后骨盆晚期位移。主要结局指标为失败，定义为与术后即刻位置相比，骨盆后部的联合垂直位移至少1cm。主要分析断裂模式与失效之间的关联。患者的人口统计学数据，髂骶螺钉的位置，和前骨盆fixation methodsalso进行了study.Results：研究组包括62例明确垂直不稳定骨盆骨折，其中后方损伤治疗闭合复位和经皮髂骶螺钉固定。32例患者有骶髂关节脱位或再脱位，30例有骶骨垂直骨折。4例患者固定失败，均为骶骨垂直骨折，且均在术后前3周内。这4例患者需要翻修固定。在另外2例骶骨垂直骨折病例中，有证据表明骨折仅被固定物勉强固定，但这些骨折愈合，随访X线片不符合失效的移位标准。垂直骶骨骨折模式与失败显著相关（Fisher精确检验，P = 0.04）;与骶髂关节损伤相比，失败的额外风险为13%（95%置信区间1%至25%）。失败和前路固定方法，髂骶螺钉排列或长度，或任何人口统计学或损伤variable.Conclusions：经皮髂骶螺钉固定是一种有用的技术，在垂直不稳定骨盆骨折的管理，但垂直骶骨骨折应使外科医生更谨慎的固定失败和损失的减少。
Objective: To measure the failure rate of percutaneous iliosacral screw fixation of vertically unstable pelvic fractures and particularly to test the hypothesis that fixations in which the posterior injury is a vertical fracture of the sacrum are more likely to fail than fixations with dislocations or fracture dislocations of the sacroiliac joint.Design: Retrospective review.Setting: Level 1 trauma center.Methods: All patients with pelvic fractures admitted between January 1, 1993, and December 31, 1998, were identified from the trauma registry. Hospital records were used to identify patients treated with iliosacral screws. Radiologic studies were examined to identify patients who had unequivocally vertically unstable pelvic fractures. Immediate postoperative and follow-up anteroposterior, inlet, and outlet radiographs from a minimum of 12 months postinjury were examined. Position, length, and numbers of iliosacral screws and any evidence of screw failure (eg, bending or breakage) were recorded. Residual postoperative displacement and late displacement of the posterior pelvis were measured. The main outcome measure was failure, defined as at least 1cm of combined vertical displacement of the posterior pelvis compared with immediate postoperative position. The main analysis was for association between fracture pattern and failure. Patient demographic data, iliosacral screw position, and anterior pelvic fixation method also were studied.Results: The study group comprised 62 patients with unequivocally vertically unstable pelvic fractures in whom the posterior injury was treated with closed reduction and percutaneous iliosacral screw fixation. Of patients, 32 had dislocations or fracture-dislocations of the sacroiliac joint, and 30 had vertical fractures of the sacrum. Fixation failed in four patients, all with vertical sacral fractures and all within the first 3 weeks after surgery. These four patients required revision fixation. In two further cases with vertical sacral fractures, there was evidence that the fracture had only barely been held by the fixation, but these fractures healed, and follow-up radiographs did not meet the displacement criteria for failure. A vertical sacral fracture pattern was associated significantly with failure (Fisher exact test, P = 0.04); the excess risk of failure compared with sacroiliac joint injury was 13% (95% confidence interval 1% to 25%). There was no significant association between failure and anterior fixation method, iliosacral screw arrangement or length, or any demographic or injury variable.Conclusions: Percutaneous iliosacral screw fixation is a useful technique in the management of vertically unstable pelvic fractures, but a vertical sacral fracture should make the surgeon more wary of fixation failure and loss of reduction.