"过度入口位"透视辅助下置入骶髂关节螺钉的临床意义

Clinical significance of excessive inlet view in fluoroscopy-assisted placement of sacroiliac screws

目的探讨在"过度入口位"透视辅助下置入骶髂关节螺钉的临床意义。方法采用前瞻性研究方法纳入西安交通大学附属西安红会医院骨创伤医院环骨盆病区2020年1月至2021年1月期间收治的47例不稳定型骨盆骨折患者。男30例,女17例;平均年龄为39.4岁(25~66岁)。骨折Tile分型:B型21例,C型26例。术前测量入口位及"过度入口位"角度,术中使用C型臂X线机透视导航结合"过度入口位"透视技术辅助置入骶髂关节螺钉。术后应用CT或O型臂X线机验证骶髂关节螺钉的位置,记录患者的螺钉置入时间、骨折复位质量、骨折愈合时间及末次随访时的骨盆功能等。结果47例患者共置入67枚螺钉,其中56枚骶髂关节螺钉。平均每枚螺钉置入时间为19.9 min(9~31 min)。术前测量"过度入口位"角度平均为17.38°(12.1°~24.8°)。O型臂X线机或CT检查结果显示:所有骶髂关节螺钉均位于骶骨通道内,无螺钉错位、突破骨皮质进入骶管等情况发生。术后骨折复位质量根据Matta评分标准评定:优22例,良17例,可6例,差2例,优良率为83.0%(39/47)。47例患者术后获平均9.5个月(5~15个月)随访,骨折愈合时间平均为10.5周(7~16周)。末次随访时根据Mejeed评分系统评定骨盆功能:优26例,良15例,可6例,优良率为87.2%(41/47)。结论"过度入口位"透视是一种简单、易行的术中透视技术,可清晰识别骶骨后缘界限,有效避免螺钉突破骨皮质对骶管神经造成的医源性损伤,提高骶髂关节螺钉置入的精确性和安全性。

Objective To investigate the clinical significance of excessive inlet view in fluoroscopy-assisted placement of sacroiliac screws.Methods Included for this prospective study were 47 patients with unstable pelvic fracture who had been admitted to Department of Orthopaedic Trauma,Xi'an Honghui Hospital between January 2020 and January 2021.There were 30 males and 17 females,with a mean age of 39.4 years(from 25 to 66 years).By the Tile classification,21 fractures were type B and 26 ones type C.The inlet view and the angle of excessive inlet view were measured before operation.The intraoperative placement of sacroiliac screws was assisted by C-arm fluoroscopy navigation in the excessive inlet view.The positions of sacroiliac screws were verified by CT or O-arm fluoroscopy after operation.The screw placement time,fracture reduction quality,fracture healing time,and pelvic function at the last follow-up were recorded.Results A total of 67 screws were implanted in the 47 patients,including 56 sacroiliac screws.The insertion time for each screw averaged 19.9 min(from 9 to 31 min);the angle of excessive inlet view averaged 17.38°(from 12.1°to 24.8°).Verification by O-arm fluoroscopy or CT revealed that all sacroiliac screws were located in the sacral canal without dislocation or breaking through the cortical bone.By the postoperative Matta scoring,the reduction was excellent in 22 cases,good in 17,acceptable in 6,and poor in 2,giving an excellent to good rate of 83.0%(39/47).The average follow-up time for the 47 patients was 9.5 months(from 5 to 15 months);fracture healing time averaged 10.5 weeks(from 7 to 16 weeks).By the Mejeed scoring at the last follow-up,the pelvic function was excellent in 26 cases,good in 15 and acceptable in 6,giving an excellent to good rate of 87.2%(41/47).Conclusions Fluoroscopy in the excessive inlet view is a simple and easy intraoperative technique.It can improve accuracy and safety of sacroiliac screw placement because it allows clear identification of the posterior border of the sacrum and effectively avoids iatrogenic injury to the sacral nerve caused by screws breaking through the bone cortex.