Duwelius P J, Van Allen M, Bray T J, Nelson D
Division of Orthopedics and Rehabilitation, Oregon Health Sciences University, Portland 97201-3098.
J Orthop Trauma. 1992;6(4):420-6. doi: 10.1097/00005131-199212000-00005.
Open reduction and internal fixation (ORIF), the current treatment of choice of posterior pelvic ring disruptions with instability, has significant disadvantages. These include relatively "blind" placement of the fixation screws, infection, exsanguinating hemorrhage, and high wound complication rates. We feel fluoroscopy does not offer significant clarity in defining the posterior structure. Advantages of computed tomography (CT)-guided sacral fixation are direct visualization of the course of the screws and absence of significant wound complications. This technique provides superior visualization of the nerve roots and sacral canal compared to fluoroscopic methods. Thirteen patients (10 unilateral and 3 bilateral) with unstable but reducible sacral fractures or sacroiliac joint (SIJ) disruptions underwent CT-guided posterior pelvic ring fixation using a cannulated screw system. Skeletal traction was required intraoperatively in one case by a traction-counteraction pulley system in the CT scanner. All other reductions were performed by preoperative skeletal traction or manually by the surgeons after anesthesia in the scanner or after push-pull films demonstrated instability. The guide pin, using depth and angulation measurements derived from the scout CT scans, was positioned across the fracture or SIJ. Following CT confirmation of the position of the pin, the screw tract was drilled and the cannulated screw was placed into position. Radiographic and clinical follow-up observation (7-24 months) showed healing with no significant complications in all 13 patients. Computed tomography-guided sacral fixation is a safe alternative to ORIF in selected patients with reducible unstable pelvic fractures.
切开复位内固定术（ORIF）是目前治疗伴有不稳定的骨盆后环损伤的首选方法，但存在明显缺点。这些缺点包括固定螺钉放置相对“盲目”、感染、大量出血以及伤口并发症发生率高。我们认为透视在确定后方结构时清晰度欠佳。计算机断层扫描（CT）引导下的骶骨固定术的优点是可直接观察螺钉走行且伤口并发症少。与透视方法相比，该技术能更清晰地显示神经根和骶管。13例（10例单侧和3例双侧）伴有不稳定但可复位的骶骨骨折或骶髂关节（SIJ）损伤的患者接受了CT引导下的骨盆后环固定术，采用空心螺钉系统。术中1例通过CT扫描仪中的牵引对抗滑轮系统进行骨骼牵引。所有其他复位均通过术前骨骼牵引或在扫描仪中麻醉后由外科医生手动复位，或在推拉片显示不稳定后进行。利用从定位CT扫描获得的深度和角度测量值，将导针穿过骨折部位或骶髂关节。在CT确认导针位置后，钻出螺钉通道并置入空心螺钉。影像学和临床随访观察（7 - 24个月）显示，所有13例患者均愈合且无明显并发症。对于部分可复位的不稳定骨盆骨折患者，CT引导下的骶骨固定术是ORIF的一种安全替代方法。
