Mullis Brian H, Sagi H Claude
Orthopaedic Trauma Service, The Florida Orthopaedic Institute, Tampa, FL 33606, USA.
J Orthop Trauma. 2008 May-Jun;22(5):293-8. doi: 10.1097/BOT.0b013e31816b6b4e.
To prospectively analyze a homogenous group of trauma patients with pure sacroiliac (SI) joint dislocations treated with iliosacral screws (ISS), with specific attention to functional outcome and its correlation with the presence or absence of SI joint ankylosis and quality of reduction.
Retrospective chart and radiographic review of initial injury and treatment, with prospective long-term evaluation of radiographs, computed tomography (CT) scans, and functional assessments.
Level One Regional Trauma Center.
Twenty-three patients who were skeletally mature with traumatic vertical shear pelvic injuries associated with a pure SI joint dislocation.
Treatment consisted of closed or open reduction in the supine or prone position and insertion of a single ISS placed percutaneously for the fixation of the posterior ring injury.
Each patient was evaluated for functional outcome using version 2 of the Short-Form 36 (SF-36v2), the short version of the Musculoskeletal Functional Assessment (sMFA), the Iowa Pelvic Scoring System, and the Majeed Pelvic Scoring System. Additionally, at the follow-up visit, each patient received plain radiographs of the pelvis and CT scanning of the pelvis.
Minimum follow-up was 1 year postindex procedure (13-120 months). In this subset of patients with pure SI dislocations treated with ISS alone, anatomic reduction was the only predictor of a more favorable functional outcome (P = 0.04). Specifically, SI joint ankylosis did not affect functional outcome in these patients.
Based on the results of this study, in the treatment of vertically displaced, pure SI joint dislocations, an anatomic reduction (whether closed or open), followed by ISS fixation should be the goal because this appears to be the only predictor of a more favorable functional outcome in patients with this injury. Complete SI joint ankylosis appears to have no effect, either positive or negative, on functional outcome in these patients.
前瞻性分析一组采用髂骶螺钉（ISS）治疗的单纯骶髂（SI）关节脱位创伤患者，特别关注功能结局及其与SI关节融合的存在与否以及复位质量的相关性。
对初始损伤和治疗进行回顾性图表及影像学检查，并对X线片、计算机断层扫描（CT）和功能评估进行前瞻性长期评估。
一级区域创伤中心。
23例骨骼成熟的患者，伴有单纯SI关节脱位的创伤性垂直剪切骨盆损伤。
治疗包括仰卧位或俯卧位的闭合或切开复位，并经皮插入单枚ISS以固定后环损伤。
使用简明健康状况调查简表第2版（SF-36v2）、肌肉骨骼功能评估简版（sMFA）、爱荷华骨盆评分系统和马吉德骨盆评分系统对每位患者的功能结局进行评估。此外，在随访时，每位患者均接受骨盆X线平片和骨盆CT扫描。
术后最短随访时间为1年（13 - 120个月）。在这组仅采用ISS治疗的单纯SI关节脱位患者中，解剖复位是功能结局更优的唯一预测因素（P = 0.04）。具体而言，SI关节融合对这些患者的功能结局没有影响。
基于本研究结果，在治疗垂直移位的单纯SI关节脱位时，目标应是进行解剖复位（无论闭合或切开），然后采用ISS固定，因为这似乎是此类损伤患者功能结局更优的唯一预测因素。完全的SI关节融合对这些患者的功能结局似乎没有正面或负面影响。
