Marmor Meir, Lynch Terry, Matityahu Amir
Orthopaedic Trauma Institute UCSF, San Francisco General Hospital, San Francisco, CA 94110, USA.
Orthopedics. 2010 Feb;33(2):117-20. doi: 10.3928/01477447-20100104-26.
Percutaneous iliosacral screws are considered the standard of care for disruptions of the sacroiliac joint. This article describes a case of iatrogenic injury to the superior gluteal artery during iliosacral screw insertion and analyzes the possible reasons for this complication.A 32-year-old man diagnosed with an unstable pelvic ring injury underwent percutaneous fixation of the right sacroiliac joint. A 2-cm skin incision was made, and a straight cannulated awl was placed with the tip directly lateral to the S1 body. A guide wire was inserted and a partially threaded 6.5-mm cannulated screw with a washer was then placed over the guide wire and was found to be in excellent position. At this time, increased bleeding from the incision was observed. The incision was enlarged and dissection was carried down through the muscle. The bleeding vessel could not be visualized. Therefore, the wound was packed with sponges, and coil embolization of the right superficial gluteal artery was successfully performed.Analysis of the angiography reveled that our patient's superficial branch of the superior gluteal artery measured more than twice the average length reported in a previous anatomic study. We believe this is the first case of superior gluteal artery bleeding due to aberrant superior gluteal artery anatomy. When planning iliosacral screw insertion, the possibility of anatomical variance of the superior gluteal artery should be acknowledged and sought after in preoperative angiography, when available.
经皮髂骶螺钉被认为是治疗骶髂关节脱位的标准方法。本文描述了一例在插入髂骶螺钉过程中臀上动脉医源性损伤的病例，并分析了该并发症的可能原因。一名32岁男性被诊断为不稳定骨盆环损伤，接受了右骶髂关节的经皮固定。做了一个2厘米的皮肤切口，将一根直的空心锥子放置在S1椎体直接外侧的位置，插入一根导丝，然后将一枚带垫圈的部分螺纹6.5毫米空心螺钉套在导丝上，发现位置极佳。此时，观察到切口出血增加。扩大切口并通过肌肉进行解剖，但无法看到出血血管。因此，用海绵填塞伤口，并成功地对右臀浅动脉进行了弹簧圈栓塞。血管造影分析显示，我们患者的臀上动脉浅支长度超过了先前解剖学研究报道的平均长度的两倍。我们认为这是第一例因臀上动脉解剖变异导致臀上动脉出血的病例。在计划插入髂骶螺钉时，如果有条件，应在术前血管造影中认识到并寻找臀上动脉解剖变异的可能性。
