Papanastassiou Ioannis D, Setzer Matthias, Eleraky Mohammad, Baaj Ali A, Nam Tran, Binitie Odion, Katsares Kiesha, Cheong David, Vrionis Frank D
Neurooncology Program, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33647, USA.
J Spinal Disord Tech. 2011 Apr;24(2):76-82. doi: 10.1097/BSD.0b013e3181df8e6b.
Surgical technique article with retrospective case series.
Sacral insufficiency fractures are commonly encountered in oncologic patients and constitute a cause for persistent lower back and pelvic pain.
The aim of this study is to describe the modified technique of navigated percutaneous sacroiliac (SI) fixation using multiple long screws per level that cross both SI joints and engage bilateral iliac bones; furthermore to evaluate its safety and efficacy in oncologic patients with sacral insufficiency fractures.
Six oncologic patients (3 male, 3 female, mean age: 58.8 y) with sacral insufficiency fractures who had undergone additional radiation therapy were operated with navigated percutaneous fixation. Two patients had failed preoperative sacroplasty and 1 had failed SI pinning. Eighteen SI screws were placed (15 at S1 level and 3 at S2). In the majority of cases the screws were long enough to engage bilateral ilium and sacrum. Additionally, 1 patient underwent percutaneous iliolumbar instrumentation and in 4 patients we performed concomitant sacroplasty or polymethylmethacrylate screw augmentation. The patients were followed for 18.8 months in average (range: 12-30 mo). Outcome was assessed using the Karnofsky Performance Status score (KPS), pain scale (0-10) and detailed neurologic examination.
In 1 case, a revision of a screw was required due to radiculopathy. There was no perioperative morbidity or mortality. No hardware failure was encountered. There was significant improvement in KPS (P=0.04) and pain levels (P=0.02).
These preliminary data suggest that navigated percutaneous SI screw fixation is a safe and effective intervention in terms of pain control and performance status improvement in oncologic patients with sacral insufficiency fractures. For optimal fixation, multiple long screws that engage both iliac bones may be inserted through the S1 level in a safe manner. The technique may be combined with sacroplasty or closed posterior instrumentation to augment the screw fixation. Further investigation is needed to compare this technique with other treatment modalities.
回顾性病例系列的外科技术文章。
骶骨应力性骨折在肿瘤患者中常见，是导致持续下背部和骨盆疼痛的原因之一。
本研究旨在描述使用每节段多根长螺钉穿过双侧骶髂关节并固定双侧髂骨的导航下经皮骶髂关节（SI）固定改良技术；此外，评估其在肿瘤性骶骨应力性骨折患者中的安全性和有效性。
6例接受过额外放疗的肿瘤性骶骨应力性骨折患者（3例男性，3例女性，平均年龄：58.8岁）接受了导航下经皮固定手术。2例患者术前骶骨成形术失败，1例患者骶髂关节钢针固定失败。共置入18枚骶髂关节螺钉（S1节段15枚，S2节段3枚）。大多数情况下，螺钉足够长以固定双侧髂骨和骶骨。此外，1例患者接受了经皮髂腰固定术，4例患者同时进行了骶骨成形术或聚甲基丙烯酸甲酯螺钉增强术。患者平均随访18.8个月（范围：12 - 30个月）。使用卡诺夫斯基功能状态评分（KPS）、疼痛量表（0 - 10）和详细的神经学检查评估结果。
1例患者因神经根病需要进行螺钉翻修。无围手术期发病率或死亡率。未发生内固定失败。KPS（P = 0.04）和疼痛水平（P = 0.02）有显著改善。
这些初步数据表明，导航下经皮骶髂关节螺钉固定在控制肿瘤性骶骨应力性骨折患者的疼痛和改善功能状态方面是一种安全有效的干预措施。为实现最佳固定，可通过S1节段安全地插入多根固定双侧髂骨的长螺钉。该技术可与骶骨成形术或后路闭合固定相结合以增强螺钉固定效果。需要进一步研究将该技术与其他治疗方式进行比较。
