Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Int Orthop. 2011 Sep;35(9):1391-6. doi: 10.1007/s00264-010-1092-7. Epub 2010 Jul 20.
Correct placement of iliosacral screws remains a surgical challenge. The aim of this retrospective study was to identify parameters which impact the accuracy of this technically demanding procedure. Eighty-two patients with vertically unstable pelvic injuries treated with a total of 147 iliosacral screws were included. Assessment of postoperative CT scans revealed screw misplacement in 13 cases (8%), of which six occurred following insertion of two unilateral screws into S1. Six screw misplacements occurred in patients with dislocation injuries of the posterior pelvis. Comparison of a navigated and the standard technique revealed a decreased screw misplacement rate in the navigated group (15% standard vs. 3% navigation, p < 0.05). In addition, the malposition rate was influenced by the surgeon's individual experience (20% for low vs. 3.9% for high volume surgeons, p < 0.05). Overall, the accuracy of iliosacral screw placement depends on the number of screws inserted into S1 and the extent of dislocation. In experienced hands, the use of navigation represents a helpful tool to improve the placement accuracy.
正确放置髂骨骶螺钉仍然是一项具有挑战性的手术。本回顾性研究旨在确定影响这一技术要求高的手术准确性的参数。共纳入 82 例垂直不稳定骨盆损伤患者，共置入 147 枚髂骨骶螺钉。术后 CT 扫描评估显示 13 例（8%）存在螺钉位置不当，其中 6 例发生在 S1 两侧各置入 2 枚螺钉后。6 例螺钉位置不当发生在骨盆后脱位患者中。导航组与标准技术组比较，螺钉位置不当发生率降低（标准组 15%，导航组 3%，p<0.05）。此外，术者的个人经验也影响螺钉位置不当的发生率（低年资组 20%，高年资组 3.9%，p<0.05）。总体而言，髂骨骶螺钉的准确性取决于置入 S1 的螺钉数量和脱位程度。在经验丰富的手中，导航的使用是提高放置准确性的有用工具。
