Wang Michael Y, Williams Seth, Mummaneni Praveen V, Sherman Jonathan D
*Departments of Neurological Surgery & Rehabilitation Medicine, University of Miami Miller School of Medicine, Lois Pope LIFE Center†Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, FL‡Department of Neurological Surgery, University of California, San Francisco, CA§Carolina Spine and Neurosurgery Center, Asheville, NC.
Clin Spine Surg. 2016 Jun;29(5):E222-5. doi: 10.1097/BSD.0b013e3182733c43.
Percutaneous pedicle screws have become accepted as an effective method for segmental fixation in a variety of settings. However, fixation to the pelvis, which offers unique biomechanical advantages, had remained elusive from a minimally invasive approach.
To ascertain the safety of percutaneous iliac screws implanted placement using fluoroscopic guidance.
In an effort to verify the accuracy of a fluoroscopically guided technique for safe iliosacral screw placement, we reviewed the imaging results from 24 consecutive patients undergoing this procedure. Percutaneous iliac screw placement was accomplished using primarily x-ray-guided screw insertion (obturator outlet view technique) without frameless image-guidance and with limited exposure of bony landmarks or tactile feedback. Indications for surgery included infection, neoplasia, trauma, and deformity. All patients underwent early postoperative computed tomography scanning to determine the accuracy of screw positioning.
A total of 24 patients had 47 screws placed for fixation at the lumbosacral junction. No cases required abortion of the procedure or conversion to an open operation. All of the percutaneous screws were placed appropriately as verified by postoperative computed tomography scanning with 3-dimensional reconstruction. There were no hardware-related complications. However, one 75-year-old patient suffering a sacral fracture died of medical comorbidities on postoperative day 10.
A minimally invasive technique for iliac screw placement can be performed safely with a low likelihood of bony violation. This technique offers the unique biomechanical advantages of iliac fixation without the soft-tissue exposure traditionally needed for safe hardware insertion. The technique relies on high-quality intraoperative fluoroscopic imaging.
经皮椎弓根螺钉已成为在各种情况下进行节段性固定的有效方法。然而，骨盆固定具有独特的生物力学优势，从微创方法实现却一直难以做到。
确定在透视引导下植入经皮髂骨螺钉的安全性。
为了验证透视引导技术用于安全置入髂骶螺钉的准确性，我们回顾了连续24例接受该手术患者的影像学结果。经皮髂骨螺钉置入主要采用X线引导的螺钉插入（闭孔出口视图技术），不使用无框架图像引导，且骨标志暴露有限或触觉反馈有限。手术适应症包括感染、肿瘤、创伤和畸形。所有患者术后早期均接受计算机断层扫描以确定螺钉定位的准确性。
共有24例患者在腰骶交界处置入47枚螺钉进行固定。没有病例需要中止手术或转为开放手术。术后计算机断层扫描三维重建证实所有经皮螺钉均放置合适。没有与硬件相关的并发症。然而，一名75岁的骶骨骨折患者在术后第10天因合并症死亡。
一种微创的髂骨螺钉置入技术可以安全地进行，发生骨质侵犯的可能性较低。该技术具有髂骨固定独特的生物力学优势，且无需传统安全置入硬件所需的软组织暴露。该技术依赖于高质量的术中透视成像。
