Cai Hong-min, Liu You-wen, Li Hong-jun, Wu Xue-jian, Tang Hong-tao, Zhang Ying, Jia Yu-dong, Li Wu-yin
Zhongguo Gu Shang. 2015 Oct;28(10):910-4.
To introduce a technique pertaining to S2 iliosacral screw insertion.
The screw pathway was first measured on the preoperative pelvic CT scan or the standard sacral lateral radiograph to make sure the existence of the "safe zone" in the S2 segment for screw insertion. Under general anesthesia, patients were positioned supine or prone, depending on the injury pattern of pelvic ring or associated injuries requiring concomitant operation. The operation field was routinely sterilized using iodine and subsequent alcohol solution and draped. The tip of a guide wire was inserted through a stab wound to the posterior outer iliac table, manipulated in the "safe zone" being enclosed by the anterior aspect of the S2 nerve root tunnel, the anterior aspect of the sacral vertebrae, and the inferior aspect of the S1 foramen under the guidance of the standard sacral lateral fluoroscopy, and then the tip was hammered one to two millimeters into the iliac cortex. The guide wire progressed along the trajectory between the inferior aspect of the S1 foramen and the superior aspect of the S2 foramen on the pelvic outlet fluoroscopic view, and then along the posterior to the anterior aspect of the S2 sacral vertebrae and alae on the pelvic inlet fluoroscopic view with a predetermined length. At that moment, in order to ensure the safety, another standard sacral lateral view was imaged to detect the guide wire's tip which should locate posterior to the anterior aspect of the sacral vertebrae and anterior to the anterior aspect of the S2 nerve root tunnel. Subsequently, the depth was measured, the trajectory was drilled and tapped, and the screw was inserted. Following the removal of the guide wire, the wound was irrigated and sutured.
Utilizing this insertion technique, there were 30 S2 iliosacral screws in total being placed to stabilize the injured and unstable posterior pelvic ring in 27 patients. Each S2 screw was accompanied by an ipsilateral S1 screw. The S2 screw location was completely intraosseous in all patients, which was verified by postoperative pelvic outlet and inlet radiographs and CT scans. The insertion accuracy was 100 percent in the present series.
The S2 iliosacral screw insertion technique is safe and reproducible to guide the placement of the S2 screw, enhancing the stability for the compromised posterior pelvic ring.
介绍一种与S2骶髂螺钉置入相关的技术。
首先在术前骨盆CT扫描或标准骶骨侧位X线片上测量螺钉路径，以确保S2节段存在用于螺钉置入的“安全区”。在全身麻醉下，根据骨盆环损伤模式或需要同期手术的相关损伤情况，患者取仰卧位或俯卧位。手术区域常规用碘伏及后续酒精溶液消毒并铺巾。通过一个小切口将导丝尖端插入至髂骨后外侧骨板，在标准骶骨侧位透视引导下，在由S2神经根通道前侧、骶骨椎体前侧和S1孔下侧所围成的“安全区”内操作，然后将尖端锤击入髂骨皮质1至2毫米。在骨盆出口透视下，导丝沿着S1孔下侧与S2孔上侧之间的轨迹前进，然后在骨盆入口透视下沿着预定长度从S2骶骨椎体及翼的后侧至前侧前进。此时，为确保安全，再拍摄一张标准骶骨侧位片以检测导丝尖端，其应位于骶骨椎体前侧后方且S2神经根通道前侧前方。随后测量深度，钻孔并攻丝，然后置入螺钉。取出导丝后，冲洗并缝合伤口。
采用该置入技术，共为27例患者置入30枚S2骶髂螺钉以稳定损伤的不稳定骨盆后环。每枚S2螺钉均伴有同侧S1螺钉。所有患者的S2螺钉位置均完全位于骨内，术后骨盆出口和入口X线片及CT扫描证实了这一点。本系列中置入准确率为100%。
S2骶髂螺钉置入技术安全且可重复，有助于引导S2螺钉的置入，增强受损骨盆后环的稳定性。
