König M A, Hediger S, Schmitt J W, Jentzsch T, Sprengel K, Werner C M L
Department of Traumatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Eur J Trauma Emerg Surg. 2018 Apr;44(2):203-210. doi: 10.1007/s00068-016-0681-6. Epub 2016 May 11.
Minimal invasive screw fixation is common for treating posterior pelvic ring pathologies, but lack of bone quality may cause anchorage problems. The aim of this study was to report in detail a new technique combining iliosacral screw fixation with in-screw cement augmentation (ISFICA).
The patient was put under general anesthesia and placed in the supine position. A K-wire was inserted under inlet-outlet view to guide the fully threaded screw. The screw placement followed in adequate position. Cement was applied through a bone filler device, inserted at the screwdriver. The immediate control of cement distribution, accurate screw placement and potential leakage were obtained via intraoperative CT scan.
Twenty consecutive patients treated with ISFICA were included in this study. The mean age was 74.4 years (range 48-98). Screw placement, possible cement leakage and screw positioning were evaluated via intraoperative CT scan. Postoperative neurologic deficits, pain reduction and immediate postoperative mobilization were clinically evaluated.
Twenty-six screws were implanted. All patients were postoperatively, instantly mobilized with reduced pain. No neurologic deficits were apparent postoperatively. No cement leakage occurred. One breach of the iliac cortical bone was noted due to severe osteoporosis. One screw migration was seen after 1 year and two patients showed iliosacral joint arthropathy, which led to screw removal.
ISFICA is a very promising technique in terms of safety, precision and initial postoperative outcome. Long-term outcomes such as lasting mechanical stability or pain reduction and screw loosening despite cement augmentation should be investigated in further studies with larger patient numbers.
微创螺钉固定常用于治疗骨盆后环病变，但骨质欠佳可能导致锚固问题。本研究的目的是详细报告一种将髂骶螺钉固定与螺钉内骨水泥强化（ISFICA）相结合的新技术。
患者接受全身麻醉，取仰卧位。在入口-出口位透视下插入一根克氏针以引导全螺纹螺钉。螺钉在合适位置置入。通过插入螺丝刀处的骨填充装置注入骨水泥。通过术中CT扫描可即时控制骨水泥分布、准确的螺钉置入及潜在的渗漏情况。
本研究纳入了连续20例接受ISFICA治疗的患者。平均年龄为74.4岁（范围48 - 98岁）。通过术中CT扫描评估螺钉置入情况、可能的骨水泥渗漏及螺钉定位。对术后神经功能缺损、疼痛减轻情况及术后即刻活动能力进行临床评估。
共植入26枚螺钉。所有患者术后均立即活动，疼痛减轻。术后无明显神经功能缺损。未发生骨水泥渗漏。因严重骨质疏松，有1例髂骨皮质骨出现破裂。1年后发现1枚螺钉移位，2例患者出现髂骶关节病，导致螺钉取出。
就安全性、精确性及术后初期效果而言，ISFICA是一项非常有前景的技术。对于诸如持久的机械稳定性、疼痛减轻情况以及尽管有骨水泥强化但螺钉松动等长期效果，应在更大样本量的进一步研究中进行调查。
