Futamura Kentaro, Baba Tomonori, Mogami Atsuhiko, Kanda Akio, Obayashi Osamu, Iwase Hideaki, Kaneko Kazuo
Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, Japan.
Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Int Orthop. 2018 Jun;42(6):1405-1411. doi: 10.1007/s00264-017-3712-y. Epub 2018 Jan 10.
Spinopelvic fixation and triangular osteosynthesis give firm internal fixation for unstable pelvic ring injuries (UPRI), but with sacrifice of mobility of the lumbar spine. Here, we describe the procedure and outcomes of a new approach, which we refer to as "within ring"-based sacroiliac rod fixation (SIRF).
The patient was placed in a prone position and longitudinal skin incisions were made at the medial margins of the bilateral posterior superior iliac spines (PSIS). After reduction of fracture, a pedicle screw was inserted into the first sacral vertebra on the injured side and iliac screws inserted through the bilateral PSIS were bridged using rods.
SIRF was performed in 15 patients. The AO/OTA classification was 61-B2.3 in 1, C1.3 in 4, C2.3 in 7, C3.3 in 1, and H-type spinopelvic dissociation in two cases. The mean operative time was 179 (110-298) minutes, mean blood loss was 533 (100-2700) cc. One patient died during hospitalization and three patients stopped outpatient treatment. The other 11 patients achieved bone union without major loss of reduction in a mean post-operative follow-up period of 23.8 (4-50) months. The mean Majeed score at final follow-up was 86.7 (73-96) out of 96, excluding scoring sexual intercourse.
"Within ring"-based SIRF not including the lumbar spine in the fixation range is a simple, safe, and low-invasive internal fixation method for UPRI.
脊柱骨盆固定和三角接骨术可为不稳定骨盆环损伤（UPRI）提供牢固的内固定，但会牺牲腰椎的活动度。在此，我们描述一种新方法的手术过程及结果，我们将其称为“环内”骶髂棒固定术（SIRF）。
患者取俯卧位，在双侧后上棘（PSIS）内侧缘做纵行皮肤切口。骨折复位后，在受伤侧的第一骶椎置入椎弓根螺钉，并使用棒连接经双侧PSIS置入的髂骨螺钉。
15例患者接受了SIRF手术。AO/OTA分型为1例61-B2.3、4例C1.3、7例C2.3、1例C3.3，2例为H型脊柱骨盆分离。平均手术时间为179（110 - 298）分钟，平均失血量为533（100 - 2700）毫升。1例患者住院期间死亡，3例患者停止门诊治疗。其他11例患者在平均术后随访23.8（4 - 50）个月时实现骨愈合，且复位无明显丢失。末次随访时，排除性交评分后，Majeed评分平均为86.7（73 - 96）分（满分96分）。
“环内”SIRF固定范围不包括腰椎，是一种治疗UPRI的简单、安全且微创的内固定方法。
