Department of Orthopaedics, Nicklaus Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA.
Department of Orthopaedics, University of Miami Miller School of Medicine, 1611 NW 12th Ave #303, Miami, FL 33136, USA.
Spine J. 2018 Sep;18(9):1570-1577. doi: 10.1016/j.spinee.2018.01.024. Epub 2018 Feb 21.
All currently described percutaneous iliac screw placement methods are entirely dependent on fluoroscopy.
The purpose of this study was to determine the safety and the accuracy of percutaneous and open iliac screw placement using a primarily tactile technique with adjunctive anteroposterior (AP) fluoroscopy.
STUDY DESIGN/CONTEXT: All patients who underwent open and percutaneous iliac screw placement over a 5-year period were identified. Charts were reviewed to assess for any instances of neurologic or vascular injury associated with iliac screw placement. Screw accuracy was judged with postoperative computed tomography (CT) scans.
A total of 133 patients were identified who underwent open or percutaneous iliac screw placement. Computed tomography scans were available for 57 patients, and all of these patients were included in the study, with a total of 115 iliac screws.
Radiographic measurements were performed, consisting of the distance of the iliac screw to the sciatic notch on postoperative radiographs and CT scans. Computed tomography scans were used to determine iliac screw accuracy.
Charts were reviewed to assess for any neurologic or vascular injuries related to screw placement. The distance of the iliac screw to the sciatic notch was measured and compared on AP radiography and CT scans. Computed tomography scans were assessed for any screw violation of the iliac cortex or the sciatic notch. The accuracy of open iliac screw placement was compared with minimally invasive percutaneous placement.
There were no neurologic or vascular injuries related to screw placement in the 133 patients. Computed tomography scans were available for 115 iliac screws, with 3 cortical breaches, all by less than 2 mm. All 112 other screws were accurately intraosseous. There was a strong correlation between the iliac screw to the sciatic notch distance when measured by CT scan compared with AP radiography (r=0.9), thus validating the accuracy of AP fluoroscopy in guiding iliac screw placement with respect to the sciatic notch. Iliac screw accuracy was equal with the open and percutaneous insertion techniques.
The described surgical technique represents a safe and reliable surgical option for iliac screw placement. Intraoperative AP fluoroscopy accurately reflects the distance of the iliac screw to the sciatic notch. Percutaneous iliac screws placed with this technique are as accurate as open iliac screws.
所有目前描述的经皮髂螺钉放置方法完全依赖于透视。
本研究的目的是确定使用主要触觉技术联合前后（AP）透视的经皮和开放式髂螺钉放置的安全性和准确性。
研究设计/背景：确定了在 5 年期间接受开放式和经皮髂螺钉放置的所有患者。对图表进行了回顾，以评估与髂螺钉放置相关的任何神经或血管损伤的情况。通过术后计算机断层扫描（CT）扫描判断螺钉的准确性。
确定了 133 名接受开放式或经皮髂螺钉放置的患者。57 名患者可进行 CT 扫描，所有这些患者均纳入研究，共 115 枚髂螺钉。
进行了放射学测量，包括术后 X 线和 CT 扫描中髂螺钉到坐骨切迹的距离。使用 CT 扫描确定髂螺钉的准确性。
回顾图表以评估与螺钉放置相关的任何神经或血管损伤。测量并比较髂螺钉在 AP 射线照相和 CT 扫描上到坐骨切迹的距离。评估 CT 扫描中任何螺钉侵犯髂皮质或坐骨切迹的情况。比较开放式髂螺钉放置与微创经皮放置的准确性。
在 133 名患者中，没有与螺钉放置相关的神经或血管损伤。可获得 115 枚髂螺钉的 CT 扫描，其中 3 枚皮质穿透，均小于 2mm。所有 112 枚其他螺钉均准确地位于骨内。CT 扫描测量的髂螺钉到坐骨切迹的距离与 AP 射线照相具有很强的相关性（r=0.9），从而验证了 AP 透视在指导坐骨切迹髂螺钉放置方面的准确性。开放式和经皮插入技术的髂螺钉准确性相等。
所描述的手术技术代表了一种安全可靠的髂螺钉放置手术选择。术中 AP 透视准确反映了髂螺钉到坐骨切迹的距离。使用该技术放置的经皮髂螺钉与开放式髂螺钉一样准确。
