Tsuji Hironori, Takigawa Tomoyuki, Misawa Haruo, Shiozaki Yasuyuki, Yamakawa Yasuaki, Noda Tomoyuki, Ozaki Toshifumi
Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Department of Orthopaedic Surgery, Okayama University Hospital.
Clin Spine Surg. 2019 Jun;32(5):191-197. doi: 10.1097/BSD.0000000000000798.
Spinopelvic fixation provides a strong fixation for unstable pelvic ring fractures. However, the technique is usually performed with the patient in the prone position, with the applied weight on the anterior superior iliac crests aggravating fracture displacement. We developed a novel approach for minimally invasive percutaneous spinopelvic fixation that is performed with the patient in a lateral (side lying) position. We describe the application of our technique for the treatment of a bilateral pelvic ring and acetabulum fracture in a 79-year-old woman injured in a traffic accident. Initial posterior fixation was performed with the patient in the left-side lying position, using bilateral pedicle screws at L3 and L4 and a left sacral-alar iliac screw and 2 right iliac screws inserted under navigation. The lateral and cranial displacement of the right pelvic ring was reduced percutaneously. One week after this initial surgery, we proceeded with an open anterior reduction and internal fixation of the left pelvic ring and acetabulum fracture. The postoperative course was uneventful and clinical outcomes were satisfactory. Reduction of a pelvic ring fracture in a lateral position, with subsequent spinopelvic fixation, is a reasonable option for the treatment of an unstable pelvic ring fracture.
脊柱骨盆固定术为不稳定的骨盆环骨折提供了牢固的固定。然而，该技术通常在患者俯卧位下进行，施加于髂前上棘的重量会加重骨折移位。我们开发了一种新型的微创经皮脊柱骨盆固定方法，该方法在患者侧卧位下进行。我们描述了我们的技术在一名79岁因交通事故受伤的女性双侧骨盆环和髋臼骨折治疗中的应用。最初的后路固定在患者左侧卧位下进行，在L3和L4使用双侧椎弓根螺钉以及在导航引导下插入一枚左侧骶骨-髂骨翼螺钉和两枚右侧髂骨螺钉。经皮复位右侧骨盆环的侧方和头侧移位。初次手术后一周，我们进行了左侧骨盆环和髋臼骨折的切开前路复位内固定术。术后过程顺利，临床结果令人满意。侧卧位下复位骨盆环骨折并随后进行脊柱骨盆固定，是治疗不稳定骨盆环骨折的一种合理选择。
