Okuda Akinori, Maegawa Naoki, Matsumori Hiroaki, Kura Tomohiko, Mizutani Yasushi, Shigematsu Hideki, Iwata Eiichiro, Tanaka Masato, Masuda Keisuke, Yamamoto Yusuke, Tada Yusuke, Kogeichi Yohei, Takano Keisuke, Asai Hideki, Kawai Yasuyuki, Urisono Yasuyuki, Kawamura Kenji, Fukushima Hidetada, Tanaka Yasuhito
Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, Nara, 654-8522, Japan.
Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan.
J Orthop Surg Res. 2019 Feb 15;14(1):51. doi: 10.1186/s13018-019-1093-1.
Unstable sacral fractures are high-energy injuries and comprise polytrauma. Internal fixation to enable withstanding vertical loads is required to get up early from the bed after an unstable sacral fracture. We developed a new minimally invasive surgical (MIS) procedure for unstable pelvic ring fractures and reported it in Japanese in 2010. We presented our minimally invasive surgical technique of crab-shaped fixation for the treatment of unstable pelvic ring fractures and report on its short-term outcomes.
Sixteen patients with unstable pelvic ring fractures (AO types C1, 2, and 3) were treated using crab-shaped fixation. All procedures were performed with the patient in the prone position through 5-cm skin incisions created bilaterally at the level of the posterior superior iliac spine. Four iliac screws were inserted and connected with two rods under the fascia. Percutaneous pedicle screws were inserted at L5 or L4 and connected to the iliac rod using offset connectors. Fracture reduction was then performed.
The average surgical time was 158 min (range, 117-230 min), with an intraoperative bleeding volume of 299 ml (range, 80-480 ml). Thirty-three pedicle screws and 64 iliac screws were implanted with no instance of malpositioning or perforation. A surgical site infection developed in 2 of the 16 cases. Both were deep methicillin-resistant Staphylococcus aureus infections, with the removal of the distal implants required in only one of these cases. Bony union was achieved in all patients, and all vertical displacements reduced by 7.0 mm, on average (range, 5.4-9.0 mm), to < 10 cm. Correction was retained in all cases.
Crab-shaped fixation provides a feasible MIS approach for spinopelvic fixation, which allows good reduction of the vertical displacement of unstable pelvic ring fractures and bony union.
不稳定型骶骨骨折是高能量损伤，常合并多发伤。不稳定型骶骨骨折后需要进行内固定以承受垂直负荷，从而早期下床活动。我们开发了一种用于不稳定骨盆环骨折的新型微创手术（MIS）方法，并于2010年在日本进行了报道。我们展示了用于治疗不稳定骨盆环骨折的蟹形固定微创手术技术，并报告其短期疗效。
16例不稳定骨盆环骨折（AO分型C1、C2和C3型）患者采用蟹形固定治疗。所有手术均在患者俯卧位下进行，通过在双侧髂后上棘水平做5厘米的皮肤切口。插入4枚髂骨螺钉并在筋膜下与两根棒连接。在L5或L4经皮插入椎弓根螺钉，并使用偏移连接器与髂骨棒连接。然后进行骨折复位。
平均手术时间为158分钟（范围117 - 230分钟），术中出血量为299毫升（范围80 - 480毫升）。共植入33枚椎弓根螺钉和64枚髂骨螺钉，无1例位置不当或穿孔。16例中有2例发生手术部位感染。均为耐甲氧西林金黄色葡萄球菌深部感染，其中仅1例需要取出远端植入物。所有患者均实现骨愈合，所有垂直移位平均减少7.0毫米（范围5.4 - 9.0毫米），降至<10毫米。所有病例矫正均得以维持。
蟹形固定为脊柱骨盆固定提供了一种可行的微创手术方法，能有效减少不稳定骨盆环骨折的垂直移位并实现骨愈合。
