Third Hospital of Hebei Medical University, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, 050051, China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
Injury. 2019 Mar;50(3):690-696. doi: 10.1016/j.injury.2019.02.011. Epub 2019 Feb 13.
Fracture line of the sacrum always involves the Zone II region because sacral foramina are anatomically and physiologically weak regions of the sacrum. The purpose of this study is to compare the therapeutic effects of a sacroiliac screw and a minimally invasive adjustable plate (MIAP) for Zone II sacral fractures.
Patients with unilateral Zone II sacral fractures fixed with a unilateral sacroiliac screw or MIAP from August 2009 to January 2016 were recruited into this study and were divided into two groups: group A (sacroiliac screw) and group B (MIAP). Surgical time, blood loss, frequency of intraoperative fluoroscopy, and relative complications were reviewed. Radiographs and CT scans were routinely acquired to evaluate the fracture displacement and reduction quality. Fracture healing was evaluated in the radiographs at each follow-up. Functional outcome was assessed based upon the Majeed scoring system at the final follow-up.
Thirty-one patients in group A and thirty-nine patients in group B were included in this study. No significant differences in average surgical time (P = 0.221) or blood loss (P = 0.234) were noted between group A and group B. The mean frequency of intraoperative fluoroscopy was 15.74±2.98 in group A and 6.08±1.94 in group B (P = 0.000). All fractures healed well within four months in all patients, and the healing time exhibited no significant difference between the two groups (P = 0.579). Satisfactory rates of reduction quality and functional outcome were not statistically different between the two groups (P > 0.05). The complication rate was 16.13% (5/31) in group A and 5.13% (2/39) in group B (P = 0.222).
MIAP has a fixation effect and exhibits reduction potential for Zone II sacral fractures. Favourable radiographic and functional results could be obtained through the MIAP technique, which is easy to conduct without pre-contouring. Compared with the unilateral S1 sacroiliac screw technique, repeated projections and iatrogenic sacral injury can be avoided.
骶骨骨折线总是涉及 II 区，因为骶骨孔在解剖学和生理学上是骶骨的薄弱区域。本研究的目的是比较骶髂螺钉和微创可调节钢板（MIAP）治疗 II 区骶骨骨折的疗效。
招募了 2009 年 8 月至 2016 年 1 月期间接受单侧骶髂螺钉或 MIAP 固定的单侧 II 区骶骨骨折患者，并将其分为两组：A 组（骶髂螺钉）和 B 组（MIAP）。回顾手术时间、失血量、术中透视次数和相关并发症。常规获取 X 线和 CT 扫描评估骨折移位和复位质量。在每次随访时通过 X 线片评估骨折愈合情况。根据 Majeed 评分系统在最后一次随访时评估功能结果。
A 组 31 例，B 组 39 例患者纳入本研究。A 组和 B 组的平均手术时间（P=0.221）或失血量（P=0.234）无显著差异。A 组术中透视次数平均为 15.74±2.98 次，B 组为 6.08±1.94 次（P=0.000）。所有骨折在所有患者中均在四个月内愈合良好，两组愈合时间无显著差异（P=0.579）。两组复位质量和功能结果的满意度无统计学差异（P>0.05）。A 组并发症发生率为 16.13%（5/31），B 组为 5.13%（2/39）（P=0.222）。
MIAP 对 II 区骶骨骨折具有固定作用，并具有复位潜力。通过 MIAP 技术可获得良好的影像学和功能结果，操作简单，无需预成型。与单侧 S1 骶髂螺钉技术相比，可避免反复透视和医源性骶骨损伤。
