Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
World Neurosurg. 2020 Oct;142:57-61. doi: 10.1016/j.wneu.2020.06.161. Epub 2020 Jun 27.
Managing unilateral vertically displaced sacral fractures remains a challenge. A triangular osteosynthesis (TOS), which involves fixing the fractured sacrum using unilateral spinopelvic fixation and a supplemental ilio-sacral screw, continues to gain popularity as it facilitates early mobilization and improves the long-term outcome. However, it has limitations, such as destruction of the L5-S1 joint, the need for additional removal surgery, and an increased risk of infection due to the large incision. An S1 pediculoiliac construct was proposed to overcome this limitations. Its use also has complications, however, including a painful hardware prominence due to the traditional iliac screw, excessive soft tissue retraction, and limited reduction capability.
A 20-year-old woman fell from a height of 6 meters and sustained a vertical shear type sacral fracture on the left side with substantial vertical displacement. We reduced and fixed the fracture using a TOS using an S1 pedicle screw and an S2 alar iliac screw (S2AIS). The patient was allowed immediate weight-bearing as tolerated. We achieved good reduction and union with a small vertical incision, without the destruction of L5-S1 joints, a symptomatic implant prominence, or wound complications.
For unilateral vertically unstable sacral fractures, TOS using S1 pedicle screws and S2AIS is safe and has the advantage such as maintaining mobility in the lumbar pelvic region, small size wounds, and reduced soft tissue damage, and it may have a potentially low infection rate. Further studies are needed to determine the specific indications and validate the effectiveness of this procedure.
单侧垂直移位骶骨骨折的治疗仍然具有挑战性。三角骨合成术（TOS），涉及使用单侧脊柱骨盆固定和补充的髂-骶螺钉固定骨折的骶骨，由于它便于早期活动和改善长期结果，因此继续受到欢迎。然而，它有一些局限性，例如破坏 L5-S1 关节、需要额外的去除手术以及由于大切口而增加感染的风险。提出了 S1 椎弓根-骼骨构造来克服这些局限性。然而，其使用也有并发症，包括由于传统的髂螺钉而导致的疼痛性硬件突出、过多的软组织回缩和有限的复位能力。
一名 20 岁女性从 6 米高处坠落，导致左侧垂直剪切型骶骨骨折，伴有大量垂直移位。我们使用 TOS 使用 S1 椎弓根螺钉和 S2 翼状骼螺钉（S2AIS）来复位和固定骨折。患者被允许立即耐受负重。我们通过小的垂直切口实现了良好的复位和愈合，没有破坏 L5-S1 关节、症状性植入物突出或伤口并发症。
对于单侧不稳定的垂直骶骨骨折，使用 S1 椎弓根螺钉和 S2AIS 的 TOS 是安全的，具有保持腰椎骨盆区域活动度、小尺寸伤口和减少软组织损伤的优点，并且可能具有较低的感染率。需要进一步研究来确定该手术的具体适应证并验证其有效性。
