Shaw James, Gary Joshua, Ambrose Catherine, Routt Milton Chip
Department of Orthopedic Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX.
J Orthop Trauma. 2020 Nov;34(11):572-577. doi: 10.1097/BOT.0000000000001796.
Multidimensional fluoroscopy is new imaging technology that generates intraoperative cross sectional imaging. Can this technology be used to assess accuracy and safety of percutaneously placed iliosacral screws intraoperatively?
Retrospective study.
Level 1 academic trauma center.
PATIENTS/PARTICIPANTS: Fifty-two consecutive patients during a 7-month period with unstable posterior pelvic ring disruptions.
All patients were treated with percutaneous iliosacral and/or transsacral screw fixation by a single experienced surgeon. Traditional triplanar fluoroscopy was performed during guidepin insertion. Intraoperative multidimensional fluoroscopy was used for all patients after iliosacral screw fixation.
Intraoperative multidimensional fluoroscopy and postoperative computed tomography (CT) scans for each patient were retrospectively reviewed by the treating surgeon and another trauma surgeon. Screw position in relation to the sacral neuroforamen was assessed using multidimensional fluoroscopy and compared to postoperative CT scan. Screws were classified as extraforaminal, juxtaforaminal, or intraforaminal.
No screws were intraforaminally seen on intraoperative multidimensional fluoroscopy or postoperative CT scan. All iliosacral and transsacral screws were considered safe. Intraobserver and interobserver variability existed between reviewers when grading screws as extraforaminal versus juxtaforaminal. This was not clinically significant because both agreed that extraforaminal and juxtaforaminal screw positions are safe. Multidimensional fluoroscopy was used in 3 patients to assess guidepin placement before definitive screw fixation. Two patients underwent a change of fixation after reviewing multidimensional fluoroscopy. No postoperative neurological examination changes occurred.
Multidimensional fluoroscopy is a novel imaging technology that can safely be used intraoperatively to accurately determine iliosacral and transsacral screw placement.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
多维透视是一种可生成术中横断面成像的新型成像技术。该技术能否用于术中评估经皮置入的髂骶螺钉的准确性和安全性？
回顾性研究。
一级学术创伤中心。
患者/参与者：7个月期间连续52例不稳定型骨盆后环损伤患者。
所有患者均由同一位经验丰富的外科医生进行经皮髂骶和/或经骶螺钉固定。在插入导针期间进行传统的三平面透视。髂骶螺钉固定后，所有患者均使用术中多维透视。
主刀医生和另一位创伤外科医生对每位患者的术中多维透视和术后计算机断层扫描（CT）进行回顾性分析。使用多维透视评估螺钉相对于骶神经孔的位置，并与术后CT扫描结果进行比较。螺钉分为孔外、孔旁或孔内。
术中多维透视或术后CT扫描均未发现孔内螺钉。所有髂骶和经骶螺钉均被认为是安全的。在将螺钉分级为孔外或孔旁时，观察者间和观察者内存在差异。但这在临床上并不显著，因为双方都认为孔外和孔旁螺钉位置是安全的。3例患者在最终螺钉固定前使用多维透视评估导针位置。2例患者在查看多维透视后改变了固定方式。术后神经学检查无变化。
多维透视是一种新型成像技术，可在术中安全使用，以准确确定髂骶和经骶螺钉的位置。
诊断性III级。有关证据级别的完整描述，请参阅作者指南。
