Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, 264, rue Saint-Pierre, 13005 Marseille, France.
Service de chirurgie orthopédique et traumatologie, Hôpital Michallon, CHU Grenoble-Alpes Trauma Centre CS 10217, 38043 Grenoble, France.
Orthop Traumatol Surg Res. 2021 Oct;107(6):102993. doi: 10.1016/j.otsr.2021.102993. Epub 2021 Jun 27.
To date, no strong consensus exists on the best way to treat posterior pelvic ring injuries when there is no neurological deficit. Various fixation methods have been described; more recently, constructs that combine lumboiliac and iliosacral fixation have been introduced. This type of fixation is mainly indicated in cases of spinopelvic dissociation with large displacement of fracture fragments in the sagittal plane. However, these techniques are associated with postoperative complications, particularly infections and severe skin complications. This led us to propose a minimally invasive lumboiliac and iliosacral fixation technique for posterior pelvic ring injuries. The procedure is done with the patient prone. It consists of pedicle screw insertion into L4 or L5 and screw fixation of the ilium with fluoroscopy guidance; intraoperative distraction can be done depending on the amount of displacement. An iliosacral screw is then inserted percutaneously to allow reduction in the transverse plane and yield a triangular construct. In the five patients that we have operated using this technique, the mean preoperative vertical displacement was 11.9±6.9mm (SD) (min 1.3, max 19.7) versus 3.7±3.2mm (min 0.3, max 6.7) postoperatively and the mean preoperative frontal displacement was 7.5±3.7mm (min 4.2, max 12.4) versus 2.5±2.0mm (min 0.3, max 4.3) postoperatively. Minimally invasive iliosacral and lumboiliac fixation is an option for treating posterior pelvic ring fractures free of neurological deficit and especially spinopelvic dissociation.
迄今为止，对于无神经缺损的骨盆后环损伤，尚无明确的最佳治疗方法。已经描述了各种固定方法；最近，引入了结合腰骶固定和髂骶固定的构建体。这种固定主要适用于脊柱骨盆分离且骨折碎片在矢状面有大移位的情况。然而，这些技术与术后并发症相关，特别是感染和严重的皮肤并发症。这促使我们提出了一种微创的腰骶和髂骶固定技术来治疗骨盆后环损伤。该手术在患者俯卧位下进行。它包括在透视引导下将椎弓根螺钉插入 L4 或 L5 并固定髂骨；根据移位量，可在术中进行牵开。然后经皮插入髂骶螺钉，以允许在横断面上复位并形成三角形结构。在我们使用该技术治疗的五名患者中，术前垂直移位的平均值为 11.9±6.9mm（标准差）（最小 1.3，最大 19.7），术后为 3.7±3.2mm（最小 0.3，最大 6.7）；术前额状面移位的平均值为 7.5±3.7mm（最小 4.2，最大 12.4），术后为 2.5±2.0mm（最小 0.3，最大 4.3）。微创的髂骶和腰骶固定是治疗无神经缺损且无脊柱骨盆分离的骨盆后环骨折的一种选择。
