经皮后路骨盆环固定中螺钉穿出及医源性神经损伤的危险因素
Risk factors for screw breach and iatrogenic nerve injury in percutaneous posterior pelvic ring fixation.
作者信息
Hadeed Michael M, Woods David, Koerner Jason, Strage Katya E, Mauffrey Cyril, Parry Joshua A
机构信息
Denver Health Medical Center, Department of Orthopaedic Surgery, USA.
Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA.
出版信息
J Clin Orthop Trauma. 2022 Aug 19;33:101994. doi: 10.1016/j.jcot.2022.101994. eCollection 2022 Oct.
BACKGROUND
Percutaneous screw fixation of the posterior pelvic ring is technically demanding and can result in cortical breach. The purpose of this study was to examine risk factors for screw breach and iatrogenic nerve injury.
METHODS
A retrospective review at a single level-one trauma center identified 245 patients treated with 249 screws for pelvic ring injuries with postoperative computed tomography (CT) scans. Cortical screw breach, iatrogenic nerve injury, and associated risk factors were evaluated.
RESULTS
There were 86 (35%) breached screws. The breach rate was similar between screw types (33% S1-iliosacral (S1-IS), 44% S1-transsacral (S1-TS), 31% S2-IS, and 30% S2-TS) and was not associated with patient characteristics, Tile C injuries, or corridor size or angle. The overall rate of screw revision for screw malpositioning was 1.2% (3/249). Iatrogenic nerve injuries occurred in 8 (3.2%) of the 249 screws. Screws that caused iatrogenic nerve injuries had greater screw breach distances (5.4 vs. 0 mm, MD 5, CI 2.3 to 8.7, p < 0.0001), were more likely to be S1-IS screws (88% vs. 47%, PD 40%, CI 7 to 58%, p = 0.006), more likely to be placed in Tile C injuries (75% vs. 44%, PD 31%, CI -3 to 55%, p = 0.04), and there was a trend for having a screw corridor size <10 mm (75% vs. 47%, PD 28, CI -6 to 52%, p = 0.06). Of the 7 iatrogenic nerve injuries adjacent to screw breaches, two nerve injuries recovered after screw removal, three recovered with screw retention, and two did not recover with screw retention.
CONCLUSION
Screw breaches were common and iatrogenic nerve injuries were more likely with S1-IS screws. Surgeons should maintain a high degree of caution when placing these screws and consider removal of any breached screw associated with nerve injury.
背景
骨盆后环的经皮螺钉固定技术要求高，且可能导致皮质骨破损。本研究的目的是探讨螺钉破损和医源性神经损伤的危险因素。
方法
在一家一级创伤中心进行回顾性研究，纳入245例接受249枚螺钉治疗骨盆环损伤的患者，并进行术后计算机断层扫描（CT）。评估皮质骨螺钉破损、医源性神经损伤及相关危险因素。
结果
有86枚（35%）螺钉发生破损。不同类型螺钉的破损率相似（S1-髂骶螺钉（S1-IS）为33%，S1-经骶骨螺钉（S1-TS）为44%，S2-IS为31%，S2-TS为30%），且与患者特征、Tile C型损伤或螺钉通道大小及角度无关。因螺钉位置不当进行螺钉翻修的总体发生率为1.2%（3/249）。249枚螺钉中有8枚（3.2%）发生医源性神经损伤。导致医源性神经损伤的螺钉有更大的螺钉破损距离（5.4 vs. 0 mm，平均差5，可信区间2.3至8.7，p < 0.0001），更可能是S1-IS螺钉（88% vs. 47%，比例差40%，可信区间7至58%，p = 0.006），更可能用于Tile C型损伤（75% vs. 44%，比例差31%，可信区间-3至55%，p = 0.04），且有螺钉通道大小<10 mm的趋势（75% vs. 47%，比例差28，可信区间-6至52%，p = 0.06）。在与螺钉破损相邻的7例医源性神经损伤中，2例神经损伤在取出螺钉后恢复，3例在保留螺钉的情况下恢复，2例在保留螺钉的情况下未恢复。
结论
螺钉破损常见，S1-IS螺钉更易导致医源性神经损伤。外科医生在置入这些螺钉时应保持高度谨慎，并考虑取出与神经损伤相关的任何破损螺钉。
Zotero 插件