Comadoll Shea M, Haselhuhn Jason J, Sembrano Jonathan N, Ogilvie Christian M, Cheng Edward Y, Jones Kristen E, Martin Christopher T, Polly David W
Departments of1Orthopedic Surgery and.
2Neurosurgery, University of Minnesota, Minneapolis, Minnesota.
Neurosurg Focus. 2023 Jan;54(1):E9. doi: 10.3171/2022.10.FOCUS22608.
Sacroiliac joint (SIJ) fusion utilizing intraoperative navigation requires a standard reference frame, which is often placed using a percutaneous pin. Proper placement ensures the correct positioning of SIJ fusion implants. There is currently no grading scheme for evaluation of pin placement into the pelvis. The purpose of this study was to evaluate the occurrence of ideal percutaneous pin placement into the posterior ilium during navigated SIJ fusion.
After IRB approval was obtained, electronic medical records and intraoperative computed tomography images of patients who underwent navigated SIJ fusion by the senior author between October 2013 and January 2020 were reviewed. A pin placement grading scheme and the definition of "ideal" placement were developed by the authors and deemed acceptable by fellow attending surgeons. Six attending surgeons completed two rounds of pin placement grading, and statistical analysis was conducted.
Of 90 eligible patients, 73.3% had ideal pin placement, 17.8% medial/lateral breach, and 8.9% complete miss. Male patients were 3.7 times more likely to have ideal placement than females (p < 0.05). There was no relationship between BMI, SIJ fusion laterality, or pin placement laterality and ideal placement. Interobserver reliability was 0.72 and 0.70 in the first and second rounds, respectively, and defined as "substantial agreement." Intraobserver reliability ranged from 0.74 (substantial agreement) to 0.92 (almost perfect agreement).
Nonideal pin placement occurred in 26.7% of cases, but a true "miss" into the sacrum was rare. Ideal pin placement was more likely in males and was not associated with BMI, SIJ fusion laterality, or pin placement laterality. The grading scheme developed has high intraobserver and interobserver reliability, indicating that it is reproducible and can be used for future studies. When placing percutaneous pins, surgeons must be aware of factors that can decrease placement accuracy, regardless of location.
利用术中导航进行骶髂关节（SIJ）融合需要一个标准参考框架，该框架通常通过经皮针来放置。正确放置可确保SIJ融合植入物的正确定位。目前尚无用于评估针在骨盆中放置情况的分级方案。本研究的目的是评估在导航SIJ融合过程中，经皮针理想放置于髂骨后部的发生率。
在获得机构审查委员会（IRB）批准后，回顾了2013年10月至2020年1月期间由资深作者进行导航SIJ融合的患者的电子病历和术中计算机断层扫描图像。作者制定了针放置分级方案和“理想”放置的定义，并得到了主治外科医生同行的认可。六位主治外科医生完成了两轮针放置分级，并进行了统计分析。
在90例符合条件的患者中，73.3%的患者针放置理想，17.8%的患者出现内侧/外侧突破，8.9%的患者完全未命中。男性患者针放置理想的可能性是女性的3.7倍（p < 0.05）。体重指数（BMI）、SIJ融合侧别或针放置侧别与理想放置之间无相关性。观察者间信度在第一轮和第二轮分别为0.72和0.70，被定义为“高度一致”。观察者内信度范围从0.74（高度一致）到0.92（几乎完全一致）。
26.7%的病例出现非理想的针放置情况，但真正“未命中”骶骨的情况很少见。男性更有可能实现理想的针放置，且与BMI、SIJ融合侧别或针放置侧别无关。所制定的分级方案具有较高的观察者内和观察者间信度，表明它具有可重复性，可用于未来的研究。在放置经皮针时，外科医生必须意识到可能降低放置准确性无论位置如何的因素。
