Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.
Department of Orthopaedic Surgery, Washington University, St. Louis, MO; and.
J Orthop Trauma. 2023 Aug 1;37(8):371-376. doi: 10.1097/BOT.0000000000002608.
To characterize the success and complications of percutaneous posterior pelvic fixation in the treatment of displaced spinopelvic dissociation patterns.
Retrospective cohort study.
Three Level I trauma centers.
53 patients with displaced spinopelvic patterns were enrolled.
Percutaneous iliosacral screw fixation was used.
Main outcome measures include incidence of union, fixation failure, and soft tissue complications.
All patients had displaced, unstable patterns with a mean preoperative kyphosis of 29.7 ± 15.4 degrees (range, 0-70). Most of the patients treated were neurologically intact (72%) or had an unknown examination at the time of fixation (15%). The median follow-up was 254 days (interquartile range, 141-531). The union rate was 98%. Radiographic and clinical follow-up demonstrated 1 case (2%) of nonunion. Two patients (4%) had radiographic evidence of screw loosening at the final follow-up, both of whom had fixation with a single sacroiliac-style screw placed bilaterally and went on to uneventful union. Neurologic recovery occurred at an average of 195 ± 114 days (range, 82-363 days). When present, long-term neurologic sequelae most commonly consisted of radicular pain and paresthesias at the final follow-up (n = 3, 6%).
Percutaneous posterior pelvic fixation of select displaced spinopelvic dissociation seems to be safe with a low complication rate and reliable union. In a cohort of displaced fractures that were fixed in situ, we found a 2% rate of fixation failure/nonunion. Although rare, radicular pain and paresthesias were the most common long-term neurologic sequela.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
描述经皮后路骨盆固定治疗移位性脊柱骨盆分离模式的成功率和并发症。
回顾性队列研究。
三个一级创伤中心。
纳入 53 例移位性脊柱骨盆模式患者。
采用经皮髂骶螺钉固定。
主要观察指标包括愈合率、固定失败率和软组织并发症。
所有患者均存在移位、不稳定的模式，术前平均后凸角为 29.7°±15.4°（范围，0°-70°）。大多数患者神经功能完整（72%）或固定时检查结果未知（15%）。中位随访时间为 254 天（四分位距，141-531 天）。愈合率为 98%。影像学和临床随访显示 1 例（2%）患者存在非愈合。最终随访时，有 2 例（4%）患者出现螺钉松动的影像学证据，均为双侧双侧骶髂螺钉固定，最终均愈合良好。神经功能恢复的平均时间为 195±114 天（范围，82-363 天）。存在时，长期神经后遗症最常见的是终末随访时的神经根痛和感觉异常（n=3，6%）。
选择性经皮后路骨盆固定治疗移位性脊柱骨盆分离似乎是安全的，并发症发生率低，愈合可靠。在一组原位固定的移位骨折患者中，我们发现固定失败/不愈合的发生率为 2%。虽然罕见，但神经根痛和感觉异常是最常见的长期神经后遗症。
治疗性 IV 级。有关证据水平的完整描述，请参见作者说明。
