Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
Faculty of Medicine, the University of Jordan, Amman, Jordan.
Eur J Orthop Surg Traumatol. 2023 Oct;33(7):3107-3117. doi: 10.1007/s00590-023-03543-9. Epub 2023 Apr 8.
The objective of this review was to present a thorough overview of the complications associated with conventional percutaneous sacroiliac screw fixation to identify areas for improvement in surgical technique and patient selection.
PubMed/Medline, Web of Science, Embase, Ovid, Cochrane library, and Google Scholar were systematically searched for original human studies reporting on complications of conventional percutaneous sacroiliac fixation in traumatic pelvic ring injuries from January 1, 2000, to April 30, 2022. The main meta-analysis was based on the random effect model to pool all complications reported in the included studies. The results were reported as weighted proportions with 95% confidence intervals. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
A total of 56 studies with 3644 screws (2871 procedures) met the inclusion criteria, with a mean age of 40.5 years. The most frequently reported complications were screw malposition with a weighted proportion of 6% (95% CI: 5-9%) and involved 189 out of 3644 screws, persistent pain following the procedure with a weighted proportion of 3% (95% CI: 2-4%) and affected 98 out of 2871 patients, and nerve injury, which had a weighted proportion of 2% (95% CI: 1-3%) and was observed in 41 out of 2871 procedures. The L5 and S1 nerve roots were more frequently affected. Revision surgery was required for 184 out of 2871 patients with a weighted proportion of 5% (95% CI: 3-7%). The primary reason for the revision was persistent pain after the initial procedure, which affected 74 out of 184 patients, with a weighted proportion of 2.0% (95% CI: 1.2-2.8%).
This study showed that screw malposition, the need for revision surgery, persistent pain, and nerve injuries were the most frequent complications following conventional percutaneous sacroiliac screw fixation. However, these results must be interpreted in context due to confounding factors, including the lack of high-quality studies and the absence of uniformity in defining some complications across studies.
本综述旨在全面介绍与传统经皮骶髂螺钉固定相关的并发症，以确定在手术技术和患者选择方面需要改进的领域。
系统检索了 PubMed/Medline、Web of Science、Embase、Ovid、Cochrane 图书馆和 Google Scholar 上 2000 年 1 月 1 日至 2022 年 4 月 30 日期间报告外伤性骨盆环损伤中传统经皮骶髂固定并发症的原始人类研究。主要的荟萃分析采用随机效应模型对纳入研究中报告的所有并发症进行汇总。结果以加权比例（95%置信区间）表示。本综述符合 PRISMA（系统评价和荟萃分析的首选报告项目）指南。
共有 56 项研究（2871 例手术）符合纳入标准，共 3644 枚螺钉，平均年龄为 40.5 岁。最常报告的并发症是螺钉位置不当，加权比例为 6%（95%CI：5-9%），涉及 3644 枚螺钉中的 189 枚；术后持续性疼痛，加权比例为 3%（95%CI：2-4%），涉及 2871 例患者中的 98 例；神经损伤，加权比例为 2%（95%CI：1-3%），涉及 2871 例手术中的 41 例。L5 和 S1 神经根更容易受到影响。2871 例患者中有 184 例（加权比例为 5%（95%CI：3-7%））需要进行翻修手术。翻修的主要原因是初次手术后持续疼痛，影响了 184 例患者中的 74 例，加权比例为 2.0%（95%CI：1.2-2.8%）。
本研究表明，传统经皮骶髂螺钉固定后，螺钉位置不当、需要翻修手术、持续性疼痛和神经损伤是最常见的并发症。然而，由于混杂因素的存在，包括缺乏高质量的研究以及缺乏对一些并发症在研究间定义的一致性，因此必须对这些结果进行解释。
