Department of Orthopaedics Surgery, General Hospital of Central Theater Command, Wuhan, China.
School of Medicine, Wuhan University of Science and Technology, Wuhan, China.
Orthop Surg. 2023 Jul;15(7):1814-1822. doi: 10.1111/os.13763. Epub 2023 Jun 22.
Screw loosening is a common complication of iliosacral screw fixation, with subsequent loss of stability and fracture re-displacement. This study aimed to investigate the incidence of and risk factors for screw loosening after iliosacral screw fixation for posterior pelvic ring injury.
A total of 135 patients with posterior pelvic ring injuries who were treated with iliosacral screw fixation in our department between July 2015 and April 2021 were selected for this retrospective analysis. The possible risk factors for screw loosening were investigated using univariate and multivariate logistic regression analyses of patient demographics and trauma-related and iatrogenic variables, including age, sex, body mass index, Osteoporosis Self-Assessment Tool for Asians (OSTA) index, mechanism of injury, Young-Burgess classification, site of injury, type of injury, type of screw, mode of fixation, numbers of guidewire adjustments, accuracy of screw position, and quality of fracture reduction.
The incidence of screw loosening was 15.6% (n = 21). The mean duration for screw loosening was 3.2 ± 1.5 months after operation. Univariate analysis results showed that the Young-Burgess classification, type of injury, site of injury, type of screw, mode of fixation, and OSTA index might be related to screw loosening (p < 0.05). According to the multivariate logistic regression, vertical shear injuries (Odds ratios [OR] 9.80, 95% Confidence intervals [CI] [1.96-73.28], p = 0.008), type of injury (OR 0.25, 95% CI [0.13-0.79], p = 0.027), common screws (OR 6.94, 95% CI [1.53-31.40], p = 0.012), screws insertion only at the level of the first sacral segment (S1) (OR 8.79, 95% CI [1.18-65.46], p = 0.034), injury site located in the medial sacral foramina (OR 6.28, 95% CI [1.16-34.06], p = 0.033), and lower OSTA index [OR 0.41, 95% CI [0.24-0.71], p = 0.001] were significantly related to screw loosening.
Vertical shear injuries, sacral fractures, injury site located in the medial sacral foramina, and lower OSTA index are significantly associated with the postoperative occurrence of screw loosening. Transiliac-transsacral screw fixation and screws insertion both at the level of the S1 and second sacral segment can prevent screw loosening.
螺钉松动是髂骨螺钉固定后常见的并发症，随后会导致稳定性丧失和骨折再移位。本研究旨在探讨骨盆后环损伤后路髂骨螺钉固定后螺钉松动的发生率和危险因素。
回顾性分析 2015 年 7 月至 2021 年 4 月我科收治的 135 例骨盆后环损伤患者，采用单因素和多因素 logistic 回归分析患者的人口统计学和与创伤相关及医源性变量，包括年龄、性别、体质量指数、亚洲人骨质疏松自我评估工具（OSTA）指数、损伤机制、Young-Burgess 分类、损伤部位、损伤类型、螺钉类型、固定方式、导丝调整次数、螺钉位置准确性和骨折复位质量，以探讨螺钉松动的可能危险因素。
螺钉松动发生率为 15.6%（n=21）。术后螺钉松动的平均时间为 3.2±1.5 个月。单因素分析结果显示，Young-Burgess 分类、损伤类型、损伤部位、螺钉类型、固定方式和 OSTA 指数可能与螺钉松动有关（p<0.05）。多因素 logistic 回归分析显示，垂直剪切损伤（优势比[OR]9.80，95%置信区间[CI]为[1.96-73.28]，p=0.008）、损伤类型（OR 0.25，95%CI[0.13-0.79]，p=0.027）、普通螺钉（OR 6.94，95%CI[1.53-31.40]，p=0.012）、仅在 S1 水平置入螺钉（OR 8.79，95%CI[1.18-65.46]，p=0.034）、损伤部位位于骶骨内侧孔（OR 6.28，95%CI[1.16-34.06]，p=0.033）和较低的 OSTA 指数（OR 0.41，95%CI[0.24-0.71]，p=0.001）与螺钉松动显著相关。
垂直剪切损伤、骶骨骨折、损伤部位位于骶骨内侧孔和较低的 OSTA 指数与术后螺钉松动显著相关。经髂骨经骶骨螺钉固定和同时在 S1 和第 2 骶骨节段置入螺钉可以预防螺钉松动。
