Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan.
Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kweishan 333, Taoyuan, Taiwan.
J Orthop Traumatol. 2023 Sep 21;24(1):51. doi: 10.1186/s10195-023-00728-0.
Percutaneous iliosacral (IS) screw fixation and trans-iliac trans-sacral (TITS) screw fixation are clinically effective treatments of posterior pelvic sacroiliac fractures. In order to accurately assess the sacrum position relative to the pelvis, pelvic incidence (PI) is a commonly utilized radiographic parameter in sagittal view. This study aimed to investigate and compare the surgical outcomes and radiographic parameters of IS or TITS screw fixations for the treatment of posterior sacroiliac complex fractures with different PI values.
The data on patients with posterior pelvic sacroiliac fractures who underwent percutaneous IS or TITS screw fixations, or both, at a single level I trauma center between January 2017 and June 2020 were reviewed. We documented the patient characteristics and fracture types, reviewed surgical records, and measured the radiographic parameters via plain films and multi-planar computed tomography (mpCT) images. Radiographic variations in PI, sacral slope, pelvic tilt, sacral dysmorphism, pelvic ring reduction quality, screw deviation angles, screw malposition grading, and iatrogenic complications were documented and analyzed.
A total of 85 patients were included, and 65 IS and 70 TITS screws were accounted for. Patients were divided into two groups according to screw fixation method and further divided into four sub-groups based on baseline PI values. The PI cutoff values were 49.85° and 48.05° in the IS and TITS screw groups, respectively, according to receiver operating characteristic analysis and Youden's J statistic. Smaller PI values were significantly correlated with sacral dysmorphism (p = 0.027 and 0.003 in the IS and TITS screw groups, respectively). Patients with larger PI values were at a significantly increased risk of screw malposition in the TITS screw group (p = 0.049), with no association in the IS screw group. Logistic regression confirmed that a larger PI value was a significant risk factor for screw malposition in the TITS screw group (p = 0.010). The post-operative outcomes improved from poor/fair (at 6 months) to good/average (at 12 months) based on the Postel Merle d'Aubigné and Majeed scores, with no significant differences between subgroups.
Both percutaneous IS and TITS screw fixations are safe and effective treatments for posterior pelvic sacroiliac fractures. Due to the higher risk of screw malposition in patients with larger PI values, it is crucial to identify potential patients at risk when performing TITS screw fixation surgery.
Level III.
经皮髂骨螺钉固定和经髂骨经骶骨（TITS）螺钉固定是治疗骨盆后环骶髂骨骨折的有效方法。为了准确评估骶骨相对于骨盆的位置，骨盆入射角（PI）是矢状位中常用的影像学参数。本研究旨在探讨和比较不同 PI 值的经皮髂骨或 TITS 螺钉固定治疗骨盆后环骶髂复合体骨折的手术效果和影像学参数。
回顾 2017 年 1 月至 2020 年 6 月在一家单一级创伤中心接受经皮髂骨螺钉或 TITS 螺钉固定或两者联合固定治疗的骨盆后环骶髂骨骨折患者的数据。我们记录了患者特征和骨折类型，查阅了手术记录，并通过平片和多平面计算机断层扫描（mpCT）图像测量影像学参数。记录并分析了 PI、骶骨倾斜度、骨盆倾斜度、骶骨畸形、骨盆环复位质量、螺钉偏斜角度、螺钉位置不良分级和医源性并发症的影像学变化。
共纳入 85 例患者，其中 65 例行髂骨螺钉固定，70 例行 TITS 螺钉固定。根据螺钉固定方法将患者分为两组，并根据基线 PI 值进一步分为四组。根据受试者工作特征分析和 Youden's J 统计，IS 螺钉组和 TITS 螺钉组的 PI 截断值分别为 49.85°和 48.05°。PI 值较小与骶骨畸形显著相关（IS 螺钉组和 TITS 螺钉组分别为 p=0.027 和 0.003）。PI 值较大的患者 TITS 螺钉组螺钉位置不良的风险显著增加（p=0.049），而 IS 螺钉组则无此关联。Logistic 回归证实，较大的 PI 值是 TITS 螺钉组螺钉位置不良的显著危险因素（p=0.010）。根据 Postel-Merle d'Aubigné 和 Majeed 评分，术后 6 个月时，从差/差（6 个月）改善为好/好（12 个月），但亚组之间无显著差异。
经皮髂骨螺钉固定和 TITS 螺钉固定均是治疗骨盆后环骶髂骨骨折的安全有效方法。由于 PI 值较大的患者螺钉位置不良的风险较高，在进行 TITS 螺钉固定手术时，识别潜在的高危患者至关重要。
III 级。
