Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 boulevard Sainte-Anne, Toulon Cedex 9, 83800, France.
Neurosurg Rev. 2024 Aug 1;47(1):389. doi: 10.1007/s10143-024-02650-3.
Unstable trauma lesion of the spinopelvic junction, including U-shaped sacral fractures and Tile C pelvic ring disruptions, require surgical stabilization in order to realign the bone arches of the pelvis thus reducing the upcoming orthopaedic impairment during sitting, standing, and walking positions, decompress the nerves roots of the cauda equina in a view of reducing neurological impairment, and allow early weight bearing. Even though posterior open modified triangular spinopelvic fixation is particularly efficient for treating unstable trauma lesions of the spinopelvic junction, it may not be sufficient alone in order to prevent long-term counter-nutation, i.e. rotation and anteflexion deformity of the anterior pelvis under load bearing conditions. Such progressive deformation is caused by either the slight rotation of the iliac connectors within the head of iliac screws for spinopelvic constructs, or the slight rotation of sacral cancellous bone around transsacral screws in case of percutaneous procedure. Regardless of the posterior surgical technique that is used, complementary anterior pelvic fixation appears mandatory in order to prevent such deformation over time, which can lead to pelvic asymmetry and then gait imbalance.
不稳定的脊柱骨盆连接创伤病变，包括 U 形骶骨骨折和 Tile C 型骨盆环破裂，需要手术稳定以重新排列骨盆的骨弓，从而减少坐、站和走姿时的后续骨科损伤，减压马尾神经根以减少神经损伤，并允许早期负重。尽管后路改良三角形脊柱骨盆固定对于治疗不稳定的脊柱骨盆连接创伤病变特别有效，但仅靠后路固定可能不足以防止长期反旋，即前骨盆在负重条件下的旋转和前屈畸形。这种渐进性变形是由脊柱骨盆结构中髂螺钉头内的髂连接器轻微旋转或经皮手术中骶骨松质骨围绕经骶骨螺钉轻微旋转引起的。无论使用何种后路手术技术，为了防止这种变形随时间推移而导致骨盆不对称，进而导致步态失衡，补充前路骨盆固定似乎是必要的。
