Liu Guangping, Chen Zhiguang, Cao Wenhao, Zheng Yubo, Li Jiaqi, He Jie, Li Changda, Chen Hua, Tang Peifu
Department of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.
Department of Orthopaedics, Zibo Central Hospital, Zibo, China.
Orthop Surg. 2025 Mar;17(3):781-789. doi: 10.1111/os.14326. Epub 2024 Dec 26.
There are many advantages to stabilize the posterior pelvic ring injuries with a transiliac-transsacral (TITS) screw percutaneously. To identify the correct entry point and insert a guidewire accurately for a TITS screw, we propose a method of specifying the optimal entry point, and introduce a technique of enabling freehand placement of a guidewire with fluoroscopic guidance.
In this retrospective study, 116 patients who underwent pelvic CT scans and pelvic lateral radiographs at our institution from January 2020 to April 2022 were enrolled. The optimal entry point for a TITS screw was formulated in the strict mid-sagittal CT plane, and then transferred to the pelvic lateral radiograph relying on the sacral cortexes which were easily visible even in the poor fluoroscopy. The relative position of this point to other anatomical markers was checked to confirm its feasibility as an entry point. With the method to locate the entry point, 18 patients suffered the posterior pelvic ring injuries were treated with TITS screws through hammering a reverse Kirschner wire (K-wire) to insert a guidewire assisted by a canula, followed by the validation of the screw placement accuracy.
The transferred point in radiograph was consistently beneath the sacral alar slope, and located posteroinferior to the iliac cortical density (ICD) and anterosuperior to the sacral nerve root tunnel in all 116 patients. In clinical practice, 18 TITS screws were successfully placed in 18 patients without cortex violation. The average operative time for each screw was 20.11 ± 6.29 min, with an average of 14.11 ± 6.81 fluoroscopic shots per screw. At the 3-month follow-up, fracture healing was confirmed in all patients. The average Majeed score was 89.61 ± 6.90 at the final follow-up.
It's feasible to identify an entry point for a TITS screw based on the sacral cortexes, and hammering a reverse K-wire assisted by a percutaneous kyphoplasty (PKP) canula is a safe and practical technique for guidewire insertion.
经皮使用经髂-经骶（TITS）螺钉稳定骨盆后环损伤有诸多优势。为确定TITS螺钉的正确进针点并准确插入导丝，我们提出一种确定最佳进针点的方法，并介绍一种在透视引导下徒手放置导丝的技术。
在这项回顾性研究中，纳入了2020年1月至2022年4月在我院接受骨盆CT扫描和骨盆侧位X线片检查的116例患者。在严格的矢状位CT平面上确定TITS螺钉的最佳进针点，然后依靠即使在透视不佳时也易于观察到的骶骨皮质将其转移至骨盆侧位X线片上。检查该点与其他解剖标志的相对位置，以确认其作为进针点的可行性。采用该进针点定位方法，对18例骨盆后环损伤患者通过敲击反向克氏针（K针）并在套管辅助下插入导丝来置入TITS螺钉，随后验证螺钉置入的准确性。
在所有116例患者中，X线片上转移的点始终位于骶骨翼斜坡下方，髂骨皮质密度（ICD）后下方以及骶神经根通道前上方。在临床实践中，18例患者成功置入18枚TITS螺钉，无一例出现皮质破坏。每枚螺钉的平均手术时间为20.11±6.29分钟，每枚螺钉平均透视次数为14.11±6.81次。在3个月随访时，所有患者均证实骨折愈合。末次随访时平均Majeed评分为89.61±6.90。
基于骶骨皮质确定TITS螺钉的进针点是可行的，并且在经皮椎体后凸成形术（PKP）套管辅助下敲击反向K针是一种安全实用的导丝插入技术。
