Lian Jayson, Yang Rui, Akioyamen Noel O, Wang Jichuan, Ge David H, Sen Milan K, Hoang Bang, Geller David S
Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York.
Division of Orthopaedic Surgery, Jacobi Medical Center, Bronx, New York.
JBJS Essent Surg Tech. 2025 Jan 7;15(1). doi: 10.2106/JBJS.ST.22.00034. eCollection 2025 Jan-Mar.
The pelvis is one of the most common areas for metastatic bone disease. We recently described the use of a minimally invasive percutaneous screw fixation of metastatic non-periacetabular pelvic lesions, with excellent results.
The procedure can be completed in a standard operating theater without the need for special instruments. In our video we describe the appropriate intraoperative patient positioning, surgical equipment, surgical approach, and obtainment of the necessary fluoroscopic views for placement of various pelvic percutaneous screws.
Alternative treatments include surgical procedures such as curettage, cement packing, and modified Harrington total hip arthroplasty through extensive open approaches. Additionally, as an alternative to standard fluoroscopy, intraoperative navigation and an O-arm could be utilized for the placement of screws. In our experience, intraoperative navigation has been helpful for confirmation of final screw placement and length. Overreliance on intraoperative navigation in the setting of poor bone quality and an abandonment of tactile feedback and the various tips described in this video article can lead to inadvertent extraosseous screw placement and injury. Furthermore, as navigation involves only a virtually computed image, we have found it challenging to utilize in complex, curved bones, such as the superior pubic ramus.
Percutaneous screw fixation is safe and effective for the treatment of metastatic non-periacetabular pelvic lesions. Given the simplicity of the technique and instrumentation, and the tolerance of concomitant treatments, this approach is worthy of broader consideration.
In our recent study, 22 consecutive patients with painful non-periacetabular pelvic metastatic cancer underwent percutaneous screw fixation. There were no surgical complications. Postoperatively, there was significant improvement in visual analog scale pain scores and functional Eastern Cooperative Oncology Group scores, as compared with baseline.
Despite the simplicity of the intraoperative set-up and instrumentation, the procedure is technically demanding. Obtaining the correct fluoroscopic views and troubleshooting intraoperative hurdles can be challenging.
CT = computed tomographyASIS = anterior superior iliac spineGT = greater trochanterAP = anteroposteriorAIIS = anterior inferior iliac spineSI = sacroiliacTSTI = transsacral-transiliacVAS = visual analog scaleECOG = Eastern Cooperative Oncology GroupDVT = deep vein thrombosis.
骨盆是转移性骨病最常见的部位之一。我们最近描述了使用微创经皮螺钉固定治疗非髋臼周围骨盆转移性病变，效果良好。
该手术可在标准手术室完成，无需特殊器械。在我们的视频中，我们描述了术中合适的患者体位、手术设备、手术入路，以及获取用于放置各种骨盆经皮螺钉的必要透视图像。
替代治疗包括手术操作，如刮除术、骨水泥填充，以及通过广泛的开放入路进行改良的哈灵顿全髋关节置换术。此外，作为标准透视的替代方法，术中导航和O形臂可用于螺钉放置。根据我们的经验，术中导航有助于确认最终螺钉的放置位置和长度。在骨质较差的情况下过度依赖术中导航，放弃触觉反馈以及本文所述的各种技巧，可能会导致螺钉意外置于骨外并造成损伤。此外，由于导航仅涉及虚拟计算图像，我们发现在处理复杂的弯曲骨骼（如耻骨上支）时使用它具有挑战性。
经皮螺钉固定治疗非髋臼周围骨盆转移性病变安全有效。鉴于该技术和器械的简单性以及对联合治疗的耐受性，这种方法值得更广泛的考虑。
在我们最近的研究中，22例连续的有症状的非髋臼周围骨盆转移性癌患者接受了经皮螺钉固定。无手术并发症。术后，与基线相比，视觉模拟量表疼痛评分和东部肿瘤协作组功能评分有显著改善。
尽管术中设置和器械简单，但该手术在技术上要求较高。获得正确的透视图像并解决术中困难可能具有挑战性。
CT = 计算机断层扫描；ASIS = 髂前上棘；GT = 大转子；AP = 前后位；AIIS = 髂前下棘；SI = 骶髂关节；TSTI = 经骶骨 - 经髂骨；VAS = 视觉模拟量表；ECOG = 东部肿瘤协作组；DVT = 深静脉血栓形成
