Böhringer Alexander, Gebhard Florian, Eickhoff Alexander, Cintean Raffael, Gruber Tobias, Schütze Konrad, Pankratz Carlos
Department of Trauma Hand and Reconstructive Surgery, Ulm University, Ulm, Germany.
Geriatr Orthop Surg Rehabil. 2025 May 5;16:21514593251327912. doi: 10.1177/21514593251327912. eCollection 2025.
Fragility fractures of the posterior pelvic ring are associated with osteoporosis and are becoming more common with demographic change. Known limitations of conservative therapy include a significant loss of autonomy and high mortality. Surgical stabilisation using percutaneous sacroiliac (SI) or trans-iliac trans-sacral (TITS) screws, has been established to increase mobility, but long-term results have not yet been studied.
138 patients with percutaneous SI and TITS screw fixation of the posterior pelvic ring in osteoporotic fragility fractures were followed up for more than a year postoperatively in this retrospective study. Thereby, all patients were operated in the conventional supine position in a hybrid operating room consisting of a fixed, robot-assisted 3D flat-panel detector and a navigation system.
34 patients were male and 104 female. The mean age was 77.6 ± 9 years. 26 patients were ASA 1 + 2, 93 patients ASA 3 and 19 patients ASA 4. 80 fractures were classified as FFP 2, 23 FFP 3 and 35 FFP 4. Time to surgery was 127.5 ± 113.2 hours. Hospitalisation lasted an average of 15.7 ± 8.5 days. At the time of discharge, 68.8% of the patients had regained their original mobility, while 31.2% remained limited. The home situation remained unchanged in 73.9% of the patients, worsened in 26.1% and improved in 2.8%. 90.6% of the screw fixations showed no signs of loosening. In 9.4%, loosening could not be ruled out radiologically, but a surgical revision was not necessary. The 1-year mortality rate was 10.1%.
Percutaneous navigated screw fixation of the posterior pelvic ring in fragility fractures is a simple, safe, minimally invasive and precise method with good clinical results in terms of rapid recovery with early mobilization of patients to maintain autonomy and reduce mortality. Further clinical studies with controlled cohorts and a large number of patients with long follow-up periods should be carried out to compare the procedure with other methods. In particular, the question of an additional standardized treatment of the anterior pelvic ring in unstable dislocated fragility fractures should be investigated.
骨盆后环脆性骨折与骨质疏松症相关，且随着人口结构变化正变得越来越常见。保守治疗的已知局限性包括自主性显著丧失和高死亡率。采用经皮骶髂（SI）螺钉或经髂骨经骶骨（TITS）螺钉进行手术稳定已被证实可提高活动能力，但长期结果尚未得到研究。
在这项回顾性研究中，对138例因骨质疏松性脆性骨折接受骨盆后环经皮SI和TITS螺钉固定的患者进行了术后一年以上的随访。所有患者均在由固定的机器人辅助3D平板探测器和导航系统组成的混合手术室中采用传统仰卧位进行手术。
男性34例，女性104例。平均年龄为77.6±9岁。26例患者美国麻醉医师协会（ASA）分级为1+2，93例为ASA 3，19例为ASA 4。80处骨折分类为FFP 2，23处为FFP 3，35处为FFP 4。手术时间为127.5±113.2小时。住院时间平均为15.7±8.5天。出院时，68.8%的患者恢复了原来的活动能力，而31.2%的患者活动能力仍受限。73.9%的患者家庭状况保持不变，26.1%的患者家庭状况恶化，2.8%的患者家庭状况改善。90.6%的螺钉固定未显示松动迹象。在9.4%的病例中，影像学上不能排除松动，但无需进行手术翻修。1年死亡率为10.1%。
对于脆性骨折，骨盆后环经皮导航螺钉固定是一种简单、安全、微创且精确的方法，在患者早期活动以快速恢复从而维持自主性和降低死亡率方面具有良好的临床效果。应开展进一步的临床研究，设立对照队列并纳入大量患者进行长期随访，以将该手术方法与其他方法进行比较。特别是，对于不稳定脱位的脆性骨折，应研究是否需要对骨盆前环进行额外的标准化治疗。
