Ugawa Ryo, Komatsubara Tadashi, Fujiwara Yoshihiro, Yamakawa Yasuaki, Matsumoto Toshiyuki
Department of Orthopaedic Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi City, Kochi, Japan.
Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Okayama City, Japan.
Trauma Case Rep. 2025 Jun 4;58:101212. doi: 10.1016/j.tcr.2025.101212. eCollection 2025 Aug.
We report two cases of combined lumbar vertebral and sacral fractures treated with minimally invasive reconstructive surgery comprising transiliac-transsacral (TITS) screws and spinopelvic fixation (SPF). Case 1 involved a 32-year-old Japanese male patient who fell and sustained multilevel vertebral and sacral fractures with anterior displacement and kyphosis and right pubic fracture. The patient was placed in the supine position and underwent closed reduction in the hyperextended supine position. A TITS screw was inserted at S1 and a cannulated screw was inserted in the right pubic ramus under navigation. The patient's body was then changed to the prone position. Two iliac screws were inserted on each side and percutaneous pedicle screws (PPS) were inserted from Th11 to L4 under navigation. We performed percutaneous rod placement and connected the screws. Postoperative computed tomography (CT) showed no deviation of the screws from the bone and acceptable sacral deformity reduction. Case 2 involved an 83-year-old Japanese female patient who fell and sustained L5 vertebral and fragile sacral fractures. The patient was placed in the prone position, and TITS screw insertion was performed at S1 and S2 under navigation. Iliac screws were inserted on each side and PPS were inserted at the L3 and L4 vertebrae under navigation. Postoperative CT revealed no deviation of the screws from the bone. TITS screw placement and SPF allow minimally invasive reduction and reconstruction of unstable pelvic ring injuries with lower lumbar vertebral and sacral fractures.
我们报告了两例采用微创重建手术治疗的腰椎和骶骨联合骨折病例，该手术包括经髂-经骶（TITS）螺钉和脊柱骨盆固定（SPF）。病例1为一名32岁的日本男性患者，因跌倒导致多节段椎体和骶骨骨折，伴有前脱位和后凸畸形以及右侧耻骨骨折。患者仰卧位，在仰卧过伸位下行闭合复位。在导航引导下于S1置入一枚TITS螺钉，并在右侧耻骨支置入一枚空心螺钉。然后将患者体位改为俯卧位。在两侧各置入两枚髂骨螺钉，并在导航引导下从T11至L4置入经皮椎弓根螺钉（PPS）。我们进行了经皮棒置入并连接螺钉。术后计算机断层扫描（CT）显示螺钉未偏离骨质，骶骨畸形复位可接受。病例2为一名83岁的日本女性患者，因跌倒导致L5椎体和脆弱的骶骨骨折。患者俯卧位，在导航引导下于S1和S2置入TITS螺钉。在两侧置入髂骨螺钉，并在导航引导下于L3和L4椎体置入PPS。术后CT显示螺钉未偏离骨质。TITS螺钉置入和SPF可实现对伴有下腰椎和骶骨骨折的不稳定骨盆环损伤的微创复位和重建。
