Klingebiel Felix Karl-Ludwig, Klee Octavia Emilia Sophie, Long Anhua, Teuber Henrik, Teuben Michel, Halvachizadeh Sascha, Hax Jakob, Berk Till, von Spiczak Jochen, Hübner Christian, Starr Adam, Mica Ladislav, Neuhaus Valentin, Pape Hans-Christoph, Kalbas Yannik, Pfeifer Roman
Department of Trauma Surgery, University of Zurich, University Hospital of Zurich, Zurich, Switzerland.
Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Eur J Orthop Surg Traumatol. 2025 Jul 1;35(1):285. doi: 10.1007/s00590-025-04394-2.
Navigated sacroiliac screw fixation of the posterior pelvic ring has been introduced, providing the surgeon with an improved three-dimensional orientation of the anatomy. The primary aim of this study was to evaluate the influence of navigation on the surgical outcome. The secondary aim was to evaluate the relevance of sacral dysmorphism.
A retrospective cohort study of patients from 2014 to 2022 admitted with acute traumatic pelvic ring injuries was performed. Patients aged ≥ 16 years treated electively with posterior pelvic ring screw fixation and at least 12 months follow up and informed consent were included. Patients were stratified according to treatment strategy (NAV: Navigated screws vs. CONV: Conventional screws) and compared regarding implant-related complications. Patients were automatically matched 1:1 according to age, gender and fracture stability.
A total of 208 patients were included (NAV: n = 66, CONV: n = 142). After matching, 132 patients were finally included with 66 patients in each. Transsacral screws were used more often in the navigated group (69.7%; OR = 5.58, p < 0.0001). There were no significant differences regarding hardware complications. However, no malpositioning or foraminal breaching occurred in the navigated group. A back-analysis of the unmatched group with elevated power revealed that malpositioning rate in the navigated group was significantly lower (p = 0.033). The presence of sacral dysmorphism did not affect malpositioning rates yet those patients were less likely to receive a transsacral screw instrumentation.
Navigated screw fixation of the posterior pelvic ring resulted in optimal accuracy of screw placement in trauma patients. Sacral dysmorphism scores might support surgical decision-making regarding the choice of screws. Especially patients with poor bone quality might benefit from transsacral screws, which can be introduced more safely using navigation.
导航下骶髂螺钉固定后骨盆环技术已被引入，为外科医生提供了更好的解剖结构三维定位。本研究的主要目的是评估导航对手术结果的影响。次要目的是评估骶骨形态异常的相关性。
对2014年至2022年因急性创伤性骨盆环损伤入院的患者进行回顾性队列研究。纳入年龄≥16岁、接受后骨盆环螺钉固定治疗且随访至少12个月并签署知情同意书的患者。根据治疗策略（导航组：导航螺钉与传统组：传统螺钉）对患者进行分层，并比较植入物相关并发症。根据年龄、性别和骨折稳定性将患者自动1:1匹配。
共纳入208例患者（导航组：n = 66，传统组：n = 142）。匹配后，最终纳入132例患者，每组66例。导航组更常使用经骶骨螺钉（69.7%；OR = 5.58，p < 0.0001）。在硬件并发症方面没有显著差异。然而，导航组未发生螺钉位置不当或穿破椎间孔的情况。对未匹配组进行的高功效反向分析显示，导航组的位置不当率显著更低（p = 0.033）。骶骨形态异常的存在并不影响位置不当率，但这些患者接受经骶骨螺钉内固定的可能性较小。
导航下后骨盆环螺钉固定在创伤患者中实现了螺钉置入的最佳准确性。骶骨形态异常评分可能有助于螺钉选择的手术决策。特别是骨质质量差的患者可能从经骶骨螺钉中受益，使用导航可以更安全地置入这些螺钉。
