Gilli Antonio, Daoudi Samih, Moreau Pierre-Emmanuel, Riouallon Guillaume
Hôpital Paris Saint-Joseph, Paris, France.
Hôpital NOVO, Pontoise, Pontoise, France.
Eur J Orthop Surg Traumatol. 2025 Jul 16;35(1):308. doi: 10.1007/s00590-025-04402-5.
Percutaneous fixation of pelvic fractures using sacroiliac (SI) screws is recognized as a less invasive alternative to open surgery. Despite advancements in this technique, complications still occur. This study aims to evaluate the accuracy of IS screw placement assisted by intraoperative 3D navigation.
A retrospective study was conducted on patients treated for sacral fractures or SI joint dislocations between 2016 and 2023 at a single institution. All procedures were performed using O-Arm 3D fluoroscopy and StealthStation S8 navigation platform (Medtronic). For each screw, all accuracy measurements-including length, angulation, and cortical perforation-were performed on the final 3D scans.
Of the 241 screws implanted, 83.2% showed no perforation. Screw angulation was generally less accurate, with 26.5% of screws showing a minor deviation of 5° from the ideal trajectory. Accuracy was significantly lower in the axial plane compared to the coronal plane. On average, the implanted screws reached 78% of the maximum length the S1 corridor could accommodate.
This study represents the largest series to date of SI screw implantation using 3D navigation. Navigation proved to be safe for IS screw placement. Although overall accuracy in our series was slightly lower than that reported in other studies using the O-Arm, our sample included six times more patients, multiple surgeons, and a heterogeneous cohort. 3D navigation with O-Arm proved more helpful in avoiding cortical perforations than in improving screw angulation.
使用骶髂螺钉经皮固定骨盆骨折被认为是一种比开放手术侵入性更小的替代方法。尽管该技术取得了进展，但并发症仍然会发生。本研究旨在评估术中三维导航辅助下骶髂螺钉置入的准确性。
对2016年至2023年在单一机构接受骶骨骨折或骶髂关节脱位治疗的患者进行回顾性研究。所有手术均使用O型臂三维透视和StealthStation S8导航平台（美敦力公司）进行。对于每枚螺钉，所有准确性测量——包括长度、角度和皮质穿孔——均在最终三维扫描上进行。
在植入的241枚螺钉中，83.2%未出现穿孔。螺钉角度通常不太准确，26.5%的螺钉与理想轨迹有5°的微小偏差。与冠状面相比，轴向平面的准确性明显较低。平均而言，植入的螺钉达到了S1通道可容纳的最大长度的78%。
本研究是迄今为止使用三维导航进行骶髂螺钉植入的最大系列研究。导航被证明对骶髂螺钉置入是安全的。尽管我们系列研究中的总体准确性略低于其他使用O型臂的研究报告，但我们的样本包含的患者数量是其他研究的六倍，涉及多名外科医生，且患者群体具有异质性。与改善螺钉角度相比，使用O型臂的三维导航在避免皮质穿孔方面更有帮助。
