Taylor Sean, Rawall Saurabh, Peterson Asa, McGwin Gerald, Rajaram Sakthivel
Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13 Street South, Birmingham 35205-5327, Alabama, USA.
Department of Epidemiology, University of Alabama at Birmingham, 1720 University Blvd, Birmingham 35233-1816, Alabama, USA.
Adv Orthop. 2025 Jul 15;2025:9946662. doi: 10.1155/aort/9946662. eCollection 2025.
Spinopelvic dissociation is a devastating injury that remains difficult to manage due to its complexity and low incidence. Lumbopelvic fixation is a treatment option traditionally performed with an open approach. However, open fixation is associated with substantial blood loss and infection risk in critical polytrauma patients. Technological advancements have enabled this procedure to be performed percutaneously. Thus, we evaluate outcomes between patients receiving open lumbopelvic fixation and those receiving percutaneous lumbopelvic fixation. A retrospective review was conducted of patients undergoing either open or percutaneous lumbopelvic fixation for spinopelvic dissociation from 2012 to 2024. The AOSpine classification system was used to classify all fractures. Patient demographic, clinical, and operative outcomes were analyzed. 48 patients with spinopelvic dissociation were included in the final analysis, with 21 receiving open lumbopelvic fixation and 27 receiving percutaneous lumbopelvic fixation. Preoperative characteristics and demographics were similar between the two groups. The percutaneous group demonstrated significantly reduced blood loss (82 vs. 679 mL; < 0.01), shorter operative time (168 vs. 284 min; < 0.01), fewer surgical site infections (0 vs. 4; =0.03), and reduced OR cost ($35,097 vs. $23,743; =0.01) but had a higher rate of anterior pelvic ring injuries (63% vs. 19%; =0.003). There was no significant difference in length of stay (=0.63) or length of follow-up (=0.64). Our findings suggest that percutaneous lumbopelvic fixation offers an attractive less invasive and shorter procedure to treat spinopelvic dissociation without added morbidity.
脊柱骨盆分离是一种严重的损伤，由于其复杂性和低发病率，治疗仍然具有挑战性。腰骶骨盆固定术是一种传统的开放手术治疗选择。然而，开放固定术在严重多发伤患者中会导致大量失血和感染风险。技术进步使得该手术能够通过经皮方式进行。因此，我们评估接受开放腰骶骨盆固定术和经皮腰骶骨盆固定术的患者之间的治疗效果。对2012年至2024年期间因脊柱骨盆分离接受开放或经皮腰骶骨盆固定术的患者进行了回顾性研究。使用AOSpine分类系统对所有骨折进行分类。分析了患者的人口统计学、临床和手术结果。最终分析纳入了48例脊柱骨盆分离患者，其中21例接受开放腰骶骨盆固定术，27例接受经皮腰骶骨盆固定术。两组术前特征和人口统计学相似。经皮组的失血量显著减少（82 vs. 679 mL；<0.01），手术时间缩短（168 vs. 284分钟；<0.01），手术部位感染更少（0 vs. 4；=0.03），手术室成本降低（35,097美元 vs. 23,743美元；=0.01），但骨盆前环损伤发生率更高（63% vs. 19%；=0.003）。住院时间（=0.63）或随访时间（=0.64）无显著差异。我们的研究结果表明，经皮腰骶骨盆固定术为治疗脊柱骨盆分离提供了一种有吸引力的、侵入性较小且手术时间较短的方法，且不会增加发病率。
