Gahr Patrick, Garkisch Angelina, Matthis Manuel, Märdian Sven
Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
Oper Orthop Traumatol. 2025 Sep 12. doi: 10.1007/s00064-025-00914-9.
Minimally invasive stabilization of osteoporotic fractures of the posterior pelvic ring to ensure rapid and low-pain mobilization and timely fracture healing while avoiding progressive fracture instability.
Primarily unstable osteoporotic fractures of the posterior pelvic ring, in particular sacroiliac fracture dislocations (OF 5) and bilateral sacral fractures (OF 4), unilateral sacral fractures (OF 3) in constellations indicating a higher degree of instability. In addition to the type of fracture, important clinical parameters and modifiers that indicate greater instability should be taken into account when deciding on treatment options. An important aid for decision-making is the OF Pelvis Score, in which a score above 8 indicates surgical treatment.
Major soft tissue damage, decubital ulcers or infections at the surgical site; voluminous implants or defect zones/osteolysis in the transiliac screw corridor; sacroiliac dislocation fractures with a large crescent fragment, which are treated similarly to iliac fractures; high degree of vertical instability with the need for spinopelvic support.
Fluoroscopically assisted minimally invasive implantation of long large-caliber polyaxial screws in both transiliac screw corridors, subfascial insertion of a connecting rod, fixation on both sides with set screws.
Rapid mobilization with weight-bearing as tolerated (WBAT).
Between 5/2024 and 3/2025, 10 patients underwent transiliac internal fixation (TIFI) surgery for unstable fractures of the posterior pelvic ring: in 8 cases alone and in the remaining 2 cases in combination with osteosynthesis of the anterior pelvic ring. In 1 patient, the wound had to be revised due to a suture granuloma, otherwise there were no complications requiring revision. In all cases, postoperative computed tomography (CT) imaging confirmed the correct position of the implant. Stabilization of the posterior pelvic ring using TIFI is a minimally invasive, safe and highly stable osteosynthesis with a relatively simple surgical technique.
对骨盆后环骨质疏松性骨折进行微创稳定固定，以确保快速且疼痛轻微的活动能力恢复以及骨折及时愈合，同时避免骨折进展性不稳定。
主要为骨盆后环不稳定的骨质疏松性骨折，特别是骶髂关节骨折脱位（OF 5）和双侧骶骨骨折（OF 4），以及单侧骶骨骨折（OF 3）且具有更高不稳定程度的情况。除骨折类型外，在决定治疗方案时应考虑表明更大不稳定程度的重要临床参数和修正因素。决策的一个重要辅助工具是骨盆OF评分，评分高于8分表明需进行手术治疗。
手术部位存在严重软组织损伤、褥疮或感染；经髂螺钉通道有大量植入物或缺损区/骨质溶解；伴有大的新月形骨折块的骶髂关节脱位骨折，其治疗方法与髂骨骨折类似；存在高度垂直不稳定且需要脊柱骨盆支撑。
在透视辅助下，于双侧经髂螺钉通道微创植入长的大口径多轴螺钉，在筋膜下插入连接杆，用定位螺钉进行双侧固定。
根据耐受情况尽快进行负重活动（WBAT）。
在2024年5月至2025年3月期间，10例患者因骨盆后环不稳定骨折接受了经髂内固定（TIFI）手术：8例为单独手术，其余2例与骨盆前环骨固定术联合进行。1例患者因缝线肉芽肿需对伤口进行修正，除此之外无需要修正的并发症。在所有病例中，术后计算机断层扫描（CT）成像均证实植入物位置正确。使用TIFI对骨盆后环进行稳定固定是一种微创、安全且高度稳定的骨固定术，手术技术相对简单。
