Ebraheim N A, Coombs R, Jackson W T, Rusin J J
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43699.
Clin Orthop Relat Res. 1994 Oct(307):222-8.
Nineteen patients with 21 unstable fractures of the posterior pelvic complex were treated with percutaneous computed tomography (CT)-guided posterior stabilization. CT allowed satisfactory visualization of the fracture and direction and length of the screw. It also allowed the authors to perform the procedure percutaneously, while causing only minimal blood loss. CT cuts that showed the best and safest sites for screw placement were selected. The length and direction of the screw was identified, and the skin entry site was determined. The guide pin was inserted across the fracture or disrupted sacroiliac joint; its correct position was confirmed and a cannulated screw was inserted over the pin. In the majority of patients, a pelvic external fixator was applied in the CT suite. Although assessing the deformity was possible, reduction was difficult but ultimately acceptable. All patients maintained reduction of their sacroiliac complex without loss of fixation, and all fractures healed without clinical or radiographic signs of pelvic instability. This technique was not associated with neurologic injury or deep infection. All but 2 patients returned to preinjury levels of activity and function. Two patients had associated injuries that affected their final functional outcome.
19例21处骨盆后环不稳定骨折患者接受了经皮计算机断层扫描（CT）引导下的后路稳定手术。CT能清晰显示骨折情况以及螺钉的方向和长度。这也使术者能够经皮进行手术，且仅造成极少的失血。选择显示螺钉置入最佳且最安全部位的CT断层图像。确定螺钉的长度和方向，并确定皮肤进针点。将导针穿过骨折处或受损的骶髂关节；确认其正确位置后，沿导针置入空心螺钉。大多数患者在CT室中应用了骨盆外固定器。虽然可以评估畸形情况，但复位困难，不过最终还是可以接受的。所有患者骶髂复合体均维持复位，无内固定丢失，所有骨折均愈合，无骨盆不稳定的临床或影像学表现。该技术未导致神经损伤或深部感染。除2例患者外，所有患者均恢复到伤前的活动和功能水平。2例患者伴有其他损伤，影响了最终的功能结局。
