[Intraoperative slide rail CT assistance in percutaneous sacroiliac joint screws for the treatment of pelvic posterior ring injury]

OBJECTIVE

To compare the clinical efficacy of intraoperative slide rail CT combined with C-arm X-ray assistance and just C-arm for percutaneous screw in the treatment of pelvic posterior ring injury.

METHODS

A retrospective analysis was performed on the patient data of 76 patients with posterior pelvic ring injury admitted to the Department of Orthopedic Trauma from December 2018 to February 2022. Among them, 39 patients in the CT group were treated with C-arm combined with slide rail CT-assisted inline fixation including 23 males and 16 females with an average age of (44.98±7.33) years old;and the other 37 patients in the C-arm group were treated with intraline fixation treatment under only C-arm fluoroscopy including 24 males and 13 females with an average age of (44.37±10.82) years old. Among them, 42 patients with anterior ring fractures were treated with percutaneous inferior iliac spines with internal fixation (INFIX) or suprapubic support screws to fix the anterior pelvic ring. Postoperative follow-up time, operation time, complications of the two groups were compared. Results of Matta reduction criteria, Majed efficacy evaluation, the CT grading and the rate of secondary surgical revision were compared.

RESULTS

The nailing time of (32.63±7.33) min in CT group was shorter than that of (52.95±10.64) min in C-arm group (t=-9.739, P<0.05). The follow-up time between CT group (11.97±1.86) months and C-arm group (12.03±1.71) months were not statistically significant(P>0.05). The postoperative complication rates between two groups were not statistically significant (χ2=0.159, P>0.05). Results of Matta reduction criteria (Z=2.79, P<0.05), Majeed efficacy evaluation(Z=2.79, P<0.05), CT grading (Z=2.83, P<0.05) in CT group were better than those in C-arm group(P<0.05); the secondary surgical revision rate in the CT group was significantly lower than that in the C-arm group (χ2=5.641, P<0.05).

CONCLUSION

Compared with traditional C-arm fluoroscopy, intraoperative slide rail CT combined with C-arm assisted percutaneous sacroiliac joint screw placement surgery has the characteristics of short operation time, high accuracy and safety, and significant decrease in postoperative secondary revision rate, and is one of the effective methods for re-establishing the stability of the posterior ring of pelvic fracture.

[ISO-C3D NAVIGATION FOR PERCUTANEOUS SACROILIAC JOINT SCREW INTERNAL FIXATION FOR TREATMENT OF PELVIC POSTERIOR RING INJURIES]

OBJECTIVE

To investigate the advantages and effectiveness of ISO-C^3D guided percutaneous sacroiliac joint screw internal fixation for treatment of pelvic posterior ring injuries by comparing with anterior opened reduction and reconstruction plate internal fixation.

METHODS

A retrospective analysis was made on the clinical data of 54 patients with posterior ring injury treated between June 2013 and January 2016. Of 54 patients, 33 underwent ISO-C^3D guided percutaneous sacroiliac joint screws internal fixation (group A), and 21 underwent anterior opened reduction and reconstruction plate internal fixation (group B). There was no significant difference in gender, age, cause of injuries, injury to operation time, fractures type, combined injuries, and injury severity score (ISS) between 2 groups (P>0.05). The operation time, intraoperative blood loss, length of operative incision, hospitalization time, postoperative pain degree, reduction evaluation, and functional evaluation were compared between 2 groups.

RESULTS

Group A was significantly better than group B in operation time, length of operative incision, and hospitalization time (P<0.05). The intraoperative blood loss of group A (10-20 mL) was significantly less than that of group B[(524.1±160.1) mL]. All patients of the 2 groups were followed up 7 to 24 months with an average of 11.6 months. No injury of vessel or nerve occurred in group A; worse neurological symptoms of lower limbs and incision infection were observed in 2 patients of group B respectively, and the other patients achieved primary healing of incision. At 48 hours after operation, the visual analogue scale (VAS) score of group A (1.7±0.7) was significantly lower than that of group B (8.2±0.8) (t=-30.463, P=0.000). Radiological examination showed fracture reduction. According to the Matta score standard, the reduction results were excellent in 21 cases (63.6%), good in 10 cases (30.3%), and fair in 2 cases (6.1%) in group A; the reduction results were excellent in 16 cases (76.2%), good in 4 cases (19.1%), and fair in 1 case (4.7%) in group B; and there was no significant difference between 2 groups (χ²=0.961, P=0.618). Fracture or dislocation healed well in 2 groups, and the walking function was restored. According to the Majeed standard for evaluation, the results were excellent in 23 cases (69.7%), good in 9 cases (27.3%), and fair in 1 case (3.0%) in group A; the results were excellent in 14 cases (66.7%), good in 5 cases (23.8%), and fair in 2 cases (9.5%) in group B; no significant difference was shown between 2 groups (χ²=1.501, P=0.591).

CONCLUSIONS

Compared with anterior opened reduction and reconstruction plate internal fixation, ISO-C^3D navigation percutaneous sacroiliac joint screw internal fixation is an ideal surgical method to treat pelvic posterior ring injury, with the characteristics of less trauma, less pain, precise screw implant and safety.