Percutaneous iliosacral screw versus percutaneous reconstruction plate fixation for Tile C sacral fractures

doi:10.3969/j.issn.2095-4344.2014.31.014

Abstract

Abstract:

BACKGROUND: Percutaneous iliosacral screw internal fixation and percutaneous reconstruction plate internal fixation are two kinds of popular minimally invasive surgical methods in recent years. However, due to lack of the support of related evidence-based medicine, it is controversial to choose which kind of surgical methods in the clinic.
OBJECTIVE: To compare the difference for treating Tile C sacral fractures between percutaneous iliosacral screw and percutaneous reconstruction plate.
METHODS: Clinical data of 63 cases of unilateral Tile C sacral fractures were retrospectively analyzed, including 26 cases of percutaneous iliosacral screw internal fixation and 37 cases of percutaneous reconstruction plate internal fixation. The data of operation time, intraoperative bleeding loss, length of incision, X-ray exposure frequency and fracture healing time were compared between both groups. The clinical efficacy was evaluated based on Matta standards and Majeed standards.
RESULTS AND CONCLUSION: All 63 patients were followed up for 12-36 months. No significant difference in union of fracture was detected between both groups. Intraoperative bleeding loss, length of incision, and clinical therapeutic outcomes were better in the percutaneous iliosacral screw internal fixation group than in the percutaneous reconstruction plate internal fixation group. However, percutaneous iliosacral screw internal fixation has greater surgical risk, asks for higher technology compared with percutaneous reconstruction plate internal fixation, and percutaneous iliosacral screw internal fixation suits experienced treatment team. The clinical
therapeutic effects were poorer in percutaneous reconstruction plate internal fixation group than in percutaneous iliosacral screw internal fixation group, but percutaneous reconstruction plate internal fixation has shorter operative time, less X-ray exposure frequency, easier operation, and more convenient to be spread in primary hospitals.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: sacrum, fractures, bone, fracture fixation, surgical procedures, minimally invasive, internal fixators, comparative study

CLC Number:

R318

Yin Shi-yuan, Luo Xue-feng, Shen Ming-quan, Xie Zeng-ru. Percutaneous iliosacral screw versus percutaneous reconstruction plate fixation for Tile C sacral fractures[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(31): 4998-5003.

Figures/Tables 2

2.1 参与者数量分析按意向性处理，纳入63例单侧TileC型骶骨骨折患者，经皮骶髂螺钉组26例，经皮重建钢板组37例，均获得完整随访，无脱落。 2.2 基线资料比较两组患者在性别构成、年龄、体质量指数及ASA分级等方面的差异无显著性意义(P > 0.05)，具有可比性，见表1。 2.3 围手术期数据比较骶髂螺钉组与重建钢板组在手术时间、术中出血量、X射线暴露次数和切口总长度的比较中，差异均有显著性意义(P < 0.001)。骶髂螺钉组手术时间长、X射线暴露次数多，但术中出血量少，切口总长度短(表2)。 2.4 随访骨折愈合及并发症情况两组患者均获得12-36个月随访。骶髂螺钉组平均骨折愈合时间为(14.85±1.74)周，重建钢板组平均骨折愈合时间为(14.11±1.94)个月，组间比较差异无显著性意义(t=1.551，P=0.126)。所有患者均未出现切口感染、内固定物松动、医源性神经损伤等并发症，原存在神经损伤症状的患者未见加重，随访中均有不同程度的恢复。3例患者骶骨残存纵向移位(经皮重建钢板组)，13例患者术后1年骶骨骨折处仍有不同程度的慢性疼痛(经皮骶髂螺钉组4例，经皮重建钢板组9例)。 2.5 Matta标准和Majeed标准评价结果末次随访依据Matta标准，经皮骶髂螺钉组优良率达100%，经皮重建钢板组优良率达95%，且差异有显著性意义(u=3.307，P < 0.001)；依据Majeed标准，经皮骶髂螺钉组优良率达92%，经皮重建钢板组优良率达89%，差异同样有显著性意义(u=3.373，P < 0.001，表3)。 2.6 典型病例病例1：男，35岁，车祸致左侧骶骨DenisⅠ型骨折，合并左侧耻骨上下支及右侧髋臼骨折，体质量指数27.6 kg/m2，ASA分级Ⅲ级，入院后第7天在全身静脉麻醉下先切开复位重建钢板内固定骨盆前环骨折，再经皮置入骶髂螺钉内固定骶骨骨折。术后随访24个月，骨折愈合时间为14周，未出现明显并发症， Matta标准为优，Majeed标准为89分(图1)。病例2：女，27岁，车祸致左侧骶骨Denis Ⅱ型骨折，合并右侧耻骨上下支骨折，体质量指数25.1 kg/m2，ASA分级Ⅱ级，入院后6 d在全身静脉麻醉下先切开复位重建钢板内固定骨盆前环骨折，再经皮置入重建钢板内固定骶骨骨折。术后随访15个月，骨折愈合时间为15周，腰骶部久坐后常有隐痛，休息后缓解，无其他并发症，Matta标准为优，Majeed标准为86分(图2)。"

References

[1] Roy-Camille R, Saillant G, Gagna G, et al. Transverse fracture of the upper sacrum. Suicidal jumper's fracture. Spine(Phila Pa 1976). 1985;10(9):838-845.
[2] 蔡军辉,王伟良,张力成.骶骨纵形骨折的治疗进展[J].中华创伤骨科杂志,2011,13(9):881-884.
[3] Mehta S, Auerbach JD, Born CT, et al. Sacral fractures. J Am Acad Orthop Surg. 2006;14(12):656-665.
[4] 陈爱民,李永川, 赵良瑜,等.骨盆后环不稳定伴骶丛损伤的诊断和治疗[J].中华骨科杂志,2012,28(6):516-519.
[5] 贾健,胡永成,张铁良,等. 骶骨骨折的诊治现状[J].中华骨科杂志, 2009,29(12):1168-1176.
[6] 陈明,谢鸣,勘武生,等. 不稳定型骨盆骨折的手术方式探讨[J]. 中华创伤骨科杂志,2013,15(5):445-447.
[7] 蔡军辉,王伟良,张力成.骶骨纵形骨折的治疗进展[J].中华创伤骨科杂志,2011,13(9):881-884.
[8] Schildhauer TA, Chapman JR, Mayo KA.Multisegmental open sacral fracture due to impalement: a case report. Orthop Trauma. 2005;19(2):134-139.
[9] Denis F, Davis S, Comfort T. Sacral fractures:an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;(227):67-81.
[10] Schmidek HH,Smith DA,Kristiansen TK. Sacral fractures. Neurosurgery. 1984;15(5):735-746.
[11] 王雷,柳超,田纪伟.腰骨盆重建术治疗不稳定骶骨骨折[J].中华创伤杂志,2013,29(7):619-623.
[12] 胡旭栋,向宁,王光林,等.三角固定技术治疗Tile C型骨盆骨折[J]. 中华创伤骨科杂志,2012,14(5):399-404.
[13] 王奇,黄其杉,王向阳,等.骶骨后路钉板固定的解剖学研究[J].中华骨科杂志,2010,30(3):277-281.
[14] Tonetti J. Management of recent unstable fractures of the pelvic ring. An update Conference supported by the Club Bassin Cotyle. (Pelvis-Acetabulum Club). Orthop Traumatol Surg Res. 2013;99(1):S77-86.
[15] Park YS, Baek SW, Kim HS, et al. Management of sacral fractures associated with spinal or pelvic ring injury. J Trauma Acute Care Surg. 2012;73(1): 239-242.
[16] 赵艳.螺钉与钢板在骨盆骨折置入内固定应用中的生物力学评价[J].中国组织工程研究与临床康复,2011,15(48):9070-9073.
[17] 肖丹,柯雨洪,王义生.经皮骶髂关节空心螺钉置入联合骨盆外固定架治疗C型骨盆骨折48例:回顾性病例对照[J].中国组织工程研究与临床康复,2009,13(43):8560-8563.
[18] Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res. 1996;(329):129-140.
[19] Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg. 1989;71(2):304-306.
[20] Tan GQ, He JL, Fu BS, et al. Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability. Injury. 2012;43(8):1318-1325.
[21] Dudda M,Hoffmann M,Schildhauer TA. Sacrum fractures and lumbopelvic instabilities in pelvic ring injuries:Classification and biomechanical aspects. Unfallchirurg. 2013;116(11):972-978.
[22] Hoskins J, Lewis PB., Smith S, et al. Diagnosis and Management of Sacral Fractures. Contemp Spine Surg. 2011; 12(9): 1-8.
[23] Ge Z, Wang B, Zhang D, et al. Effect of iliolumbar fixation in patients with Tile C pelvic injury and analysis of relative factors. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012; 26(11):1285-1290.
[24] Mendel T,Noser H,Kuervers J,et al. The influence of sacral morphology on the existence of secure S1 and S2 transverse bone corridors for iliosacroiliac screw fixation. Injury. 2013; 44(12):1773-1779.
[25] Miller AN, Routt ML.Variations in Sacral Morphology and Implications for Iliosacral Screw Fixation. J Am Acad Orthop Surg. 2012;20(1):8-16.
[26] Osterhoff G,Ossendorf C,Wanner GA,et al. Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications. Arch Orthop Trauma Surg. 2011;131(6):809-813.
[27] Reilly MC,Bono CM,Litkouhi B,et al．The effect of sacral fracture malreduction on the safe placement of iliosacral screws.Orthop Trauma. 2003;17(2):88-94.
[28] Bodzay T,Szita J,Mano S,et al. Biomechanical comparison of two stabilization techniques for unstable sacral fractures. J Orthop Sci.2012;17(5):574-579.
[29] Padalkar P,Pereira BP,Kathare A,et al. Trans-iliosacral plating for vertically unstable fractures of sacral spine associated with spinopelvic dissociation: A cadaveric study. Indian J Orthop. 2012;46(3):274-278.
[30] Suzuki T,Hak DJ,Ziran BH,et al. Outcome and complications of posterior transiliac plating for vertically unstable sacral fractures. Injury. 2009;40(4):405-409.
[31] König MA, Seidel U, Heini P,et al. Minimal-invasive Percutaneous Reduction and Transsacral Screw Fixation for U-shaped Fractures. J Spinal Disord Tech. 2013;26(1):48-54.
[32] Koenig MA,Jehan S,Boszczyk AA,et al. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. Eur Spine J. 2012;21(5):829-836.
[33] König MA, Seidel U, Heini P, et al. Minimal-invasive Percutaneous Reduction and Transsacral Screw Fixation for U-shaped Fractures. J Spinal Disord Tech. 2013;26(1):48-54.
[34] 王国栋,周东生.骶骨多平面骨折的治疗现状[J].中华创伤骨科杂志,2012,14(7):621-623.
[35] Matta JM, Yerasimides JG. Table-skeletal fixation as an adjunct to pelvic ring reduction.Orthop Trauma. 2007; 21(9): 647-656.
[36] Ruatti S,Kerschbaumer G,Gay E,et al. Technique for reduction and percutaneous fixation of U- and H-shaped sacral fractures. Orthop Traumatol Surg Res.2013;99(5): 625-629.
[37] Schweitzer D,Zylberberg A,Cordova M,et al. Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures. Injury. 2008;39(8):869-874.
[38] Chen HW,Liu GD,Ou S,et al. Treatment of unstable sacral fractures with percutaneous reconstruction plate internal fixation. Acta Cir Bras. 2012;27(5):338-342.
[39] Coste C,Asloum Y,Marcheix PS,et al. Percutaneous iliosacral screw fixation in unstable pelvic ring lesions: The interest of O-ARM CT-guided navigation. Orthop Traumatol Surg Res. 2013;99(4):S273-278.