Clinical study of percutaneous double-segment lengthened sacroiliac screws internal fixation via three-dimensional navigation technology in treatment of Denis type Ⅱ and Ⅲ sacral fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Xiaozhen ¹ , MENG Chengfei ¹ , LU Qilin ¹ , ZHU Ling ¹ , XIE Wei ¹ , WANG Guodong ² ,  LIU Ximing ²

1. Department of Orthopaedics, Wuhan Orthopaedic Hospital of Integrated Chinese & Western Medicine (the Affiliated Hospital of Wuhan Sports University), Wuhan Hubei, 430079, P. R. China;
2. Department of Orthopaedics, General Hospital of Central Command of Chinese PLA, Wuhan Hubei, 430070, P. R. China;

Corresponding?author：

LIU Ximing, Email: gklxm@163.com

Keywords：

Sacral fracture; sacroiliac joint; lengthened sacroiliac screw; three-dimensional navigation technology

DOI：

10.7507/1002-1892.202210063

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Objective To investigate the effectiveness of percutaneous double-segment lengthened sacroiliac screws internal fixation assisted by three-dimensional (3D) navigation technology in treatment of Denis type Ⅱ and Ⅲ sacral fractures. Methods A clinical data of 45 patients with the Denis type Ⅱ and Ⅲ sacral fractures admitted between January 2017 and May 2020 was retrospectively analyzed. There were 31 males and 14 females, with an average age of 48.3 years (range, 30-65 years). The pelvic fractures were all high energy injuries. According to the Tile classification standard, there were 24 cases of type C1, 16 cases of type C2, and 5 cases of type C3. The sacral fractures were classified as Denis type Ⅱ in 31 cases and type Ⅲ in 14 cases. The interval between injury and operation was 5-12 days (mean, 7.5 days). The lengthened sacroiliac screws were implanted in S₁ and S₂ segments respectively under the assistance of 3D navigation technology. The implantation time of each screw, the intraoperative X-ray exposure time, and the occurrence of surgical complications were recorded. After operation, the imaging reexamination was used to evaluate the screw position according to Gras standard and the reduction quality of sacral fractures according to Matta standard. At last follow-up, the pelvic function was scored with Majeed scoring standard. Results The 101 lengthened sacroiliac screws were implanted with the assisting of 3D navigation technology. The implantation time of each screw was 37.3 minutes on average (range, 30-45 minutes), and the X-ray exposure time was 46.2 seconds on average (range, 40-55 seconds). All patients had no neurovascular or organ injury. All incisions healed by first intention. The quality of fracture reduction was evaluated according to Matta standard as excellent in 22 cases, good in 18 cases, and fair in 5 cases, and the excellent and good rate was 88.89%. The screw position was evaluated according to Gras standard as excellent in 77 screws, good in 22 screws, and poor in 2 screws, and the excellent and good rate was 98.02%. All patients were followed up 12-24 months (mean, 14.6 months). All fractures healed and the healing time was 12-16 weeks (mean, 13.5 weeks). Pelvic function was evaluated according to Majeed scoring standard as excellent in 27 cases, good in 16 cases, fair in 2 cases, and the excellent and good rate was 95.56%. Conclusion Percutaneous double-segment lengthened sacroiliac screws internal fixation for the treatment of Denis type Ⅱ and Ⅲ sacral fractures is minimally invasive and effective. With the assistance of 3D navigation technology, the screw implantation is accurate and safe.

Citation： WANG Xiaozhen, MENG Chengfei, LU Qilin, ZHU Ling, XIE Wei, WANG Guodong, LIU Ximing. Clinical study of percutaneous double-segment lengthened sacroiliac screws internal fixation via three-dimensional navigation technology in treatment of Denis type Ⅱ and Ⅲ sacral fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(2): 136-141. doi: 10.7507/1002-1892.202210063 Copy

1.	Welle K, Khoury M, Prangenberg C, et al. Minimally invasive lumbopelvic stabilization of sacral fracture and sacroiliac injury. Oper Orthop Traumatol, 2021, 33(6): 538-545.
2.	楊成志, 劉剛, 唐經勵, 等. 天璣骨科機器人輔助經皮骶髂空心螺釘內固定治療骨盆后環損傷合并骶骨變異. 中國修復重建外科雜志, 2022, 36(8): 940-945.
3.	Chen H, Ding C, Liu Y, et al. A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury. J Orthop Surg Res, 2022, 17(1): 285. doi: 10.1186/s13018-022-03133-1.
4.	Acklin YP, Zderic I, Richards RG, et al. Biomechanical investigation of four different fixation techniques in sacrum Denis type Ⅱ fracture with low bone mineral density. J Orthop Res, 2018, 36(6): 1624-1629.
5.	Ma Y, Zhao Y, Zou D, et al. Breakage risk of different sacroiliac screws in unilateral sacral fractures a finite element analysis. BMC Musculoskelet Disord, 2022, 23(1): 953. doi: 10.1186/s12891-022-05898-2.
6.	Brouwers L, Pull Ter Gunne AF, de Jongh MA, et al. What is the value of 3D virtual reality in understanding acetabular fractures? Eur J Orthop Surg Traumatol, 2020, 30(1): 109-116.
7.	Gras F, Marintschev I, Wilharm A, et al. 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries—a case series. BMC Musculoskelet Disord, 2010, 11: 153. doi: 10.1186/1471-2474-11-153.
8.	Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
9.	Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
10.	Decker S, Krettek C, Stübig T. Minimally invasive stabilization of sacral fractures. Unfallchirurg, 2020, 123(10): 774-782.
11.	Boudissa M, Saad M, Kerschbaumer G, et al. Posterior transiliac plating in vertically unstable sacral fracture. Orthop Traumatol Surg Res, 2020, 106(1): 85-88.
12.	Yu T, Cheng XL, Qu Y, et al. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases, 2020, 8(12): 2464-2472.
13.	J?ckle K, Spering C, Seitz MT, et al. Anatomic reduction of the sacroiliac joint in unstable pelvic ring injuries and its correlation with functional outcome. Eur J Trauma Emerg Surg, 2022, 48(2): 1491-1498.
14.	Zhang R, Yin Y, Li S, et al. Sacroiliac screw versus a minimally invasive adjustable plate for Zone Ⅱ sacral fractures: a retrospective study. Injury, 2019, 50(3): 690-696.
15.	Yu T, Zheng S, Zhang X, et al. A novel computer navigation method for accurate percutaneous sacroiliac screw implantation: A technical note and literature review. Medicine (Baltimore), 2019, 98(7): e14548. doi: 10.1097/MD.0000000000014548.
16.	Wu T, Su K, Zhang YZ, et al. Biomechanical comparison of three kinds of fixation in fracture-dislocation of the sacroiliac joint. Technol Health Care, 2019, 27(1): 89-99.
17.	張昌猛, 李皓雲, 朱智, 等. 經皮骶髂螺釘與重建鋼板治療Tile C型骨盆后環骨折效果的Meta分析. 中華創傷骨科雜志, 2017, 19(6): 476-483.
18.	Shannon SF, Oppizzi G, Schloss MG, et al. Do fully threaded transiliac-transsacral screws improve mechanical stability of vertically unstable pelvic fractures? A cadaveric biomechanical analysis. J Orthop Trauma, 2021, 35(1): e18-e24.
19.	Wakayama Y, Higashi T, Kobayashi N, et al. Clinical utility of minimally invasive posterior internal fixation within the pelvic ring using S₂ alar iliac screws for unstable pelvic ring fracture. Injury, 2022, 53(10): 3371-3376.
20.	Hosny H, Mohamed MA, Elsayed M, et al. One sacroiliac screw for posterior ring fixation in unstable pelvic fractures. Acta Orthop Belg, 2021, 87(3): 411-418.
21.	王祎, 張立峰, 王斌, 等. 骶髂關節螺釘新型輔助置釘技術的研究進展. 中華創傷骨科雜志, 2020, 22(6): 507-511.
22.	Zarei M, Moosavi M, Saghebdoust S, et al. Percutaneous iliosacral screw insertion with only outlet and inlet fluoroscopic view for unstable pelvic ring injuries: Clinical and radiological outcomes. Surg Neurol Int, 2022, 13: 455. doi: 10.25259/SNI_616_2022.
23.	鄭益釩, 楊思宇, 汪國棟, 等. 3D導航與C型臂X線機透視下經皮雙節段長骶髂關節螺釘內固定治療骨盆后環損傷的療效比較. 中華創傷骨科雜志, 2021, 23(12): 1037-1043.

1. Welle K, Khoury M, Prangenberg C, et al. Minimally invasive lumbopelvic stabilization of sacral fracture and sacroiliac injury. Oper Orthop Traumatol, 2021, 33(6): 538-545.
2. 楊成志, 劉剛, 唐經勵, 等. 天璣骨科機器人輔助經皮骶髂空心螺釘內固定治療骨盆后環損傷合并骶骨變異. 中國修復重建外科雜志, 2022, 36(8): 940-945.
3. Chen H, Ding C, Liu Y, et al. A clinical and biomechanical comparison of INFIX plus single versus double sacroiliac screw fixation for unstable pelvic ring injury. J Orthop Surg Res, 2022, 17(1): 285. doi: 10.1186/s13018-022-03133-1.
4. Acklin YP, Zderic I, Richards RG, et al. Biomechanical investigation of four different fixation techniques in sacrum Denis type Ⅱ fracture with low bone mineral density. J Orthop Res, 2018, 36(6): 1624-1629.
5. Ma Y, Zhao Y, Zou D, et al. Breakage risk of different sacroiliac screws in unilateral sacral fractures a finite element analysis. BMC Musculoskelet Disord, 2022, 23(1): 953. doi: 10.1186/s12891-022-05898-2.
6. Brouwers L, Pull Ter Gunne AF, de Jongh MA, et al. What is the value of 3D virtual reality in understanding acetabular fractures? Eur J Orthop Surg Traumatol, 2020, 30(1): 109-116.
7. Gras F, Marintschev I, Wilharm A, et al. 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries—a case series. BMC Musculoskelet Disord, 2010, 11: 153. doi: 10.1186/1471-2474-11-153.
8. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
9. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
10. Decker S, Krettek C, Stübig T. Minimally invasive stabilization of sacral fractures. Unfallchirurg, 2020, 123(10): 774-782.
11. Boudissa M, Saad M, Kerschbaumer G, et al. Posterior transiliac plating in vertically unstable sacral fracture. Orthop Traumatol Surg Res, 2020, 106(1): 85-88.
12. Yu T, Cheng XL, Qu Y, et al. Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures. World J Clin Cases, 2020, 8(12): 2464-2472.
13. J?ckle K, Spering C, Seitz MT, et al. Anatomic reduction of the sacroiliac joint in unstable pelvic ring injuries and its correlation with functional outcome. Eur J Trauma Emerg Surg, 2022, 48(2): 1491-1498.
14. Zhang R, Yin Y, Li S, et al. Sacroiliac screw versus a minimally invasive adjustable plate for Zone Ⅱ sacral fractures: a retrospective study. Injury, 2019, 50(3): 690-696.
15. Yu T, Zheng S, Zhang X, et al. A novel computer navigation method for accurate percutaneous sacroiliac screw implantation: A technical note and literature review. Medicine (Baltimore), 2019, 98(7): e14548. doi: 10.1097/MD.0000000000014548.
16. Wu T, Su K, Zhang YZ, et al. Biomechanical comparison of three kinds of fixation in fracture-dislocation of the sacroiliac joint. Technol Health Care, 2019, 27(1): 89-99.
17. 張昌猛, 李皓雲, 朱智, 等. 經皮骶髂螺釘與重建鋼板治療Tile C型骨盆后環骨折效果的Meta分析. 中華創傷骨科雜志, 2017, 19(6): 476-483.
18. Shannon SF, Oppizzi G, Schloss MG, et al. Do fully threaded transiliac-transsacral screws improve mechanical stability of vertically unstable pelvic fractures? A cadaveric biomechanical analysis. J Orthop Trauma, 2021, 35(1): e18-e24.
19. Wakayama Y, Higashi T, Kobayashi N, et al. Clinical utility of minimally invasive posterior internal fixation within the pelvic ring using S₂ alar iliac screws for unstable pelvic ring fracture. Injury, 2022, 53(10): 3371-3376.
20. Hosny H, Mohamed MA, Elsayed M, et al. One sacroiliac screw for posterior ring fixation in unstable pelvic fractures. Acta Orthop Belg, 2021, 87(3): 411-418.
21. 王祎, 張立峰, 王斌, 等. 骶髂關節螺釘新型輔助置釘技術的研究進展. 中華創傷骨科雜志, 2020, 22(6): 507-511.
22. Zarei M, Moosavi M, Saghebdoust S, et al. Percutaneous iliosacral screw insertion with only outlet and inlet fluoroscopic view for unstable pelvic ring injuries: Clinical and radiological outcomes. Surg Neurol Int, 2022, 13: 455. doi: 10.25259/SNI_616_2022.
23. 鄭益釩, 楊思宇, 汪國棟, 等. 3D導航與C型臂X線機透視下經皮雙節段長骶髂關節螺釘內固定治療骨盆后環損傷的療效比較. 中華創傷骨科雜志, 2021, 23(12): 1037-1043.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical study of percutaneous double-segment lengthened sacroiliac screws internal fixation via three-dimensional navigation technology in treatment of Denis type Ⅱ and Ⅲ sacral fractures

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