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 S 1 and S 2 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.
目的: 探讨3D导航技术辅助下经皮双节段加长骶髂螺钉内固定治疗Denis Ⅱ、Ⅲ型骶骨骨折的疗效。.
方法: 回顾性分析2017年1月—2020年5月收治的45例骶骨DenisⅡ、Ⅲ型骨折患者临床资料。男31例，女14例；年龄30～65岁，平均48.3岁。骨盆骨折均为高能量致伤，按照Tile分型标准：C1型24例，C2型16例，C3型5例；骶骨骨折Denis分型：Ⅱ型31例，Ⅲ型14例。患者受伤至手术时间5～12 d，平均7.5 d。 术中在3D导航技术辅助下植入S 1、S 2双节段加长骶髂螺钉。记录每枚螺钉植入时间、术中X线暴露时间以及手术并发症发生情况。术后影像学复查，参照Gras评价标准评定螺钉位置情况，参照Matta评分标准评价骶骨骨折复位质量。末次随访时，采用Majeed评分标准对骨盆功能进行评价。.
结果: 术中共植入加长骶髂螺钉101枚，每枚螺钉植入时间30～45 min，平均37.3 min；术中X线暴露时间40～55 s，平均46.2 s。术中均无神经、血管及脏器损伤发生。术后切口均Ⅰ期愈合。影像学复查示，参照Matta评分标准，骨折复位质量达优22例、良18例、可5例，优良率为88.89%；参照Gras评价标准，螺钉位置达优77枚、良22枚、差2枚，优良率为98.02%。患者术后均获随访，随访时间12～24个月，平均14.6个月。骨折均愈合，愈合时间为12～16周，平均13.5周。末次随访时，根据Majeed评分标准，骨盆功能达优27例、良16例、可2例，优良率95.56%。.
结论: 经皮双节段加长骶髂螺钉内固定治疗骶骨Denis Ⅱ、Ⅲ型骨折微创有效，在3D导航技术辅助下植钉精准、安全。.
Keywords: Sacral fracture; lengthened sacroiliac screw; sacroiliac joint; three-dimensional navigation technology.