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首页> 外文期刊>Revista Brasileira de Ortopedia >CT-guided percutaneous sacroiliac stabilization in unstable pelvic fractures: a safe and accurate technique
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CT-guided percutaneous sacroiliac stabilization in unstable pelvic fractures: a safe and accurate technique

机译：CT引导下不稳定的骨盆骨折的经皮sa sa稳定术：一种安全，准确的技术

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Objective The use of open reduction and internal fixation (ORIF) for unstable pelvic injuries is associated with extensive blood loss, iatrogenic neurovascular injury, and infection. Moreover, the placement of sacroiliac (SI) screws is a blinded procedure, guided primarily by palpation and two-dimensional radiological screening, which demands expertise. The complex three-dimensional anatomy of SI joint and its proximity to neurovascular structure require a safe and precise technique. Computed tomography (CT)-guided SI joint stabilization allows an accurate intra-operative assessment of screw placement. This study demonstrated a technique of CT-guided closed reduction and screw fixation of the SI joint in unstable pelvic fractures. Methods This was a retrospective non-randomized cohort study conducted at a tertiary care hospital. Six patients with unstable pelvic fractures were operated; the anterior rim was stabilized first by ORIF with plate on the superior and anterior aspects of the pubic symphysis. Subsequently, the posterior stabilization was made percutaneously under CT guidance with a 7-mm cannulated cancellous screw. Results The mean operative time was 48min (35–90min), the mean effective radiation dose was 9.32 (4.97–13.27), and the mean follow-up was 26 months (6–72 months). All patients had satisfactory healing, with near-anatomic reduction and no complications, except in one case where the plate broke at 61 months post surgery, but no intervention was required. The mean VAS score at the final follow-up was 1.8, and all patients returned to their original occupation without any limitations. Conclusion CT-guided SI joint stabilization offers many advantages, including safe and accurate screw placement, reduced operating time, decreased blood loss, early definitive fixation, immediate mobilization, and fewer infections and wound complications.
机译：目的使用切开复位内固定术（ORIF）治疗不稳定的骨盆损伤会导致大量失血，医源性神经血管损伤和感染。此外，cro（SI）螺钉的放置是盲法，主要是通过触诊和二维放射学检查来指导，这需要专业知识。 SI关节的复杂三维解剖及其与神经血管结构的接近程度需要安全且精确的技术。计算机断层扫描（CT）引导的SI关节稳定术可在术中准确评估螺钉的位置。这项研究证明了在不稳定的骨盆骨折中，CT引导的SI关节闭合复位和螺钉固定的技术。方法这是在三级医院进行的一项回顾性非随机队列研究。六例不稳定的骨盆骨折患者进行了手术;首先通过ORIF在耻骨联合的上下两侧用钢板固定前缘。随后，在7毫米空心松质螺钉的CT引导下经皮进行后路稳定。结果平均手术时间为48分钟（35–90分钟），平均有效放射剂量为9.32（4.97–13.27），平均随访时间为26个月（6–72个月）。所有患者均获得满意的愈合，几乎解剖复位，无并发症，除了一例术后61个月钢板破裂，但无需干预。最后一次随访的平均VAS评分为1.8，所有患者无任何限制地恢复了原来的职业。结论CT引导的SI关节稳定术具有许多优点，包括安全准确的螺钉放置，减少的手术时间，减少的失血量，早期的固定固定，立即的动员以及更少的感染和伤口并发症。

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