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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Surgical Technique of Percutaneous Iliosacral Screw Fixation in S3 Level in Unstable Pelvic Fracture with Closed Degloving Injury and Morrell Lavallee Lesion: Two Case Reports
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Surgical Technique of Percutaneous Iliosacral Screw Fixation in S3 Level in Unstable Pelvic Fracture with Closed Degloving Injury and Morrell Lavallee Lesion: Two Case Reports

机译：S3水平在不稳定的骨盆骨折中经皮骨螺钉固定的外科技术，闭合脱凝损伤和Morrell Lavallee病变：两种情况报告

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Unstable pelvic ring fractures raise treatment challenges in severely injured patients. Beside patient survival, demanding surgical technique also required. Classic technique of internal fixation requires extensive surgical exposure that leads to most complications of the pelvic fractures fixation. Therefore less invasive technique is a reasonable alternative especially in unstable pelvic fracture with soft tissue injury or potential infection. Unfortunately in sacral dysmorphism pelvic injury or in complete vertical sacral fracture, we need S3 level insertion to improve stability of iliosacral (IS) screw in S1 or S2. Purpose of this study was to show feasibility technically inserting IS screw in S3 level. Methods: We reported 2 cases of unstable pelvic injury. First case was an 11 years old boy with Torode and Zieg IV or Marvin Tile C1 pelvic fracture with right sacroiliac joint disruption and soft tissue injuries of skin avulsion on the left hip and Morel-Lavallée lesion on the right hip. He was managed with early anatomic reduction and fixation with percutaneous screws on both pubic rami and IS screw (sacroiliac lag screw type) on S1 and S3. Second case was a 30 years old male with open pelvic fracture Faringer zone III type, Marvin Tile B2 or YoungBurgess LC I and also with vertical sacral fracture Denis zone 1. This polytrauma case had associated injuries includes Morel-Lavallée lesion, intraperitoneal bladder rupture, infected laparotomy wound dehiscence, and immunocompromised. The same minimal invasive management of pelvic fracture was performed in this case by inserting percutaneous screws on pubic rami and IS (sacral screw type) on S1 and S3. Functional outcome was evaluated using Majeed and Hannover pelvic scoring system. Results: All patients survived and considered to have good reduction, with no residual displacement on the sacroiliac joint. The former case, at 21-month follow up, present with excellent outcome (80 out of 80) by Majeed score and very good outcome (4 out of 4) by Hannover score; while the latter case, at 18-month follow up, present with poor outcome (50 out of 100) by Majeed score and fair outcome (2 out of 4) by Hannover score. Conclusion: Percutaneous screw fixation for pelvic ring injury is a less invasive alternative that can be used for early stabilization of unstable anterior and posterior pelvic fractures and provide stable internal fixation. IS screw is feasible to be inserted in S3 level either sacroiliac joint type or sacral screw type.
机译：不稳定的骨盆环骨折在严重受伤的患者中提高治疗挑战。除了患者存活方面，还需要苛刻的手术技术。内固定的经典技术需要广泛的手术暴露，导致骨盆骨折固定的大多数并发症。因此，较少的侵入性技术是合理的替代方案，特别是在不稳定的盆腔骨折，具有软组织损伤或潜在感染。遗憾的是，在骶疑词盆腔损伤或完全垂直的骶骨骨折中，我们需要S3水平插入以提高S1或S2中ILIOSacral（IS）螺钉的稳定性。本研究的目的是在技术上插入的可行性是S3水平的螺钉。方法：我们报告了2例不稳定骨盆损伤。第一次案例是一个11岁的男孩，Torode和Zieg IV或Marvin瓷砖C1盆腔骨折，左臀部左髋关节和羊毛禽的皮肤撕裂软组织损伤，右臀部。他的早期解剖减少和固定在耻骨苎麻上用经皮螺钉固定并在S1和S3上用经皮螺钉进行固定。第二种案例为30岁的男性，开放的盆腔骨折Faringer区III类型，Marvin瓷砖B2或无论是垂直骶骨骨折丹尼斯区1.此Polytrauma案例有伤害包括Morel-Lavallée病灶，腹腔膀胱破裂，受感染的剖腹度伤口裂开，免疫润滑。在这种情况下，通过将经皮螺钉插入耻骨苎麻的经皮螺钉，在S1和S3上插入相同的骨盆骨折的最小侵袭性管理。使用Majeed和Hannover Pelvic评分系统评估功能结果。结果：所有患者均存活并被认为具有良好的减少，对骶髂关节没有残留位移。前案件，在21个月后，在汉诺威评分的主要成绩和非常好的成绩（其中40分中为80人），汉诺威评分虽然后一种情况，在18个月的后续行动中，在汉诺威评分的主要成绩和公平的成绩（其中2分中为5分），呈现出差（50分）。结论：骨盆环损伤的经皮螺钉固定是一种较少的侵入性替代方案，可用于早期稳定不稳定和后骨盆骨折并提供稳定的内固定。是螺杆可行可插入S3水平骶髂关节型或骶螺杆型。

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