| Purpose:Percutaneous iliosacral screws for posterior pelvic ring instability injuries are an important technique.Although the traditional placement of screws under X-ray fluoroscopy has the advantages of less bleeding and less trauma,it still has disadvantages such as more radiation exposure and screw misalignment.The purpose of this study was to use simulated screws based on preoperative CT(computed tomography)data to guide the safe,effective,and rapid intraoperative placement of iliosacral screws for unstable posterior pelvic ring injuries.Methods:We retrospectively analyzed 41 pelvic patients with posterior pelvic ring instability injury treated with percutaneous iliosacral screws at our hospital from June2019 to June 2021 and randomly divided into conventional surgery group(n=20)and preoperative planning group(n=21).Postoperative antero-posterior,inlet,and outlet pelvic views and CT scan of the pelvis were routinely taken to verify the position of the screws.Patients’ gender,age,fracture classification,mechanism of injury,time to placement of each screw,time to radiographic exposure of each screw placement,screw dislocation rate(determined by postoperative X-ray and CT),and postoperative follow-up time were recorded.Matta score was used to assess the quality of fracture replacement,Majeed score was used to assess the postoperative function of patients,and the grading of screw position was based on Smith’s criterion.Results:All the patients were followed up,and there was no statistically significant difference in the general data of gender,age,cause of injury,and fracture classification between the conventional surgery group and the preoperative planning group(P>0.05).A total of 26 screws were placed in 20 patients in the conventional surgery group,with 23.15±4.19 min per screw placement time and 1.02±0.17 min per screw placement radiation exposure time,and screw position: 6 screws out of 26 screws were misplaced(23.1%).A total of 24 screws were placed in 21 patients in the preoperative planning group,with 19.57±4.05 min per screw placement time,0.67±0.09 min per screw placement radiation exposure time,and screw position: 1screw misposition out of 24 screws(4.2%).The use of preoperative planning-assisted placement of iliosacral screws significantly reduced screw placement time,screw placement radiation exposure time,and screw misplacement rate(P<0.05).Follow-up was 12-24 months with a average of 16.4 months for the conventional surgery group and 12-24 months with a average of 15.5 months for the preoperative planning group.At the final follow-up,the quality of fracture replacement was assessed according to the Matta score.In the traditional surgery group: 14 cases were excellent,3 cases were good,2 cases were acceptable,and 1 case was poor,with an excellent rate of85.0%;in the preoperative planning group: 16 cases were excellent,2 cases were good,2 cases were acceptable,and 1 case was poor,with an excellent rate of 85.7%.The functional rehabilitation was assessed according to the Majeed score.In the conventional surgery group: excellent 13 cases,good 4 cases,acceptable 2 cases,poor1 case,with an excellent rate of 85.0%;in the preoperative planning group: excellent14 cases,good 5 cases,acceptable 1 case,poor 1 case,with an excellent rate of 90.5%.The differences in postoperative follow-up time,Matta score,and Majeed score between the two groups were not statistically significant(P>0.05).Conclusions:Preoperative CT simulation of iliosacral screw trajectory to guide intraoperative screw placement can significantly reduce operative time,decrease radiation exposure time,and improve the accuracy of screw placement,providing a new method for safe,precise,and rapid placement of iliosacral screws. |
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