ABSTRACT
Objective To investigate the therapeutic effects of navigation-guided hollow screw fixation on the treatment of elderly patients with the sacroiliac complex injury.Methods Twentyone older patients with sacroiliac complex injury received the three-dimensional images-guided percutaneous hollow screw fixation from March 2015 to May 2016.There were 14 males and 7 females with age of 60-73 years[average(63.5 ± 3.7) years].Traffic accident injury was found in 15 cases,falling injury in 5 cases,others in one case.The pelvic fractures were classified by tile classification:type B2 in 2 cases,type B3 in 6 cases,type C1 in 5 cases,type C2 in 6 cases,type C3 in 2 cases.Intraoperative observation data,the injury of nerve and blood vessel during the screw insertion,postoperative fracture reposition and so on were recorded.The quality of fracture reposition was evaluated by Matta radiological criteria after surgery,and the pelvic function was assessed by Majeed scoring criteria at the last follow-up.Results A total of 30 hollow screws in 21 elderly patients were placed under three-dimensional images navigation,and each screw fixation time was 36-45 min,average (40.5±4.7)min with a small amount of bleeding (10-20)ml.Postoperative examinations showed that S1 vertebral cortical bone screw wear was found in one patient,and the end of the bolt washer was internalized into the outer table of the ilium without breaking the medial iliac plate in another patient.The above two patients had no postoperative complications.Other screws positions were good,without nerve or vascular injury and other complications.Postoperative reposition quality evaluated by the Matta radiological criteria showed that 14 cases had excellent quality,five with good quality,two with fair quality,and no case with poor quality.Therefore,the excellent and good rates were 90.5 ％.Moreover,19 elderly patients were followed up for 7-13 months average(10.3± 2.1)months,and only one patient showed the bilateral sacroiliac joint screws outside the lateral sacroiliac joint 5 mm.However,this patient had good function in the later follow-up without further prolapse.The remaining 18 patients assessed by the pelvic X-ray and CT at the end of the follow-up showed a good fracture healing,no screw breakage,loosening,and prolapse.Meanwhile,pelvic function findings evaluated by the Majeed standard demonstrated that nine cases were with excellent function,ten with good function,and the excellent and good rates were 90.5％.Conclusions Three-dimensional images-guided hollow screw fixation for the treatment of elderly patients with the sacroiliac complex injury is safe and effective with less trauma and high nailing accurateness.However,the placing process should be cautious in the elderly with osteoporosis.
ABSTRACT
With ever-increasing knowledge of biomechanics and anatomy of pelvis,more and more findings have been made on the integrated sacroiliac joint system.The sacroiliac complex plays a very important role i n the functions of pelvis due to its specia l biomechanical features.The sacro iliac screw internal fixation is bio mechanically superior to other fixation methods.[