Abstract：
BACKGROUND: The main complication of percutaneous iliosacral screw fixation is implant malposition, which can lead to vascular and nerve damage. The anatomical variability of the sacrum can make screw insertion difficult under fluoroscopic guidance. Among the methods described to improve the accuracy of this technique, stands out the use of computed tomography (CT). The aim of this study is to compare the results of iliosacral screw insertion with fluoroscopy or CT navigation.
METHODS: Retrospective cohort study of 66 iliosacral screws in 56 patients during 11 years. The screws were inserted with fluoroscopy in the operating room or with CT in the radiodiagnosis area. We collected data on patient characteristics, lesions, treatment, and clinical and radiological results.
RESULTS: Forty-seven screws were inserted with fluoroscopy and 19 with CT. A percentage of 18.2 of screws perforated the S1 osseous corridor. All of them were inserted with fluoroscopy guidance (0 vs. 34%; p<0.01). Those operated with CT accumulated more sacral dysmorphism criteria than those operated with fluoroscopy (2.2 vs. 1.6; p=0.02). The S1 corridor on the axial CT view was narrower in those in whom perforation had occurred (18.8 vs. 21.0mm; p=0.02). Two cases with perforation developed S1 radiculalgia. Two endopelvic screws had to be removed.
CONCLUSIONS: We advise the use of CT guidance for iliosacral screw insertion in patients with sacral dysmorphism or narrow S1 corridors in facilities where other navigation methods are not available.
METHODS: Retrospective cohort study of 66 iliosacral screws in 56 patients during 11 years. The screws were inserted with fluoroscopy in the operating room or with CT in the radiodiagnosis area. We collected data on patient characteristics, lesions, treatment, and clinical and radiological results.
RESULTS: Forty-seven screws were inserted with fluoroscopy and 19 with CT. A percentage of 18.2 of screws perforated the S1 osseous corridor. All of them were inserted with fluoroscopy guidance (0 vs. 34%; p<0.01). Those operated with CT accumulated more sacral dysmorphism criteria than those operated with fluoroscopy (2.2 vs. 1.6; p=0.02). The S1 corridor on the axial CT view was narrower in those in whom perforation had occurred (18.8 vs. 21.0mm; p=0.02). Two cases with perforation developed S1 radiculalgia. Two endopelvic screws had to be removed.
CONCLUSIONS: We advise the use of CT guidance for iliosacral screw insertion in patients with sacral dysmorphism or narrow S1 corridors in facilities where other navigation methods are not available.
摘要：
背景：经皮髂骨螺钉内固定的主要并发症是种植体错位，会导致血管和神经损伤.骶骨的解剖变异性会使在透视引导下的螺钉插入困难。在描述的提高该技术准确性的方法中，突出使用计算机断层扫描（CT）。这项研究的目的是比较透视或CT导航的结果。
方法：回顾性队列研究，对56例患者中的66个骶髂螺钉进行了11年的研究。在手术室通过透视检查或在放射诊断区域通过CT插入螺钉。我们收集了病人特征的数据,病变,治疗,以及临床和放射学结果。
结果：透视检查插入47颗螺钉，CT检查插入19颗螺钉。百分比为18.2的螺钉穿透了S1骨走廊。均在透视引导下插入(0vs.34%；p<0.01)。CT手术的患者比透视手术的患者积累了更多的骶骨畸形标准（2.2vs.1.6；p=0.02）。在发生穿孔的患者中，轴向CT视图上的S1走廊较窄（18.8vs.21.0mm;p=0.02)。2例穿孔发展为S1神经根痛。必须移除两个内肾盂螺钉。
结论：我们建议在没有其他导航方法的设施中，对于骶骨畸形或S1走廊狭窄的患者，使用CT引导下插入髂骶骨螺钉。
方法：回顾性队列研究，对56例患者中的66个骶髂螺钉进行了11年的研究。在手术室通过透视检查或在放射诊断区域通过CT插入螺钉。我们收集了病人特征的数据,病变,治疗,以及临床和放射学结果。
结果：透视检查插入47颗螺钉，CT检查插入19颗螺钉。百分比为18.2的螺钉穿透了S1骨走廊。均在透视引导下插入(0vs.34%；p<0.01)。CT手术的患者比透视手术的患者积累了更多的骶骨畸形标准（2.2vs.1.6；p=0.02）。在发生穿孔的患者中，轴向CT视图上的S1走廊较窄（18.8vs.21.0mm;p=0.02)。2例穿孔发展为S1神经根痛。必须移除两个内肾盂螺钉。
结论：我们建议在没有其他导航方法的设施中，对于骶骨畸形或S1走廊狭窄的患者，使用CT引导下插入髂骶骨螺钉。
