Abstract：
METHODS: Retrospective Cohort Study.
OBJECTIVE: To compare the outcomes and complications of transiliac-transsacral screw fixation (TIS) and lumbopelvic fixation (LPS), the 2 most common fixation methods for nondisplaced and minimally displaced H-/U- type sacral fragility fractures.
METHODS: Medical records of patients treated with TIS or LPS for nondisplaced and minimally displaced H-/U-type sacral fragility fractures at 2 level A trauma centers between 2012 and 2022 were analyzed. Postoperative low back pain and mobility levels were assessed as primary outcomes before discharge and at 6 weeks and 6 months postoperatively. Surgery time, blood loss, and surgical complication rates were assessed as secondary outcomes. Statistical analyses consisted of Fisher\'s exact tests for frequency distributions and Mann-Whitney-U tests and t-tests for group comparisons.
RESULTS: 52 patients undergoing TIS (mean age: 78 ± 9 years) and 36 patients undergoing LPS (74 ± 10 years) with no discrepancy in demographic parameters were identified. There were no differences in low back pain levels between the 2 groups before surgery, before discharge, at 6 weeks postoperatively, and at 6 months postoperatively (P > 0.05). There were no differences in mobility levels before surgery, before discharge, at 6 weeks postoperatively, and at 6 months postoperatively (P > 0.05). Duration of surgery was shorter after TIS (36 ± 13 min) compared to LPS (113 ± 31 min) (P < 0.0001). Intraoperative blood loss was lower for TIS (median <20 mL) compared to LPS (median 125 mL) (P < 0.0001). Postoperative radiculopathy was less frequent after TIS (n = 1) compared to LPS (n = 3) (P > 0.05). Median length of stay was shorter after TIS (11 days) compared to LPS (14 days) (P < 0.05). Rates of reoperations directly related to the index surgery were lower after TIS (n = 2) compared to LPS (n = 10) (P < 0.01). Implant failures were observed only after LPS (n = 1).
CONCLUSIONS: Patients with nondisplaced and minimally displaced H-/U- type sacral fragility fractures may preferably be treated using TIS, as it is equivalent to LPS in terms of low back pain reduction and restoration of mobility, but allows for shorter operative time, less blood loss and lower reoperation rates. Prospective randomized studies should be conducted to substantiate our findings and develop distinct treatment recommendations.
OBJECTIVE: To compare the outcomes and complications of transiliac-transsacral screw fixation (TIS) and lumbopelvic fixation (LPS), the 2 most common fixation methods for nondisplaced and minimally displaced H-/U- type sacral fragility fractures.
METHODS: Medical records of patients treated with TIS or LPS for nondisplaced and minimally displaced H-/U-type sacral fragility fractures at 2 level A trauma centers between 2012 and 2022 were analyzed. Postoperative low back pain and mobility levels were assessed as primary outcomes before discharge and at 6 weeks and 6 months postoperatively. Surgery time, blood loss, and surgical complication rates were assessed as secondary outcomes. Statistical analyses consisted of Fisher\'s exact tests for frequency distributions and Mann-Whitney-U tests and t-tests for group comparisons.
RESULTS: 52 patients undergoing TIS (mean age: 78 ± 9 years) and 36 patients undergoing LPS (74 ± 10 years) with no discrepancy in demographic parameters were identified. There were no differences in low back pain levels between the 2 groups before surgery, before discharge, at 6 weeks postoperatively, and at 6 months postoperatively (P > 0.05). There were no differences in mobility levels before surgery, before discharge, at 6 weeks postoperatively, and at 6 months postoperatively (P > 0.05). Duration of surgery was shorter after TIS (36 ± 13 min) compared to LPS (113 ± 31 min) (P < 0.0001). Intraoperative blood loss was lower for TIS (median <20 mL) compared to LPS (median 125 mL) (P < 0.0001). Postoperative radiculopathy was less frequent after TIS (n = 1) compared to LPS (n = 3) (P > 0.05). Median length of stay was shorter after TIS (11 days) compared to LPS (14 days) (P < 0.05). Rates of reoperations directly related to the index surgery were lower after TIS (n = 2) compared to LPS (n = 10) (P < 0.01). Implant failures were observed only after LPS (n = 1).
CONCLUSIONS: Patients with nondisplaced and minimally displaced H-/U- type sacral fragility fractures may preferably be treated using TIS, as it is equivalent to LPS in terms of low back pain reduction and restoration of mobility, but allows for shorter operative time, less blood loss and lower reoperation rates. Prospective randomized studies should be conducted to substantiate our findings and develop distinct treatment recommendations.
摘要：
方法：回顾性队列研究。
目的：比较椎弓根螺钉内固定（TIS）和腰骨盆内固定（LPS）的疗效和并发症。非移位和最小移位H-/U型骶骨脆性骨折的2种最常见的固定方法。
方法：分析2012年至2022年在2个A级创伤中心接受TIS或LPS治疗的无移位和最小移位H-/U型骶骨脆性骨折患者的病历。在出院前以及术后6周和6个月评估术后下腰痛和活动水平作为主要结果。手术时间,失血,和手术并发症发生率被评估为次要结局.统计分析包括Fisher对频率分布的精确检验，Mann-Whitney-U检验和t检验用于组比较。
结果：52例接受TIS的患者（平均年龄：78±9岁）和36例接受LPS的患者（74±10岁），人口统计学参数无差异。两组患者术前腰背痛水平无差异，出院前,术后6周，术后6个月（P>0.05）。手术前的活动水平没有差异，出院前,术后6周，术后6个月（P>0.05）。与LPS（113±31分钟）相比，TIS后的手术时间（36±13分钟）更短（P<0.0001）。与LPS（中位数125mL）相比，TIS（中位数<20mL）的术中失血量更低（P<0.0001）。与LPS（n=3）相比，TIS（n=1）术后神经根病的发生率较低（P>0.05）。与LPS（14天）相比，TIS（11天）后的中位住院时间更短（P<0.05）。与LPS（n=10）相比，TIS（n=2）后与索引手术直接相关的再手术率更低（P<0.01）。仅在LPS后观察到植入物失败(n=1)。
结论：无移位和最小移位的H-/U-型骶骨脆性骨折患者可优选使用TIS治疗，因为它在减少腰痛和恢复活动方面相当于LPS，但允许更短的手术时间，失血少，再手术率低。应进行前瞻性随机研究以证实我们的发现并制定不同的治疗建议。
目的：比较椎弓根螺钉内固定（TIS）和腰骨盆内固定（LPS）的疗效和并发症。非移位和最小移位H-/U型骶骨脆性骨折的2种最常见的固定方法。
方法：分析2012年至2022年在2个A级创伤中心接受TIS或LPS治疗的无移位和最小移位H-/U型骶骨脆性骨折患者的病历。在出院前以及术后6周和6个月评估术后下腰痛和活动水平作为主要结果。手术时间,失血,和手术并发症发生率被评估为次要结局.统计分析包括Fisher对频率分布的精确检验，Mann-Whitney-U检验和t检验用于组比较。
结果：52例接受TIS的患者（平均年龄：78±9岁）和36例接受LPS的患者（74±10岁），人口统计学参数无差异。两组患者术前腰背痛水平无差异，出院前,术后6周，术后6个月（P>0.05）。手术前的活动水平没有差异，出院前,术后6周，术后6个月（P>0.05）。与LPS（113±31分钟）相比，TIS后的手术时间（36±13分钟）更短（P<0.0001）。与LPS（中位数125mL）相比，TIS（中位数<20mL）的术中失血量更低（P<0.0001）。与LPS（n=3）相比，TIS（n=1）术后神经根病的发生率较低（P>0.05）。与LPS（14天）相比，TIS（11天）后的中位住院时间更短（P<0.05）。与LPS（n=10）相比，TIS（n=2）后与索引手术直接相关的再手术率更低（P<0.01）。仅在LPS后观察到植入物失败(n=1)。
结论：无移位和最小移位的H-/U-型骶骨脆性骨折患者可优选使用TIS治疗，因为它在减少腰痛和恢复活动方面相当于LPS，但允许更短的手术时间，失血少，再手术率低。应进行前瞻性随机研究以证实我们的发现并制定不同的治疗建议。
