目的:螺钉松动是骶髂螺钉固定的常见并发症,随后失去稳定性和裂缝重新移位。本研究旨在探讨骨盆后环损伤骶髂螺钉固定术后螺钉松动的发生率及危险因素。
方法:选取2015年7月至2021年4月我科收治的135例骨盆后环损伤患者进行回顾性分析。使用患者人口统计学和创伤相关和医源性变量的单变量和多变量逻辑回归分析研究了螺钉松动的可能危险因素,包括年龄,性别,身体质量指数,亚洲人骨质疏松自我评估工具(OSTA)指数,损伤机制,Young-Burgess分类,受伤部位,损伤类型,螺钉类型,固定模式,导丝调整的数量,螺钉位置的精度,和骨折复位的质量。
结果:螺钉松动的发生率为15.6%(n=21)。螺钉松动的平均持续时间为术后3.2±1.5个月。单因素分析结果显示,Young-Burgess分类,损伤类型,受伤部位,螺钉类型,固定模式,OSTA指数可能与螺钉松动有关(p<0.05)。根据多元逻辑回归,垂直剪切损伤(几率[OR]9.80,95%置信区间[CI][1.96-73.28],p=0.008),损伤类型(OR0.25,95%CI[0.13-0.79],p=0.027),普通螺钉(OR6.94,95%CI[1.53-31.40],p=0.012),仅在第一骶骨段(S1)水平插入螺钉(OR8.79,95%CI[1.18-65.46],p=0.034),损伤部位位于骶骨内侧孔(OR6.28,95%CI[1.16-34.06],p=0.033),和较低的OSTA指数[OR0.41,95%CI[0.24-0.71],p=0.001]与螺钉松动显著相关。
结论:垂直剪切损伤,骶骨骨折,损伤部位位于骶骨内侧孔,较低的OSTA指数与术后螺钉松动的发生显著相关。在S1和第二骶骨段的水平处进行经骨-骶骨螺钉固定和螺钉插入可以防止螺钉松动。
OBJECTIVE: Screw loosening is a common complication of iliosacral screw fixation, with subsequent loss of stability and fracture re-displacement. This study aimed to investigate the incidence of and risk factors for screw loosening after iliosacral screw fixation for posterior
pelvic ring injury.
METHODS: A total of 135 patients with posterior
pelvic ring injuries who were treated with iliosacral screw fixation in our department between July 2015 and April 2021 were selected for this retrospective analysis. The possible risk factors for screw loosening were investigated using univariate and multivariate logistic regression analyses of patient demographics and trauma-related and iatrogenic variables, including age, sex, body mass index, Osteoporosis Self-Assessment Tool for Asians (OSTA) index, mechanism of injury, Young-Burgess classification, site of injury, type of injury, type of screw, mode of fixation, numbers of guidewire adjustments, accuracy of screw position, and quality of fracture reduction.
RESULTS: The incidence of screw loosening was 15.6% (n = 21). The mean duration for screw loosening was 3.2 ± 1.5 months after operation. Univariate analysis results showed that the Young-Burgess classification, type of injury, site of injury, type of screw, mode of fixation, and OSTA index might be related to screw loosening (p < 0.05). According to the multivariate logistic regression, vertical shear injuries (Odds ratios [OR] 9.80, 95% Confidence intervals [CI] [1.96-73.28], p = 0.008), type of injury (OR 0.25, 95% CI [0.13-0.79], p = 0.027), common screws (OR 6.94, 95% CI [1.53-31.40], p = 0.012), screws insertion only at the level of the first sacral segment (S1) (OR 8.79, 95% CI [1.18-65.46], p = 0.034), injury site located in the medial sacral foramina (OR 6.28, 95% CI [1.16-34.06], p = 0.033), and lower OSTA index [OR 0.41, 95% CI [0.24-0.71], p = 0.001] were significantly related to screw loosening.
CONCLUSIONS: Vertical shear injuries, sacral fractures, injury site located in the medial sacral foramina, and lower OSTA index are significantly associated with the postoperative occurrence of screw loosening. Transiliac-transsacral screw fixation and screws insertion both at the level of the S1 and second sacral segment can prevent screw loosening.