Simple mathematical model of sacroiliac screws safe-zoneEasy to implement by pelvic inlet and outlet views

被引:14
作者
Herman, Amir [1 ,2 ,3 ]
Keener, Emily [4 ]
Dubose, Candice [5 ]
Lowe, Jason A. [5 ]
机构
[1] Chaim Sheba Med Ctr, Tel Hashomer, Israel
[2] Tel Aviv Univ, Fac Med, Tel Aviv, Israel
[3] Sheba Med Ctr, Talpiot Med Leadership Program, Ramat Gan, Israel
[4] Hughston Clin, Orange Pk, FL USA
[5] Univ Arizona Phoenix, Ctr Orthopaed Res & Educ, Phoenix, AZ USA
关键词
closed reduction; internal fixation; pelvic fractures; INTERNAL-FIXATION; ILIOSACRAL SCREWS; FRACTURES; EPIDEMIOLOGY; PLACEMENT; INSERTION;
D O I
10.1002/jor.23396
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Percutaneous sacral screw fixation is the mainstay of posterior pelvic ring fixation. This study quantifies the accuracy of fluoroscopic screw placement using post-operative CT scans and redefines the fluoroscopic safe zone using a mathematical calculation obtained from Inlet and outlet images. The authors hypothesized that a mathematical calculation of screw placement within the ala will improve accuracy of screw placement. A retrospective review of consecutive patients admitted to a level 1 trauma center with pelvic fractures fixed with iliosacral screws from January 2011 to December 2014 was performed. Accuracy of screw placement was determined by comparing fluoroscopy to post-operative CT scans. A mathematical calculation of screw position within the sacral ala was applied to determine assess screw position and compared to CT findings. Ninety-four patients with 156 screws met inclusion criteria, of which 50 (32.0%) had a cortical breech on CT. The sensitivity and specificity of the inlet-outlet safe zone using mathematical calculation were 97.1% and 84.0%, respectively. The positive and negative predictive values were 92.7% and 93.3%, respectively. Overall accuracies of the radiographic inlet-outlet and lateral safe zones were 92.9% and 70.0%, respectively (p-value=0.004). Sacral dysmorphism was not found to be associated with sacral cortical breech. A Simple mathematical calculation (screw position relative to percentage of bone width) on the inlet-outlet provides an accurate way to predict the accuracy of sacroiliac screws. The method is easy to implement, part of the surgery work-flow, and provides higher accuracy than relying on subjective interpretation of inlet, outlet, and lateral images. (c) 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1478-1484, 2017.
引用
收藏
页码:1478 / 1484
页数:7
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