Correlating preoperative imaging with intraoperative fluoroscopy in iliosacral screw placement

被引：45
作者：
Eastman J.G. [1 ]
Chip Routt M.L. [2 ]
Jr. [2 ]
机构：
[1] Department of Orthopaedic Surgery, University of California, Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, 95817, CA
[2] Department of Orthopaedic Surgery, University of Texas, Health Sciences Center at Houston, Houston, TX
来源：
Journal of Orthopaedics and Traumatology | 2015年 / 16卷 / 4期
关键词：
Iliosacral screw; Preoperative planning;
D O I：
10.1007/s10195-015-0363-x
中图分类号：
学科分类号：
摘要：
Background: Percutaneous iliosacral screw placement can successfully stabilize unstable posterior pelvic ring injuries. Intraoperative fluoroscopic imaging is a vital component needed in safely placing iliosacral screws. Obtaining and appropriately interpreting fluoroscopic views can be challenging in certain clinical scenarios. We report on a series of patients to demonstrate how preoperative computed tomography (CT) imaging can be used to anticipate the appropriate intraoperative inlet and outlet fluoroscopic views. Materials and methods: 24 patients were retrospectively identified with unstable pelvic ring injuries requiring operative fixation using percutaneous iliosacral screws. Utilizing the sagittal reconstructions of the preoperative CT scans, anticipated inlet and outlet angle measurements were calculated. The operative reports were reviewed to determine the angles used intraoperatively. Postoperative CT scans were reviewed for repeat measurements and to determine the location and safety of each screw. Results: Preoperative CT scans showed an average inlet of 20.5° (7°–37°) and an average outlet of 42.8° (30°–59°). Intraoperative views showed an average inlet of 24.9° (12°–38°) and an average outlet of 42.4° (29°–52°). Postoperative CT scans showed an average inlet of 19.4° (8°–31°) and an average outlet of 43.2° (31°–56°). The average difference from preoperative to intraoperative was 4.4° (−21° to 5°) for the inlet and 0.45° (−9° to 7°) for the outlet. The average difference between the preoperative and postoperative CT was 2.04° (0°–6°) for the inlet and 2.54° (0°–7°) for the outlet. Conclusion: There is significant anatomic variation of the posterior pelvic ring. The preoperative CT sagittal reconstruction images allow for appropriate preoperative planning for anticipated intraoperative fluoroscopic inlet and outlet views within 5°. Having knowledge of the desired intraoperative views preoperatively prepares the surgeon, aids in efficiently obtaining correct intraoperative views, and ultimately assists in safe iliosacral screw placement. Level of evidence: IV, Retrospective case series. © 2015, The Author(s).
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页码：309 / 316
页数：7
相关论文
共 29 条
[1]  
Routt M.L., Simonian P.T., Closed reduction and percutaneous skeletal fixation of sacral fractures, Clin Orthop Relat Res, 329, pp. 121-128, (1996)
[2]  
Routt M.L., Kregor P.J., Simonian P.T., Et al., Early results of percutaneous iliosacral screws placed with the patient in the supine position, J Orthop Trauma, 9, 3, pp. 207-214, (1995)
[3]  
Routt M.L., Nork S.E., Mills W.J., Percutaneous fixation of pelvic ring disruptions, Clin Orthop Relat Res, 375, pp. 15-29, (2000)
[4]  
Nork S.E., Jones C.B., Harding S.P., Et al., Percutaneous stabilization of U-shaped sacral fractures using iliosacral screws: technique and early results, J Orthop Trauma, 15, 4, pp. 238-246, (2001)
[5]  
Carlson D.A., Scheid D.K., Maar D.C., Et al., Safe placement of S1 and S2 iliosacral screw: the “vestibule” concept, J Orthop Trauma, 14, (2000)
[6]  
Bishop J.A., Routt M.L.C., Osseous fixation pathways in pelvic and acetabular fracture surgery: osteology, radiology, and clinical applications, J Trauma Acute Care Surg., 72, 6, pp. 1502-1509, (2012)
[7]  
Routt M.L., Simonian P.T., Agnew S.G., Et al., Radiographic recognition of the sacral alar slope for optimal placement of iliosacral screws: a cadaveric and clinical study, J Orthop Trauma, 10, 3, pp. 171-177, (1996)
[8]  
Conflitti J.M., Graves M.L., Chip Routt ML, Jr. Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated iliosacral screw insertions, J Orthop Trauma, 24, 10, pp. 630-636, (2010)
[9]  
Farrell E.D., Gardner M.J., Krieg J.C., Et al., The upper sacral nerve root tunnel: an anatomic and clinical study, J Orthop Trauma, 23, 5, pp. 333-339, (2009)
[10]  
Gardner M.J., Morshed S., Nork S.E., Et al., Quantification of the upper and second sacral segment safe zones in normal and dysmorphic sacra, J Orthop Trauma, 24, 10, pp. 622-629, (2010)
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