Intraoperative CT-assisted sacroiliac screws fixation for the treatment of posterior pelvic ring injury: a comparative study with conventional intraoperative imaging

Abstract

Pelvic injuries refer to the disruption of the inherent structural and mechanical integrity of the pelvic ring. Sacroiliac screw fixation technique is often applied for the treatment of posterior pelvic ring injury, which is prone to the iatrogenic injury. This study will compare the intraoperative and postoperative variables of patients underwent sacroiliac screw fixation with intraoperative CT and conventional imaging to evaluate the effect. Thirty-two patients with posterior pelvic ring injury treated by sacroiliac screw fixation from January 2019 to December 2020 were enrolled in this retrospective study. All patients were divided into two groups according to the different assistance of intraoperative imaging. Subsequently, the correlative data were compared and analysed statistically. Twelves cases were assigned to intraoperative CT group, and the remaining twenty cases were assigned to conventional group. There was no significant difference in duration of surgery, fracture healing time, time to ambulation, complications, and Matta radiological score. There was statistically significant difference (p < 0.05) in sacroiliac screws insertion time, length of incision, intraoperative blood loss, quality of screws position, and adjusted Majeed functional score, especially in the sexual intercourse part. With the assistance of intraoperative CT, a less misposition and functional impairment could be achieved, and a more satisfactory curative effect could be developed. Sacroiliac screws fixation with intraoperative CT is a more accurate and ideal method to treat posterior pelvic ring injuries.

Minimally Invasive 360° Fusion Using a Combination of INFIX and Minimally Invasive Spinopelvic Fixation by Intraoperative Computed Tomography Navigation for Unstable Pelvic Ring Fracture: A Technical Note

“…The radiation dosage for intraoperative CT is typically much higher than conventional fluoroscopy. 29 However, the previous paper demonstrated that total radiation exposure for intraoperative CT‐assisted posterior spinal fusion throughout treatment is not significantly different from fluoroscopy. 30 This may be related to the times of intraoperative fluoroscopy, duration of use, and the rate of pre‐and postoperative CT scans.…”

“…Another issue that deserves more attention is radiation dosage. The radiation dosage for intraoperative CT is typically much higher than conventional fluoroscopy 29 . However, the previous paper demonstrated that total radiation exposure for intraoperative CT‐assisted posterior spinal fusion throughout treatment is not significantly different from fluoroscopy 30 .…”

Incidence of Suboptimal Fluoroscopic Outlet Imaging of the Sacrum and Pelvic Retroversion Necessary for Optimal Views

“…Technical advances including CT guidance, navigation, multidimensional fluoroscopy, and biplanar fluoroscopy have all applied to this procedure. [22][23][24][25][26] However, the superiority of advanced imaging techniques over simple fluoroscopy with regard to the risks of neurovascular injury and implant malposition has not been clearly established. [22][23][24][25]27 The majority of pelvic fracture surgeons continue to use simple fluoroscopy, the most affordable and available imaging modality, for percutaneous pelvis fixation.…”

“…[22][23][24][25][26] However, the superiority of advanced imaging techniques over simple fluoroscopy with regard to the risks of neurovascular injury and implant malposition has not been clearly established. [22][23][24][25]27 The majority of pelvic fracture surgeons continue to use simple fluoroscopy, the most affordable and available imaging modality, for percutaneous pelvis fixation. 26,[28][29][30] Patient factors influence the quality and feasibility of fluoroscopic imaging in pelvis surgery.…”

Combined pelvic and acetabular injuries: clinical features and treatment strategies of a unique injury pattern

“…In this study, we took an individual approach to treatment, carefully assessing patients on preoperative X-ray and CT, and we referred to the following principles for the selection of the order of reduction: 1. In general, a displacement of the posterior pelvic ring of less than 1 cm is acceptable [ 23 , 24 ], whereas the displacement of the weight-bearing area at the top of the acetabulum should be less than 2 mm [ 25 – 27 ]. Therefore, we sought more anatomical reduction in the acetabulum during treatment.…”