Abstract：Objective To compare the effect of ISO-C3D navigation and conventional C-arm fluoroscopy in iliosacral screws insertion for treatment of posterior pelvic ring injuries. Methods Sixty-five patients with posterior pelvic ring injuries managed by minimally invasive percutaneous iliosacral screws from June 2006 to January 2012 were reviewed. There were 37 males and 28 females, at age range of 18-63 years (mean 35.9 years). Pelvic fracture classification based on Tile system was type B1 in 10 cases, type B2 in 15, type B3 in nine, type C1 in 18 and type C2 in 13. Patients were divided into ISO-C3D navigation group (Group A, n=35) and C-arm fluoroscopy group (Group B, n=30) according to the difference in intraoperative fluoroscopy methods. Intraoperative fluoroscopy time, time cost in inserting a screw, patient satisfaction rate for bone reduction, bone union time and excellent-good rate of postoperative function were recorded. Results Eighty cannulated screws were inserted for the 65 patients. Average fluoroscopy time and time cost in inserting a screw were shorter in Group A than in Group B (P<0.01), but there was no statistical difference between the two groups in patient satisfaction rate for bone reduction. No patient presented with infection, vascular nerve injury or other complications. Follow-up was 6-24 months (mean 12.7 months) for all the patients. Functional recovery showed no statistical difference between the two groups at postoperative 6 months. All fractures were healed and no delayed union or nonunion happened. Conclusion As compared with conventional C-arm fluoroscopy, computer-navigated surgery can reduce fluoroscopy time and improve screw insertion accuracy.
HE Ji-liang,ZHOU Dong-sheng,LI Qing-hu et al. Comparison of conventional X-ray fluoroscopy and ISO-C3D navigation for placement of sacroiliac screws in treatment of posterior pelvic ring fractures[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(8): 723-728.
［1］Hinsche AF, Giannoudis PV, Smith RM. Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res, 2002, (395):135-144.
［2］Keating JF, Werier J, Blachut P, et al. Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. J Orthop Trauma, 1999, 13(2):107-113.
［3］Routt ML Jr, Kregor PJ, Simonian PT, et al. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma, 1995, 9(3):207-214.
［5］Rampersaud YR, Foley KT, Shen AC, et al. Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine, 2000, 25(20):2637-2645.
［6］Routt ML Jr, Simonian PT. Closed reduction and percutaneous skeletal fixation of sacral fractures. Clin Orthop Relat Res, 1996, (329):121-128.
［7］Ebraheim NA, Haman SP, Xu R, et al. The lumbosacral nerves in relation to dorsal S1 screw placement and their locations on plain radiographs. Orthopedics, 2000, 23(3):245-247.
［9］Schep NW, Haverlag R, van Vugt AB. Computer-assisted versus conventional surgery for insertion of 96 cannulated iliosacral screws in patients with postpartum pelvic pain. J Trauma, 2004, 57(6):1299-1302.〖ZK)〗
［10］Smith HE, Yuan PS, Sasso R, et al. An evaluation of image-guided technologies in the placement of percutaneous iliosacral screws. Spine, 2006, 31(2):234-238.
［11］Tile M. Fracture of the pelvis and acetabulum//Tile M. Classification. 2nd Eed.Baltimore:Williams and Wilkins, 1995:66-101.
［12］Baker SP, O’Neill B, Haddon W Jr, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma, 1974, 14(3):187-196.
［13］Matta JM. Fracture of the acetabulum：accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11):1632-1645.
［14］Majeed SA. Grading the outcome of pelvic fracture. J Bone Joint Surg (Br), 1989, 71(2):304-306.
［15］Kabak S， Halici M， Tuncel M， et al. Functional outcome of open reduction and internal fixation for completely unstable pelvic ring fractures (type C)：a report of 40 cases. J Orthop Trauma, 2003, 17(8)：555-562.
［25］Giannoudis PV, Papadokostakis G, Alpantaki K, et al. Is the lateral sacral fluoroscopic view essential for accurate percutaneous sacroiliac screw insertion? An experimental study. Injury, 2008, 39(8): 875-880.
［26］Zwingmann J, Konrad G, Kotter E, et al. Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res, 2009, 467(7):1833-1838.
［27］Collinge C, Coons D, Tornetta P, et al. Standard multiplanar fluoroscopy versus a fluoroscopically based navigation system for the percutaneous insertion of iliosacral screws: a cadaver model. J Orthop Trauma, 2005, 19(4):254-258.
［28］Amiot LP, Lang K, Putzier M, et al. Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine, 2000, 25(5): 606-614.
［29］Mosheiff R, Khoury A, Weil Y, et al. First generation computerized fluoroscopic navigation in percutaneous pelvic surgery. J Orthop Trauma, 2004, 18(2):106-111.
