A novel computer navigation method for accurate percutaneous sacroiliac screw implantation

Abstract

The purpose of this study was to assess the accuracy of percutaneous sacroiliac screw (PSS) placement assisted by screw view model of navigation system for treatment of sacroiliac fractures. Data pertaining to 18 consecutive patients with posterior pelvic ring fracture who received sacroiliac screw fixation between January 2015 and July 2018 at the Second Hospital of Jilin University were retrospectively analyzed. Kirschner wires were placed under the guidance of navigation's screw view mode. The position of the screws was evaluated by computed tomography (CT) scan postoperatively. Fracture dislocation of sacroiliac joint was measured in axial, sagittal, and coronal views of 3 dimensional (3D) CT images preoperatively, postoperatively and at the last follow-up visit. The duration of trajectory planning, guide wire implantation time, screw placement time, intraoperative blood loss, and incidence of screw loosening and clinical complications were also assessed. A total of 27 screws were placed unilaterally or bilaterally into segments S1 or S2. Screw placement was rated as excellent for 88.9% of screws (n = 24), good for 7.4% (n = 2), and poor for 3.7% (n = 1). Preoperatively, the average fracture dislocation of sacroiliac joint on axial, sagittal, and coronal views was 14.3 mm, 9.6 mm, and 7.4 mm, respectively, and the corresponding postoperative figures were 5.6 mm, 3.2 mm, 4.1 mm, respectively. The corresponding correction rates were 60.8%, 66.7%, and 44.6%, respectively. The mean duration of trajectory planning was 6.5 min (2.7–8.9 min). Mean screw implantation time was 32 min (range, 20–53 min), and the mean guide wire implantation time was 3.7 min (range, 2.1–5.3 min). No clinical complications such as neurovascular injury, infection or screw loosening were observed on follow-up. The PSS placement under guidance of screw view model of navigation is a convenient, safe and reliable method.

A screw view model of navigation guided minimal invasive percutaneous pelvic screws insertion for lateral compression pelvic ring injuries

“…A percutaneous anterior inferior iliac spine screw (PAIISS) was designed to fix the iliac fracture along the anterior inferior iliac spine to the posterior superior iliac spine, and a PIS screw was planned and passed through the fracture line from left iliac wing. Besides, a percutaneous sacroiliac screw (PSIS) screw was also designed and inserted, details reference to Yu et al [21] …”

A case report of S1-S3 sacroiliac screw fixation for posterior pelvic ring injury with S1 sacral dysmorphism

“…Percutaneous sacroiliac screw has been widely used in the treatment of unstable posterior pelvic ring injury, due to its advantages of minimally invasive, good stability and low infection rates [1][2][3][4][5][6] . The S1 and S2 sacral vertebrae are the traditional and classic locations for sacroiliac screw placement 7,8 .…”

Topographic localization of the sacroiliac joint and superior gluteal artery branches on the posterolateral ilium

“…Although the SIJ anatomy has been studied well on the sacral aspect of the joint, morphological assessment of the corresponding articular anatomy at the posterolateral ilium is rarely found the literature (Alvis-Miranda et al, 2014;Chen et al, 2020;Theologis et al, 2016;Wong et al, 2019;Yin et al, 2017;Yu et al, 2019). Considering the implications of SIJ dysmorphisms, mapping of the sacral articulation at the posterolateral ilium is helpful to achieve safe instrumentation, fusion, or arthrodesis at the joint (Altman et al, 1999;Collinge et al, 2005;Kurosawa et al, 2019;Marmor et al, 2010;Weigelt et al, 2019;Zhao et al, 2018).…”

“…The positions of specific segments of the arteries were superimposed on the grid system using the posterior‐superior and posterior‐inferior iliac spines as coordinate reference points. Use of this grid system may be helpful in critically evaluating positional variabilities of SGA branches for safe screw placements at the posterolateral ilium in addition to intra‐operative imaging as routinely performed during these instrumentations (Chen et al, 2020; Guerin et al, 2020; Theologis et al, 2016; Yin et al, 2017; Yu et al, 2019).…”