Technik der perkutanen SI-Verschraubung mit Unterstützung durch konventionellen C-Bogen

Hilgert, R. E.; Finn, J. Paul; Egbers, H.-J.

doi:10.1007/s00113-005-0967-3

Cited by 21 publications

(13 citation statements)

References 20 publications

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“…Percutaneous sacroiliac (SI) screw fixation is a minimally invasive and effective method for the stabilization of the posterior pelvic ring [ 1 – 6 ]. Screw placement under two-dimensional (2D) fluoroscopic control is the gold standard [ 4 , 6 – 8 ]. CT-controlled and navigated SI screw fixation techniques are demanding procedures and, therefore, not widely available beyond trauma centers [ 6 , 9 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

A simple approach for the preoperative assessment of sacral morphology for percutaneous SI screw fixation

Goetzen

Ortner

Lindtner

et al. 2016

Arch Orthop Trauma Surg

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BackgroundPercutaneous sacroiliac screw fixation under fluoroscopic control is an effective method for posterior pelvic ring stabilization. However, sacral dysmorphism has a high risk of L5 nerve injury. This study describes a simple method for the preoperative assessment of the sacral morphology using CT scans with widely available tools.Materials and methodsCT scans of 1000 patients were analyzed. True inlet, outlet, and lateral views of the sacrum were obtained using a two-dimensional reconstruction tool to align the sacrum in a reproducible manner. Corridor morphology in the inlet view was measured to calculate different morphological types: (1) Ascending type, (2) Horizontal type, and (3) Descending type. In a second step, the corridor was analyzed for the presence of an anterior indentation of the sacrum between the SI joint and the midsagittal plane with proximity to the nerve root L5, which, therefore, may be harmed during screw misplacement.ResultsA notch was found in the majority of cases with relative frequencies ranging from 69 % (upper quartile of S1) to 95 % (upper quartile of S2). Descending types were, by far, the most frequent corridor type with one exception: In the upper quartile of S1, the ascending type was the most frequent corridor (71 %). Horizontal types were less frequent with a relative incidence between 2 and 14 %.DiscussionThis study should increase the awareness for sacral dysmorphism, emphasize the importance of a preoperative assessment of the osseous corridor, and provide a simple method for the preoperative assessment with widely available tools.

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Section: Introductionmentioning

confidence: 99%

A simple approach for the preoperative assessment of sacral morphology for percutaneous SI screw fixation

Goetzen

Ortner

Lindtner

et al. 2016

Arch Orthop Trauma Surg

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“…The positive effect of percutaneous approaches on perioperative complications has been described previously, therefore we are using a minimally invasive approach [41,49,50]. Similar to the therapy of osteoporotic fractures in other regions of the body, the use of angular stable implants has significant potential to result in higher stability and pullout forces than conventional implants [51][52][53][54].…”

Section: Discussionmentioning

confidence: 95%

“…Far more data is available concerning ilio-sacral screw osteosynthesis in polytraumatized patients. Radiation doses up to two minutes and a dose-length-product (DLP) of up to 952.4 mGycm are described in studies that examined polytraumatized patients treated with ilio-sacral screw osteosynthesis [38][39][40][41]. (SD 7) per screw, radiation doses or times have not been assessed.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

Schmerwitz¹,

Jungebluth²,

Lehmann³

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Fragility fractures of the pelvis (FFP) are common in older patients. We evaluated the clinical outcome of using a minimally invasive posterior locked compression plate (MIPLCP) as therapeutic alternative. Methods 53 Patients with insufficiency fractures of the posterior pelvic ring were treated with MIPLCP when suffering from persistent pain and immobility under conservative treatment. After initial X-ray, CT-scans of the pelvis were performed. In some cases an MRI was also performed to detect occult fractures. Postoperatively patients underwent conventional X-ray controls. Data were retrospectively analyzed for surgical and radiation time, complication rate, clinical outcome and compared to the literature. Results Patients (average age 79.1 years) underwent surgery with operation time of 52.3 min (SD 13.9), intra-operative X-ray time of 9.42 s (SD 9.6), mean dose length product of 70.1 mGycm (SD 57.9) and a mean hospital stay of 21.2 days (SD 7.7). 13% patients (n = 7) showed surgery-related complications, such as wound infection, prolonged wound secretion, irritation of the sacral root or clinically inapparent screw malpositioning. 17% (n = 9) showed postoperative complications (one patient died due to pneumonia 24 days after surgery, eight patients developed urinal tract infections). 42 patients managed to return to previous living situation. 34 were followed-up after a mean period of 31.5 (6–90) months and pain level at post-hospital examination of 2.4 (VAS) with an IOWA Pelvic Score of 85.6 (55–99). Conclusion We showed that MIPLCP osteosynthesis is a safe surgical alternative in patients with FFP 3 and FFP 4. This treatment is another way of maintaining a high level of stability in the osteoporotic pelvic ring with a relatively low complication rate, low radiation and moderate operation time and a good functional outcome.

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“…The orientation of the k-wire was then turned to the center of the vertebral body. Subsequent the precise k-wire position was verified in the a-p, inlet and outlet view [ 20 ]. Central placement of the S2 screw was intended between the sacral foramina S1 and S2.…”

Section: Methodsmentioning

confidence: 99%

Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques

Pishnamaz¹,

Wilkmann²,

Na³

et al. 2016

PLoS ONE

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BackgroundElectromagnetic tracking is a relatively new technique that allows real time navigation in the absence of radiation. The aim of this study was to prove the feasibility of this technique for the treatment of posterior pelvic ring fractures and to compare the results with established image guided procedures.MethodsTests were performed in pelvic specimens (Sawbones®) with standardized sacral fractures (Type Denis I or II). A gel matrix simulated the operative approach and a cover was used to disable visual control. The electromagnetic setup was performed by using a custom made carbon reference plate and a prototype stainless steel K-wire with an integrated sensor coil. Four different test series were performed: Group OCT: Optical navigation using preoperative CT-scans; group O3D: Optical navigation using intraoperative 3-D-fluoroscopy; group Fluoro: Conventional 2-D-fluoroscopy; group EMT: Electromagnetic navigation combined with a preoperative Dyna-CT. Accuracy of screw placement was analyzed by standardized postoperative CT-scan for each specimen. Operation time and intraoperative radiation exposure for the surgeon was documented. All data was analyzed using SPSS (Version 20, 76 Chicago, IL, USA). Statistical significance was defined as p< 0.05.Results160 iliosacral screws were placed (40 per group). EMT resulted in a significantly higher incidence of optimal screw placement (EMT: 36/40) compared to the groups Fluoro (30/40; p< 0.05) and OCT (31/40; p< 0.05). Results between EMT and O3D were comparable (O3D: 37/40; n.s.). Also, the operation time was comparable between groups EMT and O3D (EMT 7.62 min vs. O3D 7.98 min; n.s.), while the surgical time was significantly shorter compared to the Fluoro group (10.69 min; p< 0.001) and the OCT group (13.3 min; p< 0.001).ConclusionElectromagnetic guided iliosacral screw placement is a feasible procedure. In our experimental setup, this method was associated with improved accuracy of screw placement and shorter operation time when compared with the conventional fluoroscopy guided technique and compared to the optical navigation using preoperative CT-scans. Further studies are necessary to rule out drawbacks of this technique regarding ferromagnetic objects.

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Technik der perkutanen SI-Verschraubung mit Unterstützung durch konventionellen C-Bogen

Abstract: Standard X-ray views in combination with standardized aiming of screw entry position and final screw thread position enable the surgeon to find the "safe zone" for iliosacral screw insertion and to prevent iliosacral screw malpositioning with high accuracy.

Cited by 21 publications

References 20 publications

A simple approach for the preoperative assessment of sacral morphology for percutaneous SI screw fixation

A simple approach for the preoperative assessment of sacral morphology for percutaneous SI screw fixation

Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis

Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques

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