Clinical study of percutaneous double-segment lengthened sacroiliac screws internal fixation via three-dimensional navigation technology in treatment of Denis type Ⅱ and Ⅲ sacral fractures

Abstract

To investigate the effectiveness of percutaneous double-segment lengthened sacroiliac screws internal fixation assisted by three-dimensional (3D) navigation technology in treatment of Denis type Ⅱ and Ⅲ sacral fractures. A clinical data of 45 patients with the Denis type Ⅱ and Ⅲ sacral fractures admitted between January 2017 and May 2020 was retrospectively analyzed. There were 31 males and 14 females, with an average age of 48.3 years (range, 30-65 years). The pelvic fractures were all high energy injuries. According to the Tile classification standard, there were 24 cases of type C1, 16 cases of type C2, and 5 cases of type C3. The sacral fractures were classified as Denis type Ⅱ in 31 cases and type Ⅲ in 14 cases. The interval between injury and operation was 5-12 days (mean, 7.5 days). The lengthened sacroiliac screws were implanted in S 1 and S 2 segments respectively under the assistance of 3D navigation technology. The implantation time of each screw, the intraoperative X-ray exposure time, and the occurrence of surgical complications were recorded. After operation, the imaging reexamination was used to evaluate the screw position according to Gras standard and the reduction quality of sacral fractures according to Matta standard. At last follow-up, the pelvic function was scored with Majeed scoring standard. The 101 lengthened sacroiliac screws were implanted with the assisting of 3D navigation technology. The implantation time of each screw was 37.3 minutes on average (range, 30-45 minutes), and the X-ray exposure time was 46.2 seconds on average (range, 40-55 seconds). All patients had no neurovascular or organ injury. All incisions healed by first intention. The quality of fracture reduction was evaluated according to Matta standard as excellent in 22 cases, good in 18 cases, and fair in 5 cases, and the excellent and good rate was 88.89%. The screw position was evaluated according to Gras standard as excellent in 77 screws, good in 22 screws, and poor in 2 screws, and the excellent and good rate was 98.02%. All patients were followed up 12-24 months (mean, 14.6 months). All fractures healed and the healing time was 12-16 weeks (mean, 13.5 weeks). Pelvic function was evaluated according to Majeed scoring standard as excellent in 27 cases, good in 16 cases, fair in 2 cases, and the excellent and good rate was 95.56%. Percutaneous double-segment lengthened sacroiliac screws internal fixation for the treatment of Denis type Ⅱ and Ⅲ sacral fractures is minimally invasive and effective. With the assistance of 3D navigation technology, the screw implantation is accurate and safe.