Three-dimensional navigation for placement of percutaneous sacroiliac joint screws in internal fixation of sacroiliac complex injury

Abstract

Objective To investigate the clinical results of three-dimensional navigation for placement of percutaneous sacroiliac joint screws in the internal fixation of sacroiliac complex injury. Methods A retrospective study was conducted of the 30 patients who had been treated for sacroiliac complex injury from March 2015 to January 2016 and fully followed up. They were 22 males and 8 females, aged from 25 to 63 years (average, 44.2 years). According to Tile classification for pelvic fractures, there were 14 cases of type B (type B1 in 6, type B2 in 6 and type B3 in 2), and 16 cases of type C (type C1 in 9, type C2 in 5, and type C3 in 2). Three cases complicated with preoperative injury to lumbosacral trunk were treated with anterior plate and percutaneous sacroiliac joint screws; the other 27 cases with internal fixation with percutaneous sacroiliac joint screws. The placement of screws was aided by three-dimensional navigation. The time for each screw placement and X-ray exposure was recorded intraoperatively. Postoperative reduction quality was assessed using Matta radiological criteria and Majeed criteria was used at the final follow-ups to evaluate the pelvic function. Results Altogether 36 sacroiliac joint screws were inserted in the 30 patients under three-dimensional navigation. The time for each screw placement ranged from 28 to 40 minutes (average, 33.2 minutes); the intraoperative X-ray exposure time ranged from 1.2 to 2.5 minutes (average, 1.4 minutes). No infection occurred at either incision or placement site. According to Matta radiological criteria, reduction was excellent in 16, good in 11 and fair in 3, giving an excellent to good rate of 90.0%. The follow-up time for the 30 patients ranged from 6 to 12 months (average, 10.6 months). At the final follow-ups, X-ray and CT three-dimensional reconstruction showed fine fracture union and no loosening or breakage of screws in all. By the Majeed criteria, the pelvic function was excellent in 17 cases, good in 8 cases, fair in 4 cases, and poor in one, giving a good to excellent rate of 83.3%. Conclusion Three-dimensional navigation for placement of percutaneous sacroiliac joint screws in internal fixation of sacroiliac complex injury can lead to precise placement, minimal invasion, safety and effectiveness. Key words: Sacroiliac joint; Wounds and injuries; Fracture fixation, internal; Bone nails; Surgery, computer-assisted