Abstract
Purpose: Numerous different fixation techniques are used to treat vertical shear sacral fractures. We report our experience with spinopelvic fixation using a minimally invasive technique. Methods: Thirty-eight patients with vertical pelvic and sacral fractures were treated with spinopelvic fixation (traditional open method, n = 21; minimally invasive technique, n = 17). Intergroup comparisons and statistical analysis were performed for intraoperative blood loss, operative time, post-operative radiographic grading, post-operative functional score, and complication rates. Results: Patients treated with the minimally invasive technique had a significantly shorter operative time (−52 min, p = 0.022), reduced blood loss volume (−287 mL, p < 0.001), and better cosmetic appearance (p < 0.05) than those in the traditional open group. There were no significant intergroup differences in post-operative radiographic grading (p = 0.489) or post-operative functional scores (p = 0.072). The complication rate was lower in the minimally invasive group (1/17 patients) than in the traditional open group (2/21 patients). Conclusions: Minimally invasive spinopelvic fixation is a viable treatment for sacral fractures and can reduce blood loss and operative time.
Highlights
According to the Denis classification [3], sacral fractures can be classified into three zones: zone I, the fracture line is lateral to the foramen and traverses the sacral ala; zone II, the fracture is transforaminal; and zone III, the fracture is medial to the foramen and traverses the central spinal canal
Sacral fractures are often accompanied with other associated injuries such as pelvic ring fractures, lower limb fractures, other axial bone fractures, or visceral injuries [1,9]
Extensive surgical dissection to expose the posterior structures of the lower lumbar spine and posterior iliac crest is necessary in the traditional open method
Summary
The five sacral vertebrae, which have a triangular, concave shape, fuse to form the sacrum. The sacrum is a key stone of the axial skeleton and pelvic ring. The base of the sacrum articulates with the fifth lumbar spine and its intervertebral disc. The sacral ala articulates horizontally with the iliac bone and forms the sacroiliac joint, which is connected to strong ligaments. The sacroiliac joint can afford axial loading from the trunk and transmit it to the lower limbs through the pelvic ring [1]. The fracture pattern may be isolated or combined with pelvic ring fracture. Sacral fracture combined with anterior ring fracture is usually unstable and accounts for approximately 30–40% of all pelvic ring fractures [2]. Sacral fracture caused by high-energy trauma has a high incidence of associated injury and often a complex fracture pattern, which is difficult to interpret. According to the Denis classification [3], sacral fractures can be classified into three zones: zone I, the fracture line is lateral to the foramen and traverses the sacral ala; zone II, the fracture is transforaminal; and zone III, the fracture is medial to the foramen and traverses the central spinal canal
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