Three dimensional fluoroscopy navigation-assisted percutaneous iliosacral screw insertion in the treatment of unstable posterior pelvic ring trauma

JIA Shuai-jun; LV Shang-jun; HE Li-jun; LIU Jian

Abstract：Objective To evaluate the application of 3D fluoroscopy navigation-assisted percutaneous screw fixation in the treatment of unstable posterior pelvic ring trauma .Methods Between Mar.2009 to Dec.2012,18 patients with posterior pelvic ring injuries were included for percutaneous screw fixation using an optoelectronic 3D-fluoroscopy navigation system .There were 13 males and 5 females with an average age of 40.2 years ( ranged from 23 to 61 years).Fractures were caused by traffic accident in 12 cases,high fall injury in 5 cases,and collapsed building in 1 case.The interval from injury to hospitalization was 3h-5d (mean 25h).According to the AO classi-fication, there were 3 cases of B1.2 type,2 cases of B2.2 type,7 cases of C1.2 type,5 cases of C1.3 type,and 1 case of C2.3 type.Results Totally 40 iliosacral screws were inserted ( mean operation time per screw 29.12 ± 3.00 minutes,mean fluoroscopy time per screw 4.55 ±0.80 minutes).The blood loss ranged from 10 to 20 ml. The postoperative pelvic X ray and three dimensional CT showed that the fractures had good reduction and all the screws had good position .No screw misplacement was observed in intraoperative fluoroscopic images .There were no wound infections , neurovascualr injuries or other organ injuries .According to the rating system of Matta ,12 pa-tients had excellent results ,5 patients had good results ,and 1 patient had a fair result .The excellent to good rate was 94%.According to Majeed functional scoring the results were excellent in 11 cases and good in 7 cases,with an excellent and good rate of 100%.Conclusion Percutaneous screw fixation with 3D fluoroscopy-assisted navigation of pelvic ring fractures can produce excellent results in selected patients .It is a safe and effective alternative for the treatment of pelvic ring fractures .