| BackgroundThe unstable fracture of the pelvic posterior ring is a common type of injury with high energy.In recent years,percutaneous iliosacral screw fixation has been widely used for unstable pelvic fractures.However,freehand screw setting has high technical requirements,difficulty and risk.With the aid of navigation technology,iliosacral screw placement is accurate and safe,but the high cost and complicated operation of navigation equipment limit its popularization in primary hospitals.And other simple auxiliary screw placement methods are few.Therefore,this paper proposes the biplanar positioning method to assist iliosacral screw placement,in order to provide a new idea for the minimally invasive treatment of unstable pelvic fractures.ObjectiveIn this paper,the specific effects of iliosacral screw placement were compared under the guidance of biplanar positioning method and traditional free-hand placement,in order to preliminarily investigate the efficacy,safety and reliability of biplanar positioning technique for iliosacral screw placement.MethodsIn this retrospective study,a total of 41 patients with unstable pelvic posterior ring injury admitted to the Second Hospital of Shandong University from October 2020 to February 2022 were included.According to the method of iliosacral screw insertion,the patients were divided into two groups:biplanar group and traditional group.In biplanar group,firstly,according to the inlet view obtained by the C-arm,one K-wire k1 was externally fixed at the surface projection position of the iliosacral screw inlet position,so that the other K-wire k2 was parallel to k1 at the inlet position to determine the first plane PA.In the same way,the second plane PB was obtained by fixing one K-wire k3 in the surface projection position of the iliosacral screw in the outlet view and another K-wire k4 parallel to k3 in the outlet view.The straight line intersecting the two planes is the extension line of the iliosacral screw in vitro.Two K-wires k5 and k6 are fixed to k1 and k2 so that they exist in PA,and two K-wires k7 and k8 are fixed to k3 and k4 so that they exist in PB.Make k5 and k7 intersect at one point A,and k6 and k8 intersect at another point B.The line AB line between point A and point B is the intersection line between PA and PB.The guide needle k9 is placed along this direction to determine the needle entry point and direction of the screw.In the traditional group,the entry point and direction of needle were determined according to repeated fluoroscopy,and the guide needle was inserted while the fluoroscopy was used,and the iliosacral screw was inserted after the guide needle was properly positioned.The following data were collected and compared between the two groups:①Patient general data;②Operation time;③Fluoroscopy times;④Adjusting the number of guide needles;⑤Intraoperative blood loss;⑥Fracture reduction;⑦Fracture healing time;⑧Postoperative functional recovery.⑨Position of screws inserted.ResultsAmong the 41 patients,there were 18 patients in the double-plane group,including 11 males and 7 females,with an average age of(49.72±12.24)years,and 23 patients in the control group,including 13 males and 10 females,with an average age of(51.78±11.57)years.There were no significant differences in general data between the two groups(p>0.05).The operation time of the two groups was statistically significant(p<0.05),and the biplanar group(47.78±10.88)minutes was significantly lower than the traditional group(59.78±13.69)minutes.The number of fluoroscopy was significantly different between the two groups(p<0.05),and the biplanar group(22.78±4.14)times was significantly less than the traditional group(31.96±9.35)times.The number of guide needle adjustment between the two groups was statistically significant(p<0.05),and the number of guide needle adjustment in the biplanar group(1.94± 1.30)was significantly lower than that in the traditional group(4.74±2.16).The intraoperative blood loss between the two groups was statistically significant(p<0.05),and the biplanar group(22.50±7.91)mL was significantly lower than the traditional group(30.43±10.22)mL.There was no significant difference in Matta reduction grade,fracture healing time,and Majeed function score at the last follow-up between the two groups(p>0.05).A total of 51 screws were implanted in the two groups,including 18 S1 screws and 6 S2 screws in the biplanar group.There were 23 S1 screws and 4 S2 screws in the traditional group.In the biplanar group,the excellent and good rate of screw position was 91.7%,among which 18 screws were excellent,4 screws were good and 2 screws were ordinary.The excellent and good rate of screw placement in the traditional group was 85.2%,including excellent 12 screws,good 11 screws and ordinary 4 screws.The screw position grade of the biplane group was better than that of the traditional group,and the difference was statistically significant(p<0.05).ConclusionCompared with traditional manual implantation of iliosacral screw,biplanar positioning method can significantly shorten the operation time,reduce the amount of blood loss,and help to reduce iatrogenic injury of patients.It can significantly reduce the number of intraoperative guide needle adjustment and intraoperative fluoroscopy,which is helpful to reduce the radiation exposure of patients and medical staff.With higher safety and accuracy,patients can avoid neurovascular injury.In conclusion,the biplanar positioning method is a safe and effective positioning method,which can be used as a new scheme to assist the implantation of iliosacral screw. |
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