不同微创螺钉固定术治疗骶骨骨折的比较

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2025-04-08 DOI:10.1016/j.injury.2025.112317

Martin Naisan , Andreas Kramer , Stefan Kindel , Marcus Richter , Florian Ringel , Philipp Hartung

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引用次数: 0

摘要

背景：经皮螺钉入骨术是治疗伴有固定疼痛的老年患者骶骨脆性骨折的金标准。然而，关于骶髂螺钉的最佳类型、长度或插入位置的比较证据仍然有限。目的：本研究旨在比较长经骶骨螺钉与短经骶骨螺钉桥接骶髂关节的效果。研究设计/设置回顾性队列单中心研究。患者样本：经皮骶髂螺钉治疗骶骨脆性骨折的老年患者。主要结果：随访3个月、6个月和12个月螺钉松动。次要结局：手术时间、术后疼痛、活动能力改善和住院时间。方法分析2018年至2021年间接受治疗的122例患者（中位年龄81岁，女性84%）的数据。患者被分为三组[1]：两枚长经骶骨螺钉[2]，一枚长螺钉和两枚短螺钉的组合，[3]四枚短骶髂螺钉。评估骨折特征、FFP分级和螺钉松动的危险因素。结果双侧骨折占73%，FFP分类为2型（48%）、3型（12%）和4型（40%）。骨盆前骨折占63%，粉碎性骨折占34%，h型骨折占29%。长螺钉组松动率为17%，联合组为6%，短螺钉组为4%。与联合组（61.8分钟）和短螺钉组（83.4分钟）相比，长螺钉组的手术时间最短（平均52.6分钟）。88%的患者在3个月时疼痛评分低于5,92%的患者在12个月时疼痛评分低于5。螺钉长度是发生松动的重要危险因素（p = 0.04）。结论经骶长螺钉具有微创固定效果，手术时间短，但松动率高。四枚短骶髂螺钉的骨融合术表现出优越的长期稳定性，使其成为骶骨脆性骨折的一种有希望的选择。

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Comparing different minimally invasive screw osteosyntheses methods for the stabilization of the sacral fractures

Background Context

Percutaneous screw osteosynthesis is the gold standard for managing sacral fragility fractures in geriatric patients with immobilizing pain. However, comparative evidence regarding the optimal type, length, or insertion position of sacroiliac screws remains limited.

Purpose

This study aimed to compare outcomes between long transsacral screws bridging both sacroiliac joints and short sacroiliac screws.

Study Design/Setting

Retrospective cohort single-center study.

Patient Sample

Geriatric patients treated with percutaneous sacroiliac screws for sacral fragility fractures.

Outcome Measures

Primary outcome: screw loosening at 3-, 6-, and 12-month follow-ups. Secondary outcomes: surgical duration, postoperative pain, mobility improvement, and hospital stay length.

Methods

Data from 122 patients (median age 81, 84 % female) treated between 2018 and 2021 were analyzed. Patients were categorized into three groups [1]: two long transsacral screws [2], a combination of one long and two short screws, and[3] four short sacroiliac screws. Fracture characteristics, FFP classification, and risk factors for screw loosening were evaluated.

Results

Fractures were bilateral in 73 %, with FFP classifications of type 2 (48 %), type 3 (12 %), and type 4 (40 %). Anterior pelvic fractures were present in 63 %, comminuted fractures in 34 %, and H-type fractures in 29 %. Loosening rates were 17 % in the long-screw group, 6 % in the combination group, and 4 % in the short-screw group. Surgical duration was shortest for long screws (mean 52.6 min) compared to the combination (61.8 min) and short-screw (83.4 min) groups. Pain scores decreased below 5 in 88 % of patients at 3 months and 92 % at 12 months. Screw length was a significant risk factor for loosening (p = 0.04).

Conclusions

Long transsacral screws offer minimally invasive fixation with reduced surgical duration but higher loosening rates. Osteosynthesis with four short sacroiliac screws demonstrates superior long-term stability, making it a promising option for sacral fragility fractures.

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.