O-arm navigation versus C-arm navigation for guiding percutaneous long sacroiliac screws placement in treatment of Denis type <b>Ⅱ</b> sacral fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Wei ¹ , WANG Guodong ² , PEI Xuan ² , FANG Zhixun ² , CHEN Yu ² , BAO Suyaolatu ² , CHEN Jianan ² ,  LIU Ximing ^2,3

1. Department of Spine Surgery, Wuhan Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine (Affiliated Hospital of Wuhan Sports University), Wuhan Hubei, 430081, P. R. China;
2. Department of Orthopedics, General Hospital of Central Theater Command of Chinese PLA, Wuhan Hubei, 430070, P. R. China;
3. College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan Hubei, 430065, P. R. China;

Corresponding author：

LIU Ximing, Email: gklxm@163.com

Keywords：

Sacral fracture; C-arm navigation system; O-arm navigation system; sacroiliac screw; internal fixation

DOI：

10.7507/1002-1892.202310019

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis type Ⅱ sacral fractures. Methods A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022. Among them, 19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation (O-arm navigation group), and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation (C-arm navigation group). There was no significant difference in gender, age, causes of injuries, Tile classification of pelvic fractures, combined injury, the interval from injury to operation between the two groups (P>0.05). The intraoperative preparation time, the placement time of each screw, the fluoroscopy time of each screw during placement, screw position accuracy, the quality of fracture reduction, and fracture healing time were recorded and compared, postoperative complications were observed. Pelvic function was evaluated by Majeed score at last follow-up. Results All operations were completed successfully, and all incisions healed by first intention. Compared to the C-arm navigation group, the O-arm navigation group had shorter intraoperative preparation time, placement time of each screw, and fluoroscopy time, with significant differences (P<0.05). There was no significant difference in screw position accuracy and the quality of fracture reduction (P>0.05). There was no nerve or vascular injury during screw placed in the two groups. All patients in both groups were followed up, with the follow-up time of 6-21 months (mean, 12.0 months). Imaging re-examination showed that both groups achieved bony healing, and there was no significant difference in fracture healing time between the two groups (P>0.05). During follow-up, there was no postoperative complications, such as screw loosening and breaking or loss of fracture reduction. At last follow-up, there was no significant difference in pelvic function between the two groups (P>0.05). Conclusion Compared with the C-arm navigation, the O-arm navigation assisted percutaneous long sacroiliac screws for the treatment of Denis typeⅡsacral fractures can significantly shorten the intraoperative preparation time, screw placement time, and fluoroscopy time, improve the accuracy of screw placement, and obtain clearer navigation images.

Citation： ZHOU Wei, WANG Guodong, PEI Xuan, FANG Zhixun, CHEN Yu, BAO Suyaolatu, CHEN Jianan, LIU Ximing. O-arm navigation versus C-arm navigation for guiding percutaneous long sacroiliac screws placement in treatment of Denis type Ⅱ sacral fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(1): 28-34. doi: 10.7507/1002-1892.202310019 Copy

1.	Fernández-Fernández R, Diaz-Freire P, Rubio-Suárez JC. Open reduction and navigated iliosacral screws for vertically unstable pelvic fractures. Injury, 2021, 52 Suppl 4: S22-S26.
2.	Pei X, Zhou W, Wang GD, et al. Comparison of three-dimensional navigation-guided percutaneous iliosacral screw and minimally invasive percutaneous plate for the treatment of zone Ⅱ unstable sacral fractures. Orthop Surg, 2023, 15(2): 471-479.
3.	Herman A, Keener E, Dubose C, et al. Zone 2 sacral fractures managed with partially-threaded screws result in low risk of neurologic injury. Injury, 2016, 47(7): 1569-1573.
4.	周武, 刘毅, 刘国辉, 等. 3D打印导板技术辅助与透视辅助骶髂关节置钉的对比研究. 中华创伤杂志, 2018, 34(6): 484-489.
5.	Bradley H, Pierce B, O’Neill D, et al. Biomechanical comparison of 4 transsacral fixation constructs in a type 61C, zone Ⅱ pelvic fracture model. J Orthop Trauma, 2022, 36(10): 503-508.
6.	Schuetze K, Eickhoff A, Dehner C, et al. Short-term outcome of fragility fractures of the pelvis in the elderly treated with screw osteosynthesis and external fixator. Eur J Trauma Emerg Surg, 2022, 48(3): 2413-2420.
7.	郑益钒, 杨思宇, 汪国栋, 等. 3D导航与C型臂X线机透视下经皮双节段长骶髂关节螺钉内固定治疗骨盆后环损伤的疗效比较. 中华创伤骨科杂志, 2021, 23(12): 1037-1043.
8.	裴璇, 钱胜龙, 周唯, 等. 导航下经皮空心螺钉与后路经皮重建钢板内固定治疗DayⅡ型骨盆新月形骨折脱位的疗效比较. 中华创伤杂志, 2022, 38(6): 551-557.
9.	陈龙, 汪国栋, 刘曦明, 等. 3D导航辅助下经皮骶髂螺钉内固定联合逆行前柱螺钉内固定或前环外固定支架治疗Tilt骨盆骨折的疗效比较. 中华创伤杂志, 2018, 34(2): 145-151.
10.	费晨, 庄岩, 张堃, 等. 机器人结合“O”型臂辅助闭合复位经皮螺钉固定术治疗不稳定性骨盆骨折. 中华骨科杂志, 2022, 42(13): 815-822.
11.	苏正兵, 李杰, 罗刚, 等. O-arm导航辅助下经皮骶髂关节螺钉内固定治疗骶髂关节复合体损伤. 中华创伤杂志, 2020, 36(8): 709-713.
12.	Gras F, Marintschev I, Wilharm A, et al. 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries—a case series. BMC Musculoskelet Disord, 2010, 11: 153.
13.	Matta JM, Tornetta P. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res, 1996, (329): 129-140.
14.	Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
15.	Boudissa M, Carmagnac D, Kerschbaumer G, et al. Screw misplacement in percutaneous posterior pelvic iliosacral screwing with and without navigation: A prospective clinical study of 174 screws in 127 patients. Orthop Traumatol Surg Res, 2022, 108(2): 103213.
16.	Lu S, Yang K, Lu C, et al. O-arm navigation for sacroiliac screw placement in the treatment for posterior pelvic ring injury. Int Orthop, 2021, 45(7): 1803-1810.
17.	董潇蔓, 陈文欢, 贾健, 等. 骶骨前庭的影像测量及临床意义分析. 中华骨科杂志, 2022, 42(1): 41-46.
18.	Bagheri H, Govsa F. Anatomy of the sacral hiatus and its clinical relevance in caudal epidural block. Surg Radiol Anat, 2017, 39(9): 943-951.
19.	Wu LP, Li YK, Li YM, et al. Variable morphology of the sacrum in a Chinese population. Clin Anat, 2009, 22(5): 619-626.
20.	Templeman D, Goulet J, Duwelius PJ, et al. Internal fixation of displaced fractures of the sacrum. Clin Orthop Relat Res, 1996, (329): 180-185.
21.	孙玉玺, 贾健, 田维, 等. 骶骨近端发育异常与骶髂螺钉精准置入的影像学及临床研究. 中华骨科杂志, 2023, 43(12): 797-804.
22.	杨成志, 刘刚, 唐经励, 等. 天玑骨科机器人辅助经皮骶髂空心螺钉内固定治疗骨盆后环损伤合并骶骨变异. 中国修复重建外科杂志, 2022, 36(8): 940-945.
23.	唐佩福. 骨盆骨折手术机器人研究的现状、挑战与展望. 中华骨科杂志, 2023, 43(19): 1257-1260.
24.	陈焕雄, 何贤波, 李国军, 等. 术中导航漂移校准技术对Lenke 1型青少年特发性脊柱侧凸顶椎区置钉精度的影响. 海南医学院学报, 2023, 29(6): 444-451.

1. Fernández-Fernández R, Diaz-Freire P, Rubio-Suárez JC. Open reduction and navigated iliosacral screws for vertically unstable pelvic fractures. Injury, 2021, 52 Suppl 4: S22-S26.
2. Pei X, Zhou W, Wang GD, et al. Comparison of three-dimensional navigation-guided percutaneous iliosacral screw and minimally invasive percutaneous plate for the treatment of zone Ⅱ unstable sacral fractures. Orthop Surg, 2023, 15(2): 471-479.
3. Herman A, Keener E, Dubose C, et al. Zone 2 sacral fractures managed with partially-threaded screws result in low risk of neurologic injury. Injury, 2016, 47(7): 1569-1573.
4. 周武, 刘毅, 刘国辉, 等. 3D打印导板技术辅助与透视辅助骶髂关节置钉的对比研究. 中华创伤杂志, 2018, 34(6): 484-489.
5. Bradley H, Pierce B, O’Neill D, et al. Biomechanical comparison of 4 transsacral fixation constructs in a type 61C, zone Ⅱ pelvic fracture model. J Orthop Trauma, 2022, 36(10): 503-508.
6. Schuetze K, Eickhoff A, Dehner C, et al. Short-term outcome of fragility fractures of the pelvis in the elderly treated with screw osteosynthesis and external fixator. Eur J Trauma Emerg Surg, 2022, 48(3): 2413-2420.
7. 郑益钒, 杨思宇, 汪国栋, 等. 3D导航与C型臂X线机透视下经皮双节段长骶髂关节螺钉内固定治疗骨盆后环损伤的疗效比较. 中华创伤骨科杂志, 2021, 23(12): 1037-1043.
8. 裴璇, 钱胜龙, 周唯, 等. 导航下经皮空心螺钉与后路经皮重建钢板内固定治疗DayⅡ型骨盆新月形骨折脱位的疗效比较. 中华创伤杂志, 2022, 38(6): 551-557.
9. 陈龙, 汪国栋, 刘曦明, 等. 3D导航辅助下经皮骶髂螺钉内固定联合逆行前柱螺钉内固定或前环外固定支架治疗Tilt骨盆骨折的疗效比较. 中华创伤杂志, 2018, 34(2): 145-151.
10. 费晨, 庄岩, 张堃, 等. 机器人结合“O”型臂辅助闭合复位经皮螺钉固定术治疗不稳定性骨盆骨折. 中华骨科杂志, 2022, 42(13): 815-822.
11. 苏正兵, 李杰, 罗刚, 等. O-arm导航辅助下经皮骶髂关节螺钉内固定治疗骶髂关节复合体损伤. 中华创伤杂志, 2020, 36(8): 709-713.
12. Gras F, Marintschev I, Wilharm A, et al. 2D-fluoroscopic navigated percutaneous screw fixation of pelvic ring injuries—a case series. BMC Musculoskelet Disord, 2010, 11: 153.
13. Matta JM, Tornetta P. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res, 1996, (329): 129-140.
14. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
15. Boudissa M, Carmagnac D, Kerschbaumer G, et al. Screw misplacement in percutaneous posterior pelvic iliosacral screwing with and without navigation: A prospective clinical study of 174 screws in 127 patients. Orthop Traumatol Surg Res, 2022, 108(2): 103213.
16. Lu S, Yang K, Lu C, et al. O-arm navigation for sacroiliac screw placement in the treatment for posterior pelvic ring injury. Int Orthop, 2021, 45(7): 1803-1810.
17. 董潇蔓, 陈文欢, 贾健, 等. 骶骨前庭的影像测量及临床意义分析. 中华骨科杂志, 2022, 42(1): 41-46.
18. Bagheri H, Govsa F. Anatomy of the sacral hiatus and its clinical relevance in caudal epidural block. Surg Radiol Anat, 2017, 39(9): 943-951.
19. Wu LP, Li YK, Li YM, et al. Variable morphology of the sacrum in a Chinese population. Clin Anat, 2009, 22(5): 619-626.
20. Templeman D, Goulet J, Duwelius PJ, et al. Internal fixation of displaced fractures of the sacrum. Clin Orthop Relat Res, 1996, (329): 180-185.
21. 孙玉玺, 贾健, 田维, 等. 骶骨近端发育异常与骶髂螺钉精准置入的影像学及临床研究. 中华骨科杂志, 2023, 43(12): 797-804.
22. 杨成志, 刘刚, 唐经励, 等. 天玑骨科机器人辅助经皮骶髂空心螺钉内固定治疗骨盆后环损伤合并骶骨变异. 中国修复重建外科杂志, 2022, 36(8): 940-945.
23. 唐佩福. 骨盆骨折手术机器人研究的现状、挑战与展望. 中华骨科杂志, 2023, 43(19): 1257-1260.
24. 陈焕雄, 何贤波, 李国军, 等. 术中导航漂移校准技术对Lenke 1型青少年特发性脊柱侧凸顶椎区置钉精度的影响. 海南医学院学报, 2023, 29(6): 444-451.

Chinese Journal of Reparative and Reconstructive Surgery

O-arm navigation versus C-arm navigation for guiding percutaneous long sacroiliac screws placement in treatment of Denis type Ⅱ sacral fractures

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content