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：

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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, 劉毅, 劉國輝, 等. 3D打印導板技術輔助與透視輔助骶髂關節置釘的對比研究. 中華創傷雜志, 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.	鄭益釩, 楊思宇, 汪國棟, 等. 3D導航與C型臂X線機透視下經皮雙節段長骶髂關節螺釘內固定治療骨盆后環損傷的療效比較. 中華創傷骨科雜志, 2021, 23(12): 1037-1043.
8.	裴璇, 錢勝龍, 周唯, 等. 導航下經皮空心螺釘與后路經皮重建鋼板內固定治療DayⅡ型骨盆新月形骨折脫位的療效比較. 中華創傷雜志, 2022, 38(6): 551-557.
9.	陳龍, 汪國棟, 劉曦明, 等. 3D導航輔助下經皮骶髂螺釘內固定聯合逆行前柱螺釘內固定或前環外固定支架治療Tilt骨盆骨折的療效比較. 中華創傷雜志, 2018, 34(2): 145-151.
10.	費晨, 莊巖, 張堃, 等. 機器人結合“O”型臂輔助閉合復位經皮螺釘固定術治療不穩定性骨盆骨折. 中華骨科雜志, 2022, 42(13): 815-822.
11.	蘇正兵, 李杰, 羅剛, 等. O-arm導航輔助下經皮骶髂關節螺釘內固定治療骶髂關節復合體損傷. 中華創傷雜志, 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.	董瀟蔓, 陳文歡, 賈健, 等. 骶骨前庭的影像測量及臨床意義分析. 中華骨科雜志, 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.	孫玉璽, 賈健, 田維, 等. 骶骨近端發育異常與骶髂螺釘精準置入的影像學及臨床研究. 中華骨科雜志, 2023, 43(12): 797-804.
22.	楊成志, 劉剛, 唐經勵, 等. 天璣骨科機器人輔助經皮骶髂空心螺釘內固定治療骨盆后環損傷合并骶骨變異. 中國修復重建外科雜志, 2022, 36(8): 940-945.
23.	唐佩福. 骨盆骨折手術機器人研究的現狀、挑戰與展望. 中華骨科雜志, 2023, 43(19): 1257-1260.
24.	陳煥雄, 何賢波, 李國軍, 等. 術中導航漂移校準技術對Lenke 1型青少年特發性脊柱側凸頂椎區置釘精度的影響. 海南醫學院學報, 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, 劉毅, 劉國輝, 等. 3D打印導板技術輔助與透視輔助骶髂關節置釘的對比研究. 中華創傷雜志, 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. 鄭益釩, 楊思宇, 汪國棟, 等. 3D導航與C型臂X線機透視下經皮雙節段長骶髂關節螺釘內固定治療骨盆后環損傷的療效比較. 中華創傷骨科雜志, 2021, 23(12): 1037-1043.
8. 裴璇, 錢勝龍, 周唯, 等. 導航下經皮空心螺釘與后路經皮重建鋼板內固定治療DayⅡ型骨盆新月形骨折脫位的療效比較. 中華創傷雜志, 2022, 38(6): 551-557.
9. 陳龍, 汪國棟, 劉曦明, 等. 3D導航輔助下經皮骶髂螺釘內固定聯合逆行前柱螺釘內固定或前環外固定支架治療Tilt骨盆骨折的療效比較. 中華創傷雜志, 2018, 34(2): 145-151.
10. 費晨, 莊巖, 張堃, 等. 機器人結合“O”型臂輔助閉合復位經皮螺釘固定術治療不穩定性骨盆骨折. 中華骨科雜志, 2022, 42(13): 815-822.
11. 蘇正兵, 李杰, 羅剛, 等. O-arm導航輔助下經皮骶髂關節螺釘內固定治療骶髂關節復合體損傷. 中華創傷雜志, 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. 董瀟蔓, 陳文歡, 賈健, 等. 骶骨前庭的影像測量及臨床意義分析. 中華骨科雜志, 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. 孫玉璽, 賈健, 田維, 等. 骶骨近端發育異常與骶髂螺釘精準置入的影像學及臨床研究. 中華骨科雜志, 2023, 43(12): 797-804.
22. 楊成志, 劉剛, 唐經勵, 等. 天璣骨科機器人輔助經皮骶髂空心螺釘內固定治療骨盆后環損傷合并骶骨變異. 中國修復重建外科雜志, 2022, 36(8): 940-945.
23. 唐佩福. 骨盆骨折手術機器人研究的現狀、挑戰與展望. 中華骨科雜志, 2023, 43(19): 1257-1260.
24. 陳煥雄, 何賢波, 李國軍, 等. 術中導航漂移校準技術對Lenke 1型青少年特發性脊柱側凸頂椎區置釘精度的影響. 海南醫學院學報, 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

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