Comparison of fixation accuracy and efficacy between X-ray fluoroscopy and CT guided technique in sacroiliac screw fixation for type Tile B or C sacrum pelvic fractures or dislocations / 中华创伤杂志

ABSTRACT

Objective@#To investigate the effect of X-ray fluoroscopy and CT guided technique in sacroiliac screw fixation for type Tile B or C sacrum pelvic fractures or dislocations.@*Methods@#A retrospective case control study was conducted to analyze the clinical data of 103 patients with type Tile B or C posterior pelvic ring fracture or dislocation admitted to the General Hospital from Northern Theater of PLA from January 2007 to December 2017. There were 58 males and 45 females, aged 28-69 years, with an average age of 43.8 years. Among the patients, 84 had normal sacrums while 19 had dysmorphic sacrums. The accuracy and placement time of two kinds of sacroiliac screw were compared by X-ray fluoroscopy (46 patients with normal sacroiliac screw placement and 11 with dysmorphic sacroiliac screw placement) or CT guidance (66 patients with normal sacroiliac screw placement and 18 with dysmorphic sacroiliac screw placement) were compared. Matta standard was used to evaluate the imageological healing and clinical prognosis 9 months after operation.@*Results@#In normal sacrum group, there was no statistical difference in placement accuracy between X-ray fluoroscopy [89%(41/46)] and CT guided technique [94%(62/66)](P>0.05). In dysmorphic sacrum group, the placement accuracy of CT guided technique [89%(17/18)] was significantly higher than that of X-ray fluoroscopy [55%(6/11)] (P<0.05). The screw placement time of X-ray fluoroscopy [(39.1±4.9)minutes] was significantly shorter than that of CT guided technique (54.7±3.8)minutes for normal sacrums (P<0.05), and there was no significant difference in terms of placement time by CT guided technique for dysmorphic sacrums (P>0.05). Nine months after operation, in normal sacrum group, the X-ray fluoroscopy had the excellent rate of 74% (34/46), good rate of 26% (12/46) for healing and the excellent rate of 83% (38/46), good rate of 17% (8/46) for clinical prognosis, showing no significant difference from those of CT guided technique [83%(55/66), 17%(11/66); 92%(61/66), 8%(5/66)] (P>0.05). In dysmorphic sacrum group 9 months after operation, the excellent and good rate of X-ray fluoroscopy [excellent 9%(1/11), good 64%(7/11)] was significantly lower than that of CT guided technique in terms of imageological healing [excellent 56%(10/18), good 39%(7/18)](P<0.05), while no significant difference was found in terms of clinical prognosis [excellent 55%(6/11), good 36%(4/11) vs. excellent 78%(14/18), good 22%(4/18)](P>0.05).@*Conclusions@#X-ray fluoroscopy for the fixation of type Tile B or C posterior ring fractures or dislocations of the normal sacrum takes much shorter time, although the comparable effect with CT guidance in aspects of placement accuracy and bone healing rate. For the dysmorphic sacrum, CT guidance allows more accurate screw placement and has better healing rate than X-ray fluoroscopy.