Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring
详细信息 查看全文
- 作者：Frederik F. Strobl (1)
Sophia M. Haeussler (1)
Philipp M. Paprottka (1)
Ralf-Thorsten Hoffmann (1)
Oliver Pieske (2)
Maximilian F. Reiser (1)
Christoph G. Trumm (1) - 关键词：Posterior pelvic ring injury ; CT fluoroscopy ; Iliosacral screw placement
- 刊名：Skeletal Radiology
- 出版年：2014
- 出版时间：August 2014
- 年：2014
- 卷：43
- 期：8
- 页码：1093-1100
- 全文大小：
- 参考文献：1. Giannoudis PV, Grotz MR, Tzioupis C, Dinopoulos H, Wells GE, Bouamra O, et al. Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective. J Trauma. 2007;63(4):875-3. CrossRef
2. Grotz MR, Allami MK, Harwood P, Pape HC, Krettek C, Giannoudis PV. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury. 2005;36(1):1-3. CrossRef
3. Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;227:67-1.
4. Dudda M, Hoffmann M, Schildhauer TA. Sacrum fractures and lumbopelvic instabilities in pelvic ring injuries: classification and biomechanical aspects. Unfallchirurg. 2013;116(11):972-. CrossRef
5. Routt Jr ML, Nork SE, Mills WJ. Percutaneous fixation of pelvic ring disruptions. Clin Orthop Relat Res. 2000;375:15-9. CrossRef
6. van den Bosch EW, van Zwienen CM, van Vugt AB. Fluoroscopic positioning of sacroiliac screws in 88 patients. J Trauma. 2002;53(1):44-. CrossRef
7. Sciulli RL, Daffner RH, Altman DT, Altman GT, Sewecke JJ. CT-guided iliosacral screw placement: technique and clinical experience. AJR Am J Roentgenol. 2007;188(2):W181-2. CrossRef
8. Zwingmann J, Hauschild O, Bode G, Sudkamp NP, Schmal H. Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2013;133(9):1257-5. CrossRef
9. Templeman D, Schmidt A, Freese J, Weisman I. Proximity of iliosacral screws to neurovascular structures after internal fixation. Clin Orthop Relat Res. 1996;329:194-. CrossRef
10. Ziran BH, Smith WR, Towers J, Morgan SJ. Iliosacral screw fixation of the posterior pelvic ring using local anaesthesia and computerised tomography. J Bone Jt Surg Br Vol. 2003;85(3):411-. CrossRef
11. Trumm CG, Rubenbauer B, Piltz S, Reiser MF, Hoffmann RT. Screw placement and osteoplasty under computed tomographic-fluoroscopic guidance in a case of advanced metastatic destruction of the iliosacral joint. Cardiovasc Intervent Radiol. 2011;34 Suppl 2:S288-3. CrossRef
12. Chmelova J, Sir M, Jecminek V. CT-guided percutaneous fixation of pelvic fractures. Case reports. Biomed Pap Med Fac Univ Palacky Olomouc Czechoslovakia. 2005;149(1):177-1. CrossRef
13. Blake-Toker AM, Hawkins L, Nadalo L, Howard D, Arazoza A, Koonsman M, et al. CT-guided percutaneous fixation of sacroiliac fractures in trauma patients. J Trauma. 2001;51(6):1117-1. CrossRef
14. Carlson SK, Bender CE, Classic KL, Zink FE, Quam JP, Ward EM, et al. Benefits and safety of CT fluoroscopy in interventional radiologic procedures. Radiology. 2001;219(2):515-0. CrossRef
15. Paprottka PM, Helmberger T, Reiser MF, Trumm CG. Computed tomography guidance: fluoroscopy and more. Radiologe. 2013;53(11):974-5. CrossRef
16. Sarti M, Brehmer WP, Gay SB. Low-dose techniques in CT-guided interventions. Rev Publ Radiol Soc N Am Inc. 2012;32(4):1109-9. discussion 19-0.
17. Iguchi T, Ogawa K, Doi T, Miyasho K, Munetomo K, Hiraki T, et al. Computed tomography fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures. Skeletal Radiol. 2010;39(7):701-. CrossRef
18. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Annals of the ICRP. 2007; 37 (2-):1-32.
19. Joemai RM, Zweers D, Obermann WR, Geleijns J. Assessment of patient and occupational dose in established and new applications of MDCT fluoroscopy. AJR Am J Roentgenol. 2009;192(4):881-. CrossRef
20. Routt Jr ML, Kregor PJ, Simonian PT, Mayo KA. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma. 1995;9(3):207-4. CrossRef
21. Hinsche AF, Giannoudis PV, Smith RM. Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res. 2002;395:135-4. CrossRef
22. Altman DT, Jones CB, Routt Jr ML. Superior gluteal artery injury during iliosacral screw placement. J Orthop Trauma. 1999;13(3):220-. CrossRef
23. Ebraheim NA, Rusin JJ, Coombs RJ, Jackson WT, Holiday B. Percutaneous computed-tomography-stabilization of pelvic fractures: preliminary report. J Orthop Trauma. 1987;1(3):197-04. CrossRef
24. Galanski M, Nagel HD, Stamm G. CT radiation exposure risk in Germany. Fortschr Geb. 2001;173(10):R1-6. CrossRef
25. Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277-4. CrossRef
26. Paulson EK, Sheafor DH, Enterline DS, McAdams HP, Yoshizumi TT. CT fluoroscopy-guided interventional procedures: techniques and radiation dose to radiologists. Radiology. 2001;220(1):161-. CrossRef
27. Daly B, Templeton PA. Real-time CT fluoroscopy: evolution of an interventional tool. Radiology. 1999;211(2):309-5. CrossRef
28. Katada K, Kato R, Anno H, Ogura Y, Koga S, Ida Y, et al. Guidance with real-time CT fluoroscopy: early clinical experience. Radiology. 1996;200(3):851-.
29. Silverman SG, Tuncali K, Adams DF, Nawfel RD, Zou KH, Judy PF. CT fluoroscopy-guided abdominal interventions: techniques, results, and radiation exposure. Radiology. 1999;212(3):673-1. CrossRef
30. Hohl C, Suess C, Wildberger JE, Honnef D, Das M, Muhlenbruch G, et al. Dose reduction during CT fluoroscopy: phantom study of angular beam modulation. Radiology. 2008;246(2):519-5. CrossRef - 作者单位：Frederik F. Strobl (1)
Sophia M. Haeussler (1)
Philipp M. Paprottka (1)
Ralf-Thorsten Hoffmann (1)
Oliver Pieske (2)
Maximilian F. Reiser (1)
Christoph G. Trumm (1)
1. Institute for Clinical Radiology, Marchioninistr. 15, 81377, Munich, Germany
2. Department of Trauma Surgery, Ludwig-Maximilians-University Hospital Munich, Marchioninistr 15, 81377, Munich, Germany - ISSN：1432-2161
文摘
Purpose To evaluate technical success, complications, and effective dose in patients undergoing CT fluoroscopy-guided iliosacral screw placement for the fixation of unstable posterior pelvic ring injuries. Materials and methods Our retrospective analysis includes all consecutive patients with vertical sacral fractures and/or injury of the iliosacral joint treated with CT fluoroscopy-guided screw placement in our department from 11/2005 to 03/2013. Interventions were carried out under general anesthesia and CT fluoroscopy (10-0?mAs; 120?kV; 16- or 128-row scanner, Siemens Healthcare, Erlangen, Germany). Technical outcome, major and minor complications, and effective patient dose were analyzed. Results We treated 99 consecutive patients (mean age 53.1?±-1.7?years, 50 male, 49 female) with posterior pelvic ring instability with CT fluoroscopy-guided screw placement. Intervention was technically successful in all patients (n--9). No major and one minor local complication occurred (1?%, secondary screw dislocation). General complications included three cases of death (3?%) due to pulmonary embolism (n--), hemorrhagic shock (n--), or cardiac event (n--) during a follow-up period of 30?days. General complications were not related to the intervention. Mean effective patient radiation dose per intervention was 12.28?mSv?±-.25?mSv. Mean procedural time was 72.1?±-7.4?min. Conclusions CT fluoroscopy-guided screw placement for the treatment of posterior pelvic ring instabilities can be performed with high technical success and a low complication rate. This method provides excellent intrainterventional visualization of iliac and sacral bones, as well as the sacral neuroforamina for precise screw placement by applying an acceptable effective patient dose.