Effectiveness of sacroiliac screw implantation assisted by three-dimensional printed faceted honeycomb guide plate in treatment of posterior pelvic ring fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SHENG Bin ¹ , LIU Chao ² , WANG Yiwei ¹ , XIAO Rui ¹ , LU Ying ¹ , LIU Delong ¹ , YANG Zhanyu ¹ , WANG Yusi ¹

1. Department of Orthopedic Ward 7, Hunan Provincial People’s Hospital (First Af?liated Hospital of Hunan Normal University), Changsha Hunan, 410000, P. R. China;
2. Department of Orthopedic Ward 4, Changsha Fourth Hospital (Changsha Integration Medicine Hospital), Changsha Hunan, 410000, P. R. China;

Corresponding?author：

SHENG Bin, Email: shengbin2009@163.com

Keywords：

Sacroiliac screw; posterior pelvic ring fracture; three-dimensional printing; surgical guide plate

DOI：

10.7507/1002-1892.202405078

Video：

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Objective To investigate the effectiveness of sacroiliac screw implantation assisted by three-dimensional (3D) printed faceted honeycomb guide plate in the treatment of posterior pelvic ring fracture. Methods The clinical data of 40 patients with posterior pelvic ring fractures treated with sacroiliac screw implantation between December 2019 and December 2022 were retrospectively analyzed. Among them, 18 cases were treated with sacroiliac screws fixation assisted by 3D printed faceted honeycomb guide plate (guide plate group), and 22 cases were treated with sacroiliac screws percutaneously fixation under fluoroscopy (conventional group). There was no significant difference in baseline data (P>0.05) such as gender, age, time from injury to operation, and Dennis classification between the two groups. The implantation time, frequency of C-arm X-ray fluoroscopy, frequency of guide pin adjustment of each sacroiliac screw, and postoperative complications and bone healing were recorded. Majeed score was used to evaluate the functional recovery at 6 months after operation, and CT was used to observe whether the screw penetrated the bone cortex. The deviation between the virtual position and the actual position of the screw tip, the sacral foramen, and the screw entry point was measured on the sagittal CT images of the guide plate group. Results The number of screws implanted in S₁ and S₂ vertebral bodies was 14 and 16 respectively in the guide plate group, and 17 and 18 respectively in the conventional group. The implantation time of each sacroiliac screw, the frequency of C-arm X-ray fluoroscopy, and the frequency of guide pin adjustment in S₁, S₂, and all vertebrae in the guide plate group were significantly less than those in the conventional group (P<0.05). Patients in both groups were followed up 8-48 months, with an average of 19.7 months. There was no incision infection, screw displacement, or internal fixation loosening in both groups. Callus growth was observed in all patients at 12 weeks after operation, and bone healing was achieved in all patients. The healing time ranged from 12 to 24 weeks, with an average of 15.7 weeks. No sacroiliac screw penetrated the bone cortex in the guide plate group; 2 patients in the conventional group had sacroiliac screws penetrating the bone cortex without damaging blood vessels or nerves. In the guide plate group, the deviation between the virtual position and the actual position of the screw tip, the sacral foramen, and the screw entry point were (2.91±1.01), (2.10±0.74), and (1.67±0.70) mm, respectively, with an average deviation of (2.19±1.22) mm. There was no significant difference in Majeed function evaluation between the two groups at 6 months after operation (P>0.05). Conclusion The application of 3D printed faceted honeycomb guide plate in sacroiliac screw implantation for posterior pelvic ring fracture can shorten the screw implantation time, reduce the frequency of fluoroscopy and guide pin adjustment, and reduce the risk of screw penetration through the bone cortex.

Citation： SHENG Bin, LIU Chao, WANG Yiwei, XIAO Rui, LU Ying, LIU Delong, YANG Zhanyu, WANG Yusi. Effectiveness of sacroiliac screw implantation assisted by three-dimensional printed faceted honeycomb guide plate in treatment of posterior pelvic ring fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(11): 1317-1324. doi: 10.7507/1002-1892.202405078 Copy

1.	Lee CH, Hsu CC, Huang PY. Biomechanical study of different fixation techniques for the treatment of sacroiliac joint injuries using finite element analyses and biomechanical tests. Comput Biol Med, 2017, 87: 250-257.
2.	Kaiser SP, Gardner MJ, Liu J, et al. Anatomic determinants of sacral dysmorphism and implications for safe iliosacral screw placement. J Bone Joint Surg (Am), 2014, 96(14): e120. doi: 10.2106/JBJS.M.00895.
3.	Chon CS, Jeong JH, Kang B, et al. Computational simulation study on ilio-sacral screw fixations for pelvic ring injuries and implications in Asian sacrum. Eur J Orthop Surg Traumatol, 2018, 28(3): 439-444.
4.	Yang Z, Sheng B, Liu D, et al. Intraoperative CT-assisted sacroiliac screws fixation for the treatment of posterior pelvic ring injury: a comparative study with conventional intraoperative imaging. Sci Rep, 2022, 12(1): 17767. doi: 10.1038/s41598-022-22706-y.
5.	Weil YA, Khoury A, Mosheiff R, et al. Robotic assisted fixation of sacral fractures: A pilot study. OTA Int, 2019, 2(4): e046. doi: 10.1097/OI9.0000000000000046.
6.	陽宏奇, 雷青, 蔡立宏, 等. 3D 打印導板輔助空心螺釘內固定治療不穩定性骨盆骨折. 中國修復重建外科雜志, 2018, 32(2): 145-151.
7.	Yang F, Yao S, Chen KF, et al. A novel patient-specific three-dimensional-printed external template to guide iliosacral screw insertion: a retrospective study. BMC Musculoskelet Disord, 2018, 19(1): 397. doi: 10.1186/s12891-018-2320-3.
8.	Yang Z, Sheng B, Liu D, et al. Sacroiliac screws fixation navigated with three-dimensional printing personalized guide template for the treatment of posterior pelvic ring injury: A case report. Front Surg, 2023, 9: 1025650. doi: 10.3389/fsurg.2022.1025650.
9.	劉峰, 雷青, 蔡立宏, 等. 改良經皮三維打印導板與傳統透視輔助骶髂螺釘固定骨盆后環骨折的療效比較. 中南大學學報 (醫學版), 2023, 48(11): 1703-1710.
10.	陶星光, 周凱華. 基于外固定支架的3D打印導板在骨盆骨折中的應用. 中華創傷骨科雜志, 2018, 20(3): 235-241.
11.	盛斌. 輔助骶髂螺釘置入的3D打印蜂窩頭導板: 2023: 20690759[P]. 2023-10-26.
12.	Wu T, Ren X, Cui Y, et al. Biomechanical study of three kinds of internal fixation for the treatment of sacroiliac joint disruption using biomechanical test and finite element analysis. J Orthop Surg Res, 2018, 13(1): 152. doi: 10.1186/s13018-018-0858-2.
13.	Takao M, Hamada H, Sakai T, et al. Clinical application of navigation in the surgical treatment of a pelvic ring injury and acetabular fracture. Adv Exp Med Biol, 2018, 1093: 289-305.
14.	Wang J, Zhang T, Han W, et al. Robot-assisted S₂ screw fixation for posterior pelvic ring injury. Injury, 2023, 54 Suppl 2: S3-S7.
15.	Deveci MZY, Lewis DD, Lederer XJ. Evaluation of a 3-D printed drill guide to facilitate fluoroscopic-assisted Kirschner wire placement for minimally invasive iliosacral screw placement in dog cadavers. Am J Vet Res, 2023, 84(9): ajvr. 23.04. 0084. doi: 10.2460/ajvr.23.04.0084.
16.	馬馳, 樸成哲. 3D打印個體化截骨導板輔助開放楔形脛骨高位截骨術的應用現狀. 中國修復重建外科雜志, 2023, 37(3): 360-364.
17.	Wu C, Deng J, Pan J, et al. Anatomical conditions and patient-specific locked navigation templates for transverse sacroiliac screw placement: a retrospective study. J Orthop Surg Res, 2020, 15(1): 260. doi: 10.1186/s13018-020-01752-0.
18.	Kim JW, Quispe JC, Hao J, et al. Fluoroscopic views for a more accurate placement of iliosacral screws: An experimental study. J Orthop Trauma, 2016, 30(1): 34-40.
19.	Ozmeric A, Yucens M, Gulta? E, et al. Are two different projections of the inlet view necessary for the percutaneous placement of iliosacral screws? Bone Joint J, 2015, 97-B(5): 705-710.
20.	Takeba J, Umakoshi K, Kikuchi S, et al. Accuracy of screw fixation using the O-arm^? and StealthStation^? navigation system for unstable pelvic ring fractures. Eur J Orthop Surg Traumatol, 2018, 28(3): 431-438.
21.	You MR, Fan ZQ, Ye HM, et al. The design and application of an individualized 3D printing assisted guide plates in assisting sacroiliac screws insertion. Comput Assist Surg (Abingdon), 2022, 27(1): 113-119.
22.	McCarthy DA, Granger LA, Aulakh KS, et al. Accuracy of a drilling with a custom 3D printed guide or free-hand technique in canine experimental sacroiliac luxations. Vet Surg, 2022, 51(1): 182-190.
23.	Yazigi C, Chaar MS, Busch R, et al. The effect of sterilization on the accuracy and fit of 3D-printed surgical guides. Materials (Basel), 2023, 16(15): 5305. doi: 10.3390/ma16155305.
24.	Wu C, Shen D, Deng J, et al. Navigation template design and the anatomic measurement for anterograde transpubic screws. Orthop Surg, 2022, 14(12): 3408-3416.
25.	Nguyen P, Stanislaus I, McGahon C, et al. Quality assurance in 3D-printing: A dimensional accuracy study of patient-specific 3D-printed vascular anatomical models. Front Med Technol, 2023, 5: 1097850. doi: 10.3389/fmedt.2023.1097850.
26.	Jennison T, McNally M, Pandit H. Prevention of infection in external fixator pin sites. Acta Biomater, 2014, 10(2): 595-603.
27.	Kazmers NH, Fragomen AT, Rozbruch SR. Prevention of pin site infection in external fixation: a review of the literature. Strategies Trauma Limb Reconstr, 2016, 11(2): 75-85.
28.	Cavusoglu AT, Er MS, Inal S, et al. Pin site care during circular external fixation using two different protocols. J Orthop Trauma, 2009, 23(10): 724-730.
29.	Jones-Walton P. Clinical standards in skeletal traction pin site care. Orthop Nurs, 1991, 10(2): 12-16.

1. Lee CH, Hsu CC, Huang PY. Biomechanical study of different fixation techniques for the treatment of sacroiliac joint injuries using finite element analyses and biomechanical tests. Comput Biol Med, 2017, 87: 250-257.
2. Kaiser SP, Gardner MJ, Liu J, et al. Anatomic determinants of sacral dysmorphism and implications for safe iliosacral screw placement. J Bone Joint Surg (Am), 2014, 96(14): e120. doi: 10.2106/JBJS.M.00895.
3. Chon CS, Jeong JH, Kang B, et al. Computational simulation study on ilio-sacral screw fixations for pelvic ring injuries and implications in Asian sacrum. Eur J Orthop Surg Traumatol, 2018, 28(3): 439-444.
4. Yang Z, Sheng B, Liu D, et al. Intraoperative CT-assisted sacroiliac screws fixation for the treatment of posterior pelvic ring injury: a comparative study with conventional intraoperative imaging. Sci Rep, 2022, 12(1): 17767. doi: 10.1038/s41598-022-22706-y.
5. Weil YA, Khoury A, Mosheiff R, et al. Robotic assisted fixation of sacral fractures: A pilot study. OTA Int, 2019, 2(4): e046. doi: 10.1097/OI9.0000000000000046.
6. 陽宏奇, 雷青, 蔡立宏, 等. 3D 打印導板輔助空心螺釘內固定治療不穩定性骨盆骨折. 中國修復重建外科雜志, 2018, 32(2): 145-151.
7. Yang F, Yao S, Chen KF, et al. A novel patient-specific three-dimensional-printed external template to guide iliosacral screw insertion: a retrospective study. BMC Musculoskelet Disord, 2018, 19(1): 397. doi: 10.1186/s12891-018-2320-3.
8. Yang Z, Sheng B, Liu D, et al. Sacroiliac screws fixation navigated with three-dimensional printing personalized guide template for the treatment of posterior pelvic ring injury: A case report. Front Surg, 2023, 9: 1025650. doi: 10.3389/fsurg.2022.1025650.
9. 劉峰, 雷青, 蔡立宏, 等. 改良經皮三維打印導板與傳統透視輔助骶髂螺釘固定骨盆后環骨折的療效比較. 中南大學學報 (醫學版), 2023, 48(11): 1703-1710.
10. 陶星光, 周凱華. 基于外固定支架的3D打印導板在骨盆骨折中的應用. 中華創傷骨科雜志, 2018, 20(3): 235-241.
11. 盛斌. 輔助骶髂螺釘置入的3D打印蜂窩頭導板: 2023: 20690759[P]. 2023-10-26.
12. Wu T, Ren X, Cui Y, et al. Biomechanical study of three kinds of internal fixation for the treatment of sacroiliac joint disruption using biomechanical test and finite element analysis. J Orthop Surg Res, 2018, 13(1): 152. doi: 10.1186/s13018-018-0858-2.
13. Takao M, Hamada H, Sakai T, et al. Clinical application of navigation in the surgical treatment of a pelvic ring injury and acetabular fracture. Adv Exp Med Biol, 2018, 1093: 289-305.
14. Wang J, Zhang T, Han W, et al. Robot-assisted S₂ screw fixation for posterior pelvic ring injury. Injury, 2023, 54 Suppl 2: S3-S7.
15. Deveci MZY, Lewis DD, Lederer XJ. Evaluation of a 3-D printed drill guide to facilitate fluoroscopic-assisted Kirschner wire placement for minimally invasive iliosacral screw placement in dog cadavers. Am J Vet Res, 2023, 84(9): ajvr. 23.04. 0084. doi: 10.2460/ajvr.23.04.0084.
16. 馬馳, 樸成哲. 3D打印個體化截骨導板輔助開放楔形脛骨高位截骨術的應用現狀. 中國修復重建外科雜志, 2023, 37(3): 360-364.
17. Wu C, Deng J, Pan J, et al. Anatomical conditions and patient-specific locked navigation templates for transverse sacroiliac screw placement: a retrospective study. J Orthop Surg Res, 2020, 15(1): 260. doi: 10.1186/s13018-020-01752-0.
18. Kim JW, Quispe JC, Hao J, et al. Fluoroscopic views for a more accurate placement of iliosacral screws: An experimental study. J Orthop Trauma, 2016, 30(1): 34-40.
19. Ozmeric A, Yucens M, Gulta? E, et al. Are two different projections of the inlet view necessary for the percutaneous placement of iliosacral screws? Bone Joint J, 2015, 97-B(5): 705-710.
20. Takeba J, Umakoshi K, Kikuchi S, et al. Accuracy of screw fixation using the O-arm^? and StealthStation^? navigation system for unstable pelvic ring fractures. Eur J Orthop Surg Traumatol, 2018, 28(3): 431-438.
21. You MR, Fan ZQ, Ye HM, et al. The design and application of an individualized 3D printing assisted guide plates in assisting sacroiliac screws insertion. Comput Assist Surg (Abingdon), 2022, 27(1): 113-119.
22. McCarthy DA, Granger LA, Aulakh KS, et al. Accuracy of a drilling with a custom 3D printed guide or free-hand technique in canine experimental sacroiliac luxations. Vet Surg, 2022, 51(1): 182-190.
23. Yazigi C, Chaar MS, Busch R, et al. The effect of sterilization on the accuracy and fit of 3D-printed surgical guides. Materials (Basel), 2023, 16(15): 5305. doi: 10.3390/ma16155305.
24. Wu C, Shen D, Deng J, et al. Navigation template design and the anatomic measurement for anterograde transpubic screws. Orthop Surg, 2022, 14(12): 3408-3416.
25. Nguyen P, Stanislaus I, McGahon C, et al. Quality assurance in 3D-printing: A dimensional accuracy study of patient-specific 3D-printed vascular anatomical models. Front Med Technol, 2023, 5: 1097850. doi: 10.3389/fmedt.2023.1097850.
26. Jennison T, McNally M, Pandit H. Prevention of infection in external fixator pin sites. Acta Biomater, 2014, 10(2): 595-603.
27. Kazmers NH, Fragomen AT, Rozbruch SR. Prevention of pin site infection in external fixation: a review of the literature. Strategies Trauma Limb Reconstr, 2016, 11(2): 75-85.
28. Cavusoglu AT, Er MS, Inal S, et al. Pin site care during circular external fixation using two different protocols. J Orthop Trauma, 2009, 23(10): 724-730.
29. Jones-Walton P. Clinical standards in skeletal traction pin site care. Orthop Nurs, 1991, 10(2): 12-16.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of sacroiliac screw implantation assisted by three-dimensional printed faceted honeycomb guide plate in treatment of posterior pelvic ring fracture

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