World neurosurgery · 2019
Traumatic Sacral Fractures: Navigation Technique in Instrumented Stabilization.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Santoro Giorgio, Braidotti Piero, Gregori Fabrizio, Santoro Antonio, Domenicucci Maurizio
Аннотация
BACKGROUND: Sacral fractures are a challenge regarding treatment and classification. Surgical techniques using spinal navigation systems can improve treatment, especially if used in collaboration among different specialists.
METHODS: Between 2015 and 2017, we treated 25 consecutive cases of sacral fracture. Twelve patients (48%) underwent mechanical ventilation due to hypovolemic shock for severe thoracoabdominal trauma; bleeding was blocked with pelvic packing in 9 cases (36%) and transcatheter embolization in 2 cases (8%). External fixation was used in 7 cases (28%). In 20 cases (80%) spinal fractures were associated. All patients were operated on using spinal navigation by a team of neurosurgeons and orthopedic surgeons.
RESULTS: The mean time from first observation to surgery was 18 days (range 8-31). Surgical treatment consisted of iliosacral fixation in 19 cases (76%) and spinopelvic fixation in 6 cases (24%). The mean number of screws for spinopelvic fixation was 9.67 (range 6-17) with a mean operation time of 323.67 minutes (range 247-471); in iliosacral osteosynthesis the mean screw number was 1.37 (range 1-3) and mean surgical time was 78.93 minutes (range 61-130). Postoperative computed tomography showed the correct screw placement. Wound infection occurred in 2 cases (8%), managed with vacuum-assisted closure therapy; in 1 case (4%) a sacral screw was removed for decubitus.
CONCLUSIONS: Navigation systems in instrumented spinopelvic and sacropelvic reconstruction provide greater safety, reducing learning times and malpositioning. Multidisciplinary management allows us to achieve optimal results, especially when the sacral fracture is combined with spinal and pelvic lesions. The use of navigation systems could represent an important advancement.
METHODS: Between 2015 and 2017, we treated 25 consecutive cases of sacral fracture. Twelve patients (48%) underwent mechanical ventilation due to hypovolemic shock for severe thoracoabdominal trauma; bleeding was blocked with pelvic packing in 9 cases (36%) and transcatheter embolization in 2 cases (8%). External fixation was used in 7 cases (28%). In 20 cases (80%) spinal fractures were associated. All patients were operated on using spinal navigation by a team of neurosurgeons and orthopedic surgeons.
RESULTS: The mean time from first observation to surgery was 18 days (range 8-31). Surgical treatment consisted of iliosacral fixation in 19 cases (76%) and spinopelvic fixation in 6 cases (24%). The mean number of screws for spinopelvic fixation was 9.67 (range 6-17) with a mean operation time of 323.67 minutes (range 247-471); in iliosacral osteosynthesis the mean screw number was 1.37 (range 1-3) and mean surgical time was 78.93 minutes (range 61-130). Postoperative computed tomography showed the correct screw placement. Wound infection occurred in 2 cases (8%), managed with vacuum-assisted closure therapy; in 1 case (4%) a sacral screw was removed for decubitus.
CONCLUSIONS: Navigation systems in instrumented spinopelvic and sacropelvic reconstruction provide greater safety, reducing learning times and malpositioning. Multidisciplinary management allows us to achieve optimal results, especially when the sacral fracture is combined with spinal and pelvic lesions. The use of navigation systems could represent an important advancement.