A novel CT classification of sacroiliac screw bony channels and safety and accuracy assessment of sacroiliac screw placement: a clinical evaluation
10.3760/cma.j.cn115530-20250528-00231
- VernacularTitle:骶髂关节螺钉骨性通道CT分类及螺钉置入后准确性与安全性评估的临床研究
- Author:
Jiahui ZHANG
1
;
Xing HAN
;
Yubo ZHENG
;
Xin ZHAO
;
Xiguang SANG
Author Information
1. 山东大学齐鲁医院急诊外科，济南 250012
- Publication Type:Journal Article
- Keywords:
Pelvis;
Fractures, bone;
Fracture fixation, internal;
Surgical procedures;
Sacroiliac joint screws
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(9):781-788
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate a novel classification of sacroiliac screw bony channels based on CT axial scans proposed by the present study and a new grading system for accuracy and safety of sacroiliac screw placement.Methods:A retrospective study was conducted to analyze the data of 132 patients with pelvic fracture who had undergone percutaneous fixation of the posterior pelvic ring with sacroiliac screws at Department of Emergency Surgery, Qilu Hospital of Shandong University from January 2023 to January 2025. In this cohort, 79 cases were male and 53 ones female, with an age of (44.9±12.4) years. According to the Denis classification of sacral fractures, 69 cases were of type 1, 54 cases of type 2 and 9 cases of type 3. A total of 160 sacroiliac screws were placed in this cohort. Based on the preoperative CT axial plain scans of the sacrum, a novel CT classification of sacroiliac screw bony channels was proposed as follows: S 1 screw parallel channel (71 screws inserted), S 1 screw oblique channel (31 screws inserted), and S 2 screw parallel channel (58 screws inserted). A new grading system for accuracy and safety of sacroiliac screw placement was developed based on the position of sacroiliac screw relative to that of sacroiliac bony channel in postoperative CT axial scan: grade 1: screw completely within the bony channel; grade 2: screw incompletely within the bony channel without contacting the anterior or posterior cortex; grade 3: contacting but not penetrating the cortex; grade 4: penetrating the cortex. Six senior surgeons verified the inter-observer consistency and intra-observer repeatability of the new grading system for accuracy and safety of sacroiliac screw placement. Results:According to the new grading system for accuracy and safety of sacroiliac screw placement, of the 160 sacroiliac screws placed in the 132 patients, 122 were graded as grade 1, 19 as grade 2, 9 as grade 3, and 10 as grade 4, yielding an excellent and good rate of 88.13% (141/160), and an acceptability rate of 93.75% (150/160). The Kappa values for inter-observer consistency and intra-observer repeatability of the new grading system were 0.87 and 0.97, respectively. All the 132 patients were followed up for (18.3±3.6) months after surgery. During the follow-up period, none of the patients experienced such complications as retraction, breakage, or infection of the screws. Screw loosening occurred in some patients who were followed up for more than 1 year [5.51% (7/127), with 3 S 1 screws of grade 3 and 4 S 1 screws of grade 4]. Conclusion:The novel classification of sacroiliac screw bony channels based on CT axial scans proposed by the present study and the new grading system for accuracy and safety of sacroiliac screw placement can lead to a high acceptability rate of sacroiliac screw placement, indicating clinical practicality of the novel classification and the new grading system.
