A novel computer navigation method for accurate percutaneous sacroiliac screw implantation: A technical note and literature review

The purpose of this study was to assess the accuracy of percutaneous sacroiliac screw (PSS) placement assisted by screw view model of navigation system for treatment of sacroiliac fractures. Data pertaining to 18 consecutive patients with posterior pelvic ring fracture who received sacroiliac screw fixation between January 2015 and July 2018 at the Second Hospital of Jilin University were retrospectively analyzed. Kirschner wires were placed under the guidance of navigation's screw view mode. The position of the screws was evaluated by computed tomography (CT) scan postoperatively. Fracture dislocation of sacroiliac joint was measured in axial, sagittal, and coronal views of 3 dimensional (3D) CT images preoperatively, postoperatively and at the last follow-up visit. The duration of trajectory planning, guide wire implantation time, screw placement time, intraoperative blood loss, and incidence of screw loosening and clinical complications were also assessed. A total of 27 screws were placed unilaterally or bilaterally into segments S1 or S2. Screw placement was rated as excellent for 88.9% of screws (n = 24), good for 7.4% (n = 2), and poor for 3.7% (n = 1). Preoperatively, the average fracture dislocation of sacroiliac joint on axial, sagittal, and coronal views was 14.3 mm, 9.6 mm, and 7.4 mm, respectively, and the corresponding postoperative figures were 5.6 mm, 3.2 mm, 4.1 mm, respectively. The corresponding correction rates were 60.8%, 66.7%, and 44.6%, respectively. The mean duration of trajectory planning was 6.5 min (2.7–8.9 min). Mean screw implantation time was 32 min (range, 20–53 min), and the mean guide wire implantation time was 3.7 min (range, 2.1–5.3 min). No clinical complications such as neurovascular injury, infection or screw loosening were observed on follow-up. The PSS placement under guidance of screw view model of navigation is a convenient, safe and reliable method.