PMC9852618_01
The imaging examination before surgery. (A) The anteroposterior radiograph of pelvis. (B) Three-dimensional reconstruction of pelvis.
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F1
She sustained a rotationally unstable pelvic posterior ring injury (Tile B2-1) consisting of a right sacroiliac joint fracture, an ipsilateral fracture of upper and lower ramus of pubis and an ipsilateral L5 transverse process fracture (Figure 1).
Design of the guide template. (A) Example of preoperative planning for S1 screw placement. (B) Example of preoperative planning for S2 screw placement.
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F2
It was intended to navigate the guidewires into the safe zone between the neuroforamen and the cortex of the sacrum accurately (Figure 2).
3D printing model of this case. (A) The anchoring surface is used to fix the template next to the anterior superior iliac spine. (B) The bridging rod is a connection between the anchoring surface and the positioning hole outside the body. The positioning hole is used for percutaneous insertion of the guidewire.
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F3
The guide template is composed of three parts (Figure 3): anchoring surface, bridging rod, and positioning hole.
Standard posture of the patients with sacroiliac screw fixation assisted by intraoperative CT.
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F4
The patient positioned supine on a radiolucent table in an operating room integrated with mobile intraoperative CT scanner, and the standard posture was shown in the Figure 4.
The processes in inserting guidewires with 3D printing guide template. (A) Make an incision on the body surface next to the anterior superior iliac spine. (B,C) Anchor the S1 and S2 screw guide templates at the iliac spine respectively and place the guidewires along the positioning hole.
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F5
Make an incision on the body surface next to the anterior superior iliac spine, anchor the S1 and S2 screw guide templates at the iliac spine respectively, and place the guidewires along the positioning hole (Figure 5).
Radiographic imaging with C-arm.
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F6
After the placement was verified with rail-bound CT, cannulated screws were inserted for fixation (Figure 6).
The operation workflow.
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F7
The operation workflow was shown in Figure 7.
Imaging verification with rail-bound CT during operation. (A,B) Horizontal view. (C,D) Coronal view. (E) Sagittal view.
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F8
The screws were accurately placed in the safe zone as shown in the Figure 8.