骨盆腔骨折之亞洲女性於術中發生6.5公厘骶髂關節螺釘彎曲

Intra-Operative Screw Bending of a 6.5mm Iliosacral Screw during Pelvic Fracture Fixation in an Asian Female

一名19 歲的女娃因為骨盆腔及骶髂骨折送至急診，骨盆腔電腦斷層顯示她上下恥骨支及骶骨左翼有移位性骨折。因此，她接受復位及內固定手術，以經皮骶髂關節螺釘及順行性前柱螺釘進行固定。我們使用6.5公厘的骶髂關節螺釘，因為缺乏7.5公厘的骶髂關節螺釘。進行骶髂關節螺釘固定後，原本移位的恥骨己近完全復位。然而，當進行順行性前柱螺釘固定時，骶髂關節螺釘卻開始彎曲。因此可知，進行恥骨支復位時，骶髂關節應承受超過5.050N．m的力量。由於這個少見的併發症，吾人建議若遇需緊接著復位的移位性恥骨支骨折時，宜使用7.5公厘的骶髂關節螺釘來固定骶骨骨折。

A 19-year-old woman presented to the emergency department with a pelvic and sacral fracture. Computed tomography of the pelvis showed displaced left superior and inferior pubic rami and fracture of the left ala of the sacrum. She received percutaneous iliosacral and antegrade anterior column screw fixation. A 6.5mm iliosacral screw was used first because a 7.5mm screw was unavailable. The displaced pubic rami were nearly reduced after the iliosacral screw fixation. With the application of an antegrade anterior column screw, the sacroiliac screw began bending. The sacrum will endure more than 5.050 N‧m during the reduction of a pubic ramus fracture. Because of this very uncommon complication, we suggest that a 7.5mm screw be used for sacral fracture if there is a displaced pubic rami fracture that will be subsequently fixed with a screw.