（一）请介绍一下骶髂螺钉相关的解剖学知识。
Here is an introduction to the key anatomy relevant for iliosacral screw placement:
以下是与髂骶螺钉放置相关的关键解剖结构的介绍：
Sacrum - Triangular bone formed by fusion of 5 sacral vertebrae. Important landmarks are the sacral canal, neuroforamina, and sacroiliac joint.
骶骨 - 由 5 块骶椎骨融合形成的三角形骨。重要的地标是骶管、神经孔和骶髂关节。
Sacral Corridor - Pathway for screw insertion through the sacrum. Bordered by the spinal canal posteriorly, sacral ala laterally, and anterior cortex of sacrum.
骶骨走廊 - 螺钉插入骶骨的途径。后侧与椎管接壤，侧与骶鼻翼接壤，骶骨前皮质接壤。
Iliosacral Corridor - Refers to the corridor from outer table of ilium through sacrum. screw aims to engage this corridor.
髂骶走廊 - 指从髂骨外表到骶骨的走廊。螺丝旨在接合这条走廊。
S1 Body - Superior sacral segment with largest size. Common target for screw placement.
S1 身体 - 最大尺寸的骶上段。螺钉放置的常见目标。
S2 Body - Second sacral segment, smaller than S1, can also accommodate screws.
S2 本体 - 第二骶节段，小于 S1，也可以容纳螺钉。
Superior Endplate of S1 - Important fluoroscopic landmark.
S1 的上端板 - 重要的透视地标。
Sacroiliac Joint - Irregular joint between sacrum and ilium. Guides optimal screw trajectory.
骶髂关节 - 骶骨和髂骨之间的不规则关节。引导最佳螺杆轨迹。
Greater Sciatic Notch - Opening on the posterior pelvis, allows passage of the sciatic nerve. Screws should avoid this area.
坐骨神经大切口 - 在骨盆后部开口，允许坐骨神经通过。螺钉应避开该区域。
Sacral Dysmorphism - Anatomical variations like mammillary bodies, residual disc spaces, irregular neural foramina. Increase risk for screw misplacement.
骶骨畸形 - 解剖学变异，如体、残余椎间盘空间、不规则神经孔。增加螺钉错位的风险。
Neurovascular Structures - Sciatic nerve, superior gluteal artery and vein, lumbosacral plexus are at risk for injury from screw placement.
神经血管结构 - 坐骨神经、臀上动脉和静脉、腰骶丛有因放置螺钉而受伤的风险。
A solid understanding of the bony corridors for screw passage, surrounding neurovascular anatomy, and fluoroscopic landmarks is essential prior to performing iliosacral screw fixation.
在进行髂骶螺钉固定术之前，必须充分了解螺钉通道的骨走廊、周围的神经血管解剖结构和透视标志。
（二）请介绍一下骶髂螺钉置入的 最佳步骤。
Here are the best steps for iliosacral screw placement:
以下是髂骶螺钉放置的最佳步骤：
- Preoperative CT assessment
术前 CT 评估
- Evaluate sacral anatomy to determine optimal screw trajectory.
评估骶骨解剖结构以确定最佳螺钉轨迹。 - Measure ideal inlet and outlet view angles to prepare for intraoperative imaging.
测量理想的入口和出口视角，为术中成像做好准备。
- Intraoperative preparation
术中准备
- Use prone positioning to improve exposure and visualization.
使用俯卧位来改善曝光和可视化。 - Ensure high-quality C-arm fluoroscopy capable of obtaining inlet and outlet views.
确保高质量的C型臂透视能够获得入口和出口视图。 - Have screws and guidewires ready.
准备好螺钉和导丝。
- Guidewire insertion 导丝插入
- Insert guidewire under C-arm guidance, checking inlet and outlet views repeatedly.
在 C 型臂引导下插入导丝，反复检查入口和出口视图。 - Tamp guidewire gently to ensure it is in ideal osseous corridor.
轻轻地捣碎导丝，以确保它位于理想的骨走廊中。
- Screw insertion 螺钉插入
- Insert screw over guidewire.
将螺钉插入导丝上。 - Feel for increasing resistance indicating cortical perforation.
感觉阻力增加提示皮质穿孔。 - Recheck fluoroscopic views to confirm screw position.
重新检查透视视图以确认螺钉位置。
- Postoperative assessment
术后评估
- Perform CT to evaluate screw position.
进行 CT 以评估螺钉位置。 - Look for neurovascular complications.
寻找神经血管并发症。 - Plan functional rehab based on fracture reduction.
根据骨折复位计划功能性康复。
In summary, preoperative assessment, intraoperative imaging guidance, and precise surgical technique are critical for safe and effective iliosacral screw placement for unstable posterior pelvic ring fractures.
总之，术前评估、术中影像学指导和精确的手术技术对于安全有效地放置不稳定的骨盆后环骨折的髂骶螺钉至关重要。
（三）骶髂螺钉失败怎么补救？
Here are some tips on how to remedy failed iliosacral screw placement:
以下是有关如何补救髂骶螺钉放置失败的一些提示：
- Assess the cause - Use postoperative imaging to determine if failure is due to screw malposition, loosening, pullout, or nonunion. Identify the location and direction of failure.
评估病因 - 使用术后影像学检查确定失败是由于螺钉错位、松动、拔出还是不愈合。确定故障的位置和方向。 - Manage inflammation - If infected, perform incision and drainage, remove hardware, and treat with antibiotics based on cultures. Manage inflammation before revision surgery.
管理炎症 - 如果感染，进行切开引流，移除硬件，并根据培养物使用抗生素治疗。在翻修手术前管理炎症。 - Improve bone quality - Optimize nutrition, calcium, vitamin D, and treat any metabolic bone disease to improve sacral bone density prior to revision.
改善骨骼质量 - 优化营养、钙、维生素 D，并在翻修前治疗任何代谢性骨病以改善骶骨密度。 - Revise screw trajectory - Consider a different insertion point, angle, and sacral level that avoids previously used bone corridors. Lengthen screw purchase if possible.
修改螺钉轨迹 - 考虑不同的插入点、角度和骶部水平，以避免以前使用的骨走廊。如果可能，请加长螺钉购买。 - Utilize additional fixation - Add an anterior external fixator or internal fixation to share load transmission across the pelvis rather than isolated on screws.
利用额外的固定 - 添加前外固定器或内部固定器，以分担跨骨盆的负荷传递，而不是隔离在螺钉上。 - Change technique - Abandon percutaneous approach and perform open reduction internal fixation or spinopelvic fixation if poor bone quality or anatomy prevents adequate percutaneous fixation.
改变技术 - 如果骨质量或解剖结构不佳妨碍充分经皮内固定，则放弃经皮入路，进行切开复位内固定或脊髓外固定。 - Bone graft nonunions - For symptomatic nonunions, perform open reduction, decortication, and bone grafting to stimulate union.
骨移植不愈合 - 对于有症状的不愈合，应进行切开复位、去皮质和骨移植以刺激愈合。 - Manage complications - Aggressively treat any neurological deficits that arise from screw placement. Provide pain management and support ambulation as needed.
管理并发症 - 积极治疗因螺钉放置引起的任何神经功能缺损。根据需要提供疼痛管理和支持行走。 - Seek expertise - Early consultation with a pelvic specialist can facilitate difficult revision decisions and surgery if initial management fails.
寻求专科医生 - 如果初始治疗失败，早期咨询盆腔专科医生有助于做出困难的翻修决定和手术。
Staying vigilant about potential failure mechanisms, having a low threshold to intervene when required, and being flexible regarding surgical options can help get pelvic fixation back on track when iliosacral screws do not achieve the desired outcome initially.
对潜在的故障机制保持警惕，在需要时进行干预的阈值较低，并在手术选择方面保持灵活性，可以帮助在髂骶螺钉最初未达到预期结果时使骨盆固定重回正轨。
（四）怎样学习骶髂螺钉置入技术？
Here are some tips on how to learn and master the iliosacral screw insertion technique:
以下是有关如何学习和掌握髂骶螺钉插入技术的一些提示：
- Study the anatomy thoroughly - Focus on the sacrum, sacroiliac joint, and surrounding neurovascular structures. Understand the osseous corridors and safe trajectories for screw placement.
彻底研究解剖结构 - 专注于骶骨、骶髂关节和周围的神经血管结构。了解骨廊和螺钉放置的安全轨迹。 - Observe experienced surgeons - Scrub in and watch an expert perform the procedure. Take note of patient positioning, use of imaging, surgical steps, tricks to reduce radiation exposure. Ask questions about their technique.
观察经验丰富的外科医生 - 擦洗并观看专家执行手术。注意患者定位，成像使用，手术步骤，减少辐射暴露的技巧。询问有关他们的技术的问题。 - Start slowly and simply - Begin by placing screws in non-dysmorphic sacra. Use one screw rather than two. Place screws in S1 rather than S2 given its larger corridor. Stick to inlet and outlet views only.
缓慢而简单地开始 - 首先将螺钉放在非畸形骶骨中。使用一个螺钉而不是两个螺钉。将螺钉放在 S1 而不是 S2 中，因为它的走廊更大。仅坚持入口和出口视图。 - Use image guidance - Fluoroscopy, navigation systems, or 3D imaging can enhance precision and safety, especially as a beginner. Don't rely solely on tactile feedback when starting out.
使用图像引导 - 透视、导航系统或 3D 成像可以提高精度和安全性，尤其是作为初学者。开始时不要仅仅依赖触觉反馈。 - Consider cadaveric workshops - Hands-on practice under supervision builds confidence with guidewire/drill handling and tactile sensations. Allows trialing different entry points and trajectories.
考虑尸体工作坊 - 在监督下动手练习，通过导丝/钻头处理和触觉建立信心。允许试用不同的入口点和轨迹。 - Partner with a mentor - Have an experienced pelvic surgeon provide guidance on pre-op planning, screw trajectory choices, troubleshooting intraoperative issues. Review postoperative imaging together.
与导师合作 - 让经验丰富的盆腔外科医生提供有关术前计划、螺钉轨迹选择、术中问题故障排除的指导。一起回顾术后影像学检查。 - Be patient and reflective - Don't rush the learning process. Analyze difficulties encountered and improve for the next case. Be vigilant about radiation safety.
要有耐心和反思 - 不要急于学习过程。分析遇到的困难并改进下一个案例。对辐射安全保持警惕。 - Measure outcomes - Track radiation exposure, screw position accuracy, complications. Strive for continuous improvement. Consider a registry to benchmark progress.
测量结果 - 跟踪辐射暴露、螺钉位置精度、并发症。力求持续改进。考虑使用注册表来衡量进度。
With a stepwise approach focused on anatomy, seeking mentorship, and dedication to self-assessment and lifelong learning, mastery of iliosacral screw placement can be achieved. Patience and upholding high safety standards are essential when adopting this advanced technique.
通过专注于解剖学的逐步方法，寻求指导，并致力于自我评估和终身学习，可以实现髂骶螺钉放置的掌握。在采用这种先进技术时，耐心和坚持高安全标准至关重要。
（五）写一份关于骶髂螺钉技术的要点
Here is a summary of the key points about the iliosacral screw fixation technique:
以下是关于髂骶螺钉固定技术的要点摘要：
- Iliosacral screw fixation is a minimally invasive method to stabilize posterior pelvic ring injuries like fractures of the sacrum or sacroiliac joint. It provides adequate stability while reducing complications compared to open techniques.
髂骶螺钉固定术是一种微创方法，用于稳定骨盆后环损伤，如骶骨或骶髂关节骨折。与开放式技术相比，它提供了足够的稳定性，同时减少了并发症。 - Proper screw placement is critical to avoid nerve and vascular injuries. Precise placement relies on understanding the anatomy of the upper sacrum, obtaining good fracture reduction, and using intraoperative imaging guidance.
正确的螺钉放置对于避免神经和血管损伤至关重要。精确放置依赖于了解上骶骨的解剖结构，获得良好的骨折复位，并使用术中影像学引导。 - Preoperative planning using CT scans helps determine the ideal screw trajectory and anticipate the inlet and outlet X-ray angles needed intraoperatively. Having this plan facilitates getting the correct intraoperative fluoroscopic views quickly.
使用 CT 扫描的术前计划有助于确定理想的螺钉轨迹，并预测术中所需的入口和出口 X 射线角度。制定此计划有助于快速获得正确的术中透视视图。 - The surgical technique involves making a small incision, inserting a guidewire through the outer table of the ilium into the body of the sacrum under fluoroscopic guidance, drilling over the wire, and placing a cannulated screw. Inlet, outlet, and lateral views are checked repeatedly during the procedure.
手术技术包括做一个小切口，在透视引导下将导丝穿过髂骨的外表插入骶骨体，在导线上钻孔，并放置一个空心螺钉。在手术过程中反复检查入口、出口和侧视图。 - Positioning the patient prone can improve access and visualization compared to supine. Using two iliosacral screws increases stability but has a higher risk of malpositioning versus one screw.
与仰卧位相比，对患者俯卧位进行定位可以改善通道和可视化。使用两个髂骶螺钉可提高稳定性，但与一个螺钉相比，错位的风险更高。 - Postoperative CT assessment of screw position is recommended. Mobilization progresses from non-weight bearing to full weight bearing over 2-3 months as the fracture heals. Hardware removal may be done once the fracture has united.
建议对螺钉位置进行术后 CT 评估。随着骨折愈合，活动从非负重进展为完全负重，持续 2-3 个月。一旦断裂结合，就可以卸下硬件。
In summary, meticulous preoperative planning, intraoperative imaging guidance, and careful surgical technique are key to safely and effectively using iliosacral screw fixation for unstable posterior pelvic ring injuries.
总之，细致的术前计划、术中影像学指导和细致的手术技术是安全有效地使用髂骶螺钉固定治疗不稳定的后盆腔环损伤的关键。
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