Objective To design a novel 3D-printed guide plate attached to the anterior superior iliac spine (ASIS) and evaluate its efficacy and safety in assisting sacroiliac screw placement for the treatment of unstable posterior pelvic ring injuries. Methods A retrospective analysis was conducted on 60 patients with posterior pelvic ring injuries treated with sacroiliac screw fixation in our hospital from March 2021 to March 2024. Among them, 27 patients underwent sacroiliac screw placement assisted by the 3D-printed ASIS guide plate (study group), while 33 patients received conventional fluoroscopy-guided percutaneous manual screw placement (control group). There were no statistically significant differences in baseline characteristics such as gender, age, time from injury to surgery, injury mechanism, or fracture classification between the two groups (P>0.05). Comparisons were made regarding intraoperative blood loss, screw placement time per screw, number of fluoroscopic exposures, number of guidewire adjustments, and incidence of postoperative complications. Postoperative CT scans were reviewed to assess the excellent rate of screw placement using the Smith criteria and the quality of pelvic reduction using the Matta score. The accuracy of screw placement was evaluated by measuring the deviation of the actual screw trajectory from the planned trajectory preoperatively and postoperatively. Functional recovery at the final follow-up was assessed using the Majeed score. Results Intraoperative blood loss was greater in the study group than in the control group (P<0.05). The screw placement time, number of fluoroscopic exposures, and number of guidewire adjustments were all significantly lower in the study group (P<0.05). There was no statistically significant difference between the two groups regarding postoperative screw placement according to the Smith classification, pelvic reduction quality according to the Matta score, or functional recovery according to the Majeed score (P>0.05). However, one case in the control group experienced screw penetration into the sacral foramen, resulting in neurological symptoms. In the study group, the deviations between the actual entry and target points of the screws and their virtual planned positions were (3.91±1.88) mm and (4.37±2.53) mm, respectively, the deviation angle was (4.10±2.05)°. Conclusions The application of the 3D-printed ASIS guide plate technique for sacroiliac screw placement in posterior pelvic ring fractures can reduce screw placement time, decrease the number of intraoperative fluoroscopic exposures and guidewire adjustments, and lower the risk of screw penetration through the bone cortex, thus improving surgical efficiency and screw implantation safety.
Key words
3D printing technology /
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Pelvis fracture /
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Sacroiliac screw accuracy
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