Objective: To develop a renewed classification and treatment regimen for sacroiliac joint dislocation.
Methods: According to the direction of dislocation of sacroiliac joint,combined iliac,sacral fractures,and fracture morphology,sacroiliac joint dislocation was classified into 4 types. Type Ⅰ (sacroiliac anterior dislocation): main fracture fragments of posterior iliac wing dislocated in front of sacroiliac joint. Type Ⅱ (sacroiliac posterior dislocation): main fracture fragments of posterior iliac wing dislocated in posterior of sacroiliac joint. Type Ⅲ (Crescent fracturedislocation of the sacroiliac joint): upward dislocation of posterior iliac wing with oblique fracture through posterior iliac wing. Type ⅢA: a large crescent fragment and dislocation comprises no more than onethird of sacroiliac joint,which is typically inferior. Type ⅢB: intermediatesize crescent fragment and dislocation comprises between one and twothirds of joint. Type ⅢC: a small crescent fragment where dislocation comprises most,but not the entire joint. Different treatment regimens were selected for different types of fractures. Treatment for type Ⅰ sacroiliac joint dislocation: anterior iliac fossa approach pry stripping reset; sacroiliac joint fixed with sacroiliac screw through percutaneous. Treatment for type Ⅱ sacroiliac joint dislocation: posterior sacroiliac joint posterior approach; sacroiliac joint fixed with sacroiliac screw under computer guidance. Treatment for type ⅢA and ⅢB sacroiliac joint dislocation: posterior sacroiliac joint approach; sacroiliac joint fixed with reconstruction plate. Treatment for type ⅢC sacroiliac joint dislocation: sacroiliac joint closed reduction; sacroiliac joint fixed with sacroiliac screw through percutaneous. Treatment for type Ⅳ sacroiliac joint dislocation: posterior approach; sacroiliac joint fixed with spinal pelvic fixation.
Results: Results of 24 to 72 months patient follow-up (mean 34.5 months): 100% survival,100% wound healing,and 100% fracture healing. Two cases were identified as type Ⅰ sacroiliac joint dislocation,including one with coexistence of nerve injury. Patients recovered completely 12 months after surgery. Eight cases were identified as type Ⅱ sacroiliac joint dislocation; none had obvious nerve injury during treatments. Twelve cases were identified as type Ⅲ sacroiliac joint dislocation,including one with coexistence of nerve injury. Patients recovered completely 12 months after surgery. Three cases were identified as type Ⅳ sacroiliac joint dislocation with coexistence of nerve injury. Two patients fully recovered 12 months after surgery. One had partial recovery of neurological function.
Conclusion: The classification and treatment regimen for sacroiliac joint dislocation have achieved better therapeutic effect,which is worth promoting.
Keywords: Classification; Sacroiliac joint dislocation; Treatment.