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S2 骶髂螺钉的生物力学评估:与髂骨固定相比,长度和四皮质固定的影响。

Biomechanical evaluation of S2 alar-iliac screws: effect of length and quad-cortical purchase as compared with iliac fixation.

机构信息

*George Washington University MFA, Washington, DC; and †Globus Medical, Inc., Valley Forge Business Center, Audubon, PA.

出版信息

Spine (Phila Pa 1976). 2013 Sep 15;38(20):E1250-5. doi: 10.1097/BRS.0b013e31829e17ff.


DOI:10.1097/BRS.0b013e31829e17ff
PMID:23759811
Abstract

STUDY DESIGN: A biomechanical study conducted on cadaveric specimens. OBJECTIVE: (1) To compare the biomechanical strength of the S2 alar-iliac (S2AI) screw to traditional iliac fixation and (2) to examine the effect of length and trajectory on the S2AI screw. SUMMARY OF BACKGROUND DATA: A recent technique to attain spinal fixation distal to S1 pedicle screws is the S2AI screw using either an open or a percutaneous approach with an altered S2 alar screw trajectory to obtain purchase in the ilium. A novel modification of the S2AI screw is placement with bicortical purchase in the ilium (quad-cortical screw). This may allow for a shorter-length screw with equivalent biomechanics. METHODS: Seven human cadaveric spines (L2-Pelvis) were fixed at L2 proximally and the pubis distally. Pedicle screws were placed from L3-S1 with S2AI screw lengths of 65-mm, 80-mm, or 90-mm iliac screws. S2AI screws were tested with and without quad-cortical purchase. Each specimen was tested on the 6 degrees of freedom spine simulator. A load control protocol with an unconstrained pure moment of 10 Nm was used in flexion-extension, lateral bending, and axial rotation for a total of 3 load/unload cycles. The range of motion was normalized to the intact cadaveric spine (100%). RESULTS: All the instrumented constructs significantly reduced range of motion compared with the intact spine. The L3-S1 construct was statistically significantly less stable than all instrumented constructs in flexion-extension. There was statistically no significant difference between the S2AI screws of all lengths and the iliac screw constructs with offset connectors. CONCLUSION: S2AI screws are biomechanically as stable as the test constructs using iliac screws in all loading modes. Sixty-five-millimeter S2AI screws were biomechanically equivalent to 90-mm iliac screws and 80-mm S2AI screws. Quad-cortical purchase did not statistically significantly improve the biomechanical strength of S2AI screws. LEVEL OF EVIDENCE: N/A.

摘要

研究设计:对尸体标本进行的生物力学研究。 目的:(1)比较 S2 翼状髂(S2AI)螺钉与传统髂固定的生物力学强度,(2)研究长度和轨迹对 S2AI 螺钉的影响。 背景资料概要:一种最近的技术,用于获得 S1 椎弓根螺钉远端的脊柱固定,是使用 S2AI 螺钉通过开放或经皮途径,改变 S2 翼状螺钉轨迹,以获得在髂骨中的附着。S2AI 螺钉的一种新的改良是在髂骨中使用双皮质附着(四皮质螺钉)。这可能允许使用具有等效生物力学的较短长度螺钉。 方法:将七个人体尸体脊柱(L2-骨盆)固定在 L2 近端和耻骨远端。从 L3-S1 放置椎弓根螺钉,S2AI 螺钉长度分别为 65-mm、80-mm 或 90-mm 髂骨螺钉。S2AI 螺钉分别进行有无四皮质附着的测试。每个标本均在 6 自由度脊柱模拟器上进行测试。使用无约束纯力矩为 10 Nm 的负载控制方案,在屈伸、侧屈和轴向旋转方向进行 3 次加载/卸载循环。运动范围被归一化为完整的尸体脊柱(100%)。 结果:所有仪器化的结构与完整脊柱相比,运动范围均显著减小。L3-S1 结构在屈伸方向上明显比所有仪器化结构都不稳定。所有长度的 S2AI 螺钉与带有偏移连接器的髂骨螺钉结构之间在统计学上没有显著差异。 结论:S2AI 螺钉在所有加载模式下的生物力学稳定性与使用髂骨螺钉的测试结构一样。65-mm S2AI 螺钉在生物力学上等效于 90-mm 髂骨螺钉和 80-mm S2AI 螺钉。四皮质附着在统计学上并没有显著提高 S2AI 螺钉的生物力学强度。 证据水平:无。

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引用本文的文献

[1]
Obturator inlet and iliac oblique fluoroscopic views allow for placement of longer iliac screws.

N Am Spine Soc J. 2025-6-13

[2]
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Global Spine J. 2025-7

[3]
The Influence of Radiographic Parameter on the S2 Alar-Iliac Screw Virtual Trajectory in Degenerative Lumbar Scoliosis Patients: A Computed Tomography Study.

Orthop Surg. 2024-6

[4]
Pelvic Fixation Construct Trends in Spinal Deformity Surgery.

Indian J Orthop. 2024-2-22

[5]
Sacropelvic Fixation for Adult Deformity Surgery Comparing Iliac Screw and Sacral 2 Alar-Iliac Screw Fixation: Systematic Review and Updated Meta-Analysis.

Neurospine. 2023-12

[6]
Digital anatomical study and clinical application of the ideal S2 alar-lliac screw trajectory.

BMC Surg. 2023-10-4

[7]
Stability and Instrumentation Stresses Among Sacropelvic Fixation Techniques With Novel Porous Fusion/Fixation Implants: A Finite Element Study.

Int J Spine Surg. 2023-8

[8]
Avoiding Spinal Implant Failures in Osteoporotic Patients: A Narrative Review.

Global Spine J. 2023-4

[9]
Radiological Evaluation of Pelvic Morphology for S2 Alar-Iliac Screw Insertion in the Japanese Samples: A Retrospective Cohort Study.

Spine Surg Relat Res. 2022-6-28

[10]
Freehand S2-Alar-Iliac Screw Placement Technique in Lumbosacral Spinal Tumors: A Preliminary Study.

Orthop Surg. 2022-9

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