Bai Zhibiao, Gao Shichang, Liu Jia, Liang Anlin, Yu Weihua
Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
J Orthop Sci. 2018 Jan;23(1):132-136. doi: 10.1016/j.jos.2017.09.003. Epub 2017 Sep 25.
The iatrogenic injuries to the lumbar nerves during the fixation the sacroiliac (SI) joint fractures with anterior plates were often reported. No specific method had been reported to avoid it. This study was done to find a safer way of placing the anterior plates and screws for treating the sacroiliac (SI) joint fracture and/or dislocation.
The research was performed using 8 male and 7 female normal corpse pelvic specimens preserved by 10% formalin solution. Try by measuring the horizontal distance from L4, L5 nerve roots to the sacroiliac joint and perpendicular distance from L4, L5 nerve roots to the ala sacralis, the length of L4, L5 nerve roots from intervertebral foramen to the edge of true pelvis, the diameter of L4, L5 nerve roots. The angles between the sacroiliac joint and sagittal plane were measured on the CT images.
The horizontal distance between the lateral side of the anterior branches of L4, L5 nerve roots and the sacroiliac joint decreased gradually from the top to the bottom. The widest distances for L4,5 were 2.1 cm (range, 1.74-2.40) and 2.7 cm (range, 2.34-3.02 cm), respectively. The smallest distances for L4, 5 were 1.2 cm (range, 0.82-1.48 cm) and 1.5 cm (range, 1.08-1.74 cm), respectively. On CT images, the angle between the sacroiliac joint and sagittal plane was about 30°.
If we use two anterior plates to fix the sacroiliac joint, It is recommended to place one plate on the superior one third part of the joint, with exposing medially no more than 2.5 cm and the other in the middle one third part of the joint, with elevating periosteum medially no more than 1.5 cm. The screws in the sacrum are advised to incline medially about 30° directing to the true pelvis.
骶髂关节骨折前路钢板固定时医源性腰神经损伤屡有报道，尚无避免该损伤的具体方法。本研究旨在探寻一种更安全的放置前路钢板及螺钉治疗骶髂关节骨折和/或脱位的方法。
研究采用10%甲醛溶液保存的8例男性和7例女性正常尸体骨盆标本。通过测量L4、L5神经根至骶髂关节的水平距离、L4、L5神经根至骶骨翼的垂直距离、L4、L5神经根从椎间孔至真骨盆边缘的长度、L4、L5神经根的直径进行尝试。在CT图像上测量骶髂关节与矢状面的夹角。
L4、L5神经根前支外侧与骶髂关节的水平距离自上而下逐渐减小。L4、L5的最宽距离分别为2.1cm（范围1.74 - 2.40cm）和2.7cm（范围2.34 - 3.02cm）。L4、L5的最小距离分别为1.2cm（范围0.82 - 1.48cm）和1.5cm（范围1.08 - 1.74cm）。在CT图像上，骶髂关节与矢状面的夹角约为30°。
若采用两块前路钢板固定骶髂关节，建议一块钢板置于关节上1/3处，内侧暴露不超过2.5cm，另一块置于关节中1/3处，内侧骨膜掀起不超过1.5cm。骶骨螺钉建议向内侧倾斜约30°指向真骨盆。
