Zhao Yong, You Libo, Lian Wei, Zou Dexin, Dong Shengjie, Sun Tao, Zhang Shudong, Wang Dan, Li Jingning, Li Wenliang, Zhao Yuchi
Orthopaedics Department, Yantai Shan Hospital, 91#, Jiefang Road, Yantai, 264008, Shandong Province, People's Republic of China.
Operating Room, Yantai Shan Hospital, 91#, Jiefang Road, Yantai, 264008, Shandong Province, People's Republic of China.
J Orthop Surg Res. 2018 Jan 18;13(1):15. doi: 10.1186/s13018-018-0713-5.
To conduct radiologic anatomical study on the relation between S1 sacroiliac screws' entry points and the route of the pelvic outer superior gluteal artery branches with the aim to provide the anatomical basis and technical reference for the avoidance of damage to the superior gluteal artery during the horizontal sacroiliac screw placement.
Superior gluteal artery CTA (CT angiography) vascular imaging of 74 healthy adults (37 women and 37 men) was done with 128-slice spiral CT (computed tomography). The CT attendant-measuring software was used to portray the "safe bony entrance area" (hereinafter referred to as "Safe Area") of the S1 segment in the standard lateral pelvic view of three-dimensional reconstruction. The anatomical relation between S1 sacroiliac screws' Safe Area and the pelvic outer superior gluteal artery branches was observed and recorded. The number of cases in which artery branches intersected the Safe Area was counted. The cases in which superior gluteal artery branches disjointed from the Safe Area were identified, and the shortest distance between the Safe Area and the superior gluteal artery branch closest to the Safe Area was measured.
Three cases out of the 74 sample cases were excluded from this study as they were found to have no bony space for horizontal screw placement in S1 segment. Among the remaining 71 sample cases, there are 32 cases (45.1%) where the deep superior branch of superior gluteal artery passes through the Safe Area of S1 entrance point. There was no distinguishing feature and rule on how the deep superior branches and the Safe Area overlapped. In the 39 cases in which superior gluteal artery branches disjointed from the Safe Area, the deep superior branches of superior gluteal artery were the branches closest to the Safe Area and the part of the branch closest to the Safe Area was located in front of the widest part of the Safe Area. The shortest distance between the deep superior branch and the Safe Area is 0.86 ± 0.84 cm.
There is a high risk of accidental injury of the deep superior branches of superior gluteal artery in the process of S1 sacroiliac screw placement. Even if the entry points are located in the safe bony entrance area, the absolute secure placement cannot be assured. We suggest that great attention should be paid to make thorough preoperative plans.
对S1骶髂螺钉进针点与臀上动脉外侧支走行的关系进行影像学解剖学研究，旨在为骶髂螺钉水平置入时避免损伤臀上动脉提供解剖学依据和技术参考。
采用128层螺旋CT对74例健康成年人（37例女性，37例男性）进行臀上动脉CT血管造影（CTA）血管成像。利用CT随诊测量软件在三维重建的骨盆标准侧位视图中描绘S1节段的“安全骨性入路区域”（以下简称“安全区”）。观察并记录S1骶髂螺钉安全区与臀上动脉外侧支的解剖关系。统计动脉分支与安全区相交的病例数。识别臀上动脉分支与安全区不相交的病例，并测量安全区与最靠近安全区的臀上动脉分支之间的最短距离。
74例样本病例中有3例因S1节段无水平螺钉置入的骨性空间而被排除在本研究之外。在其余71例样本病例中，有32例（45.1%）臀上动脉深上支穿过S1进针点的安全区。深上支与安全区重叠的方式无明显特征和规律。在39例臀上动脉分支与安全区不相交的病例中，臀上动脉深上支是最靠近安全区的分支，且分支最靠近安全区的部分位于安全区最宽部分的前方。深上支与安全区之间的最短距离为0.86±0.84cm。
S1骶髂螺钉置入过程中臀上动脉深上支意外损伤风险较高。即使进针点位于安全骨性入路区域，也不能保证绝对安全置入。建议术前应高度重视并制定详尽的计划。
