Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, PA, United States; Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, PA, United States.
Department of Neurosurgery, University of Pennsylvania Hospital, Philadelphia, PA, United States.
J Clin Neurosci. 2019 Mar;61:315-321. doi: 10.1016/j.jocn.2018.10.130. Epub 2018 Nov 10.
Sacroiliac (SI) joint can produce debilitating lower back pain with radiation to groin, buttocks, and lower extremities. SI joint dysfunction poses a clinical challenge to the spine surgeons. Studies entailing surgical arthrodesis utilizing Titanium implants have been reported with reputedly high level of patient satisfaction. Authors have described technical aspects of surgical technique with use of titanium screw implants. The transarticular technique is used to places SI joint screw implants across the articular portion of SI joint. Cadaveric SI joint instrumentation is performed under fluoroscopic guidance. Moreover, Medline literature search is conducted to study surgical outcome, and patient satisfaction. 4 cadavers are prepped prone for the percutaneous approach. Bilaterally 6 screws are placed using transarticular placement technique under fluoroscopic guidance. The posterior technique utilizes alignment guide to place the screws inline on the inlet view, parallel in the outlet view, and parallel to the dorsal aspect of the sacral body in the lateral view. One C-arm is used in the entire technique. The technical aspects of surgical technique have been described in a stepwise fashion for easy reproducibility in the operating room. Each screw track is checked with tactile feel of a blunt K-wire before final deployment. All bilateral screws were checked on a set of fluoroscopic views. A detail clinical examination, diagnostic joint injection, with the radiological imaging must be considered before surgical consideration. SI Joint fusion utilizing 3 transarticular sacral screws is equally effective and safe procedure to treat chronic lower back pain ensuing from SI joint dysfunction.
骶髂 (SI) 关节可引起下背部疼痛，并放射至腹股沟、臀部和下肢，造成严重不适。SI 关节功能障碍给脊柱外科医生带来了临床挑战。利用钛植入物进行关节融合术的研究已有报道，据称患者满意度较高。作者描述了使用钛螺钉植入物的手术技术的技术方面。经关节技术用于在 SI 关节的关节部分放置 SI 关节螺钉植入物。在透视引导下进行尸体 SI 关节器械操作。此外，还进行了 Medline 文献检索，以研究手术结果和患者满意度。准备 4 具尸体进行经皮入路。在透视引导下，使用经关节放置技术双侧放置 6 个螺钉。后路技术使用定位器将螺钉在入口视图上排列成直线，在出口视图上平行，在侧位上平行于骶骨体的背侧。整个技术只用了一台 C 臂机。以逐步的方式描述了手术技术的技术方面，以便在手术室中易于重现。在最终部署之前，用钝的 K 线触摸每个螺钉轨道。所有双侧螺钉都在一组透视视图上进行了检查。在考虑手术之前，必须进行详细的临床检查、关节诊断注射和影像学检查。利用 3 个经关节骶骨螺钉进行 SI 关节融合是一种同样有效和安全的治疗方法，可治疗由 SI 关节功能障碍引起的慢性下腰痛。
