Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Jena, Germany.
Clinic of Orthopaedics and Sportsorthopaedics, Klinikum rd. Isar, Technische Universität München, Munich, Germany.
J Orthop Res. 2019 Mar;37(3):689-696. doi: 10.1002/jor.24199. Epub 2019 Jan 5.
(1) Can iliosacral osseous corridor diameters in sacral dysmorphism be enlarged by in-out-in screw placement at the posterior iliosacral recessus? (2) Are lumbosacral transitional vertebra (LSTV) the anatomical cause for sacral dysmorphism? (3) Are there sex-specific differences in sacral dysmorphism? 594 multislice CT scans were screened for sacral dysmorphism and 55 data-sets selected. Each pelvis was segmented manually and cylindrical iliosacral corridors (on the level of S1 and S2 vertebra) were semi-automatically determined. Corridor trajectories, -diameters and -lengths were measured. LSTV (Castellvi-type IIIb and IV) were found in 3 of 55 pelves and these lumbosacral variations are therefore not the anatomical basis for sacral dysmorphism. The prevalence of transsacral osseous corridors with diameters of <7.5 mm in axial CT images correlates with qualitative and quantitative criteria of sacral dysmorphism. Enlarging the osseous corridor diameters by penetration of the posterior iliosacral recessus increase the safe corridor diameters (females versus males) by 26% versus 15% at the level of S1- and 50% versus 48% at the level of S2-vertebra. Sex-specific differences for both corridors (osseous and in-out-in) were only found for the osseous corridor diameters at the level of S1 vertebra, being smaller in females (females versus males: 13.3 ± 3.6 mm versus 15.5 ± 3.8 mm, p = 0.04). Dysmorphic sacra can be reliably detected on standard axial CT slice images. Modified in-out-in corridors on the level of S1-vertebra allow screw placement in all patients, but is still demanding compared to non-dysmorphic sacra, due to the oblique corridor axis. Recommendations for intraoperative orientation for oblique screw placement are defined. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
(1) 在骶骨发育不良的后髂骨窝处进行内外-外螺钉固定，是否可以增大骶髂骨通道直径？(2) 腰骶移行椎（LSTV）是否是骶骨发育不良的解剖学原因？(3) 骶骨发育不良是否存在性别差异？对 594 例多层螺旋 CT 扫描进行骶骨发育不良筛查，选择 55 例数据。每个骨盆均手动分段，并半自动确定骶骨 1 节和 2 节水平的圆柱状骶髂骨通道。测量通道轨迹、直径和长度。在 55 个骨盆中有 3 个发现腰骶移行椎（Castellvi 型 IIIb 和 IV 型），因此这些腰骶部变异不是骶骨发育不良的解剖学基础。轴向 CT 图像中直径＜7.5mm 的经骶骨骨通道的患病率与骶骨发育不良的定性和定量标准相关。通过穿透后髂骨窝来增大骨通道直径可使 S1-和 S2-椎水平的安全通道直径分别增加女性（女性与男性相比）26%和 15%、50%和 48%。两种通道（骨和内外-外）的性别差异仅在 S1 椎体水平的骨通道直径中发现，女性较小（女性与男性相比：13.3±3.6mm 与 15.5±3.8mm，p=0.04）。在标准轴向 CT 切片图像上可以可靠地检测到发育不良的骶骨。在 S1 椎体水平上对内外-外通道进行修改，可以使所有患者都能进行螺钉固定，但与非发育不良的骶骨相比，由于通道轴是倾斜的，所以仍然具有挑战性。定义了用于斜向螺钉放置的术中定向建议。 ©2018 骨科研究协会。由 Wiley Periodicals, Inc. 出版。J Orthop Res.
