Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA.
Department of Orthopaedic Surgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA.
Eur J Orthop Surg Traumatol. 2022 Jul;32(5):965-971. doi: 10.1007/s00590-021-03073-2. Epub 2021 Jul 5.
Iliosacral (IS) and transsacral (TS) screws are commonly used to stabilize pelvic ring injuries. The course of the superior gluteal artery (SGA) can be close to implant insertion paths. The third sacral segment (S3) has been described as a viable osseous fixation pathway (OFP) but the proximity of the SGA to the S3 screw path is unknown.
Fifty uninjured patients with contrasted pelvic computed tomograms (CTA) were identified with an S3 path large enough for a 7.0 mm TS screw. Starting sites for S1 IS or TS, S2 and S3 TS screws were located on the volume rendered lateral CTA image and transferred onto the surface rendered 3D CTA with the SGA clearly visible. The distance from screw start sites to the SGA was measured. A distance less than 3.5 mm was considered likely for injury.
The average distances from screw start sites to the SGA were 23.0 ± 7.9 mm for S1 IS screws, 14.3 ± 6.4 mm for S2 TS screws and 25.9 ± 6.5 mm for S3 TS screws. No S1 IS screws, 5 S2 TS screws (10%), and no S3 TS screws were projected to cause injury to the SGA.
The osseous start site and soft tissue path for an S3 TS screw is remote from the SGA. The S1 IS and S3 TS pathways are further away from the SGA while the S2 TS pathway is closer and may theoretically pose a higher injury risk in patients with an available S3 OFP.
髂骨（IS）和经骶骨（TS）螺钉常用于稳定骨盆环损伤。臀上动脉（SGA）的走行可接近植入物插入路径。第三骶骨段（S3）已被描述为可行的骨固定途径（OFP），但 SGA 与 S3 螺钉路径的接近程度尚不清楚。
确定了 50 例未受伤患者的骨盆对比 CT 血管造影（CTA），其 S3 路径足够大，可容纳 7.0mm 的 TS 螺钉。S1 IS 或 TS、S2 和 S3 TS 螺钉的起始点位于容积再现侧 CTA 图像上，并转移到 SGA 清晰可见的表面再现 3D CTA 上。测量螺钉起始点与 SGA 的距离。距离小于 3.5mm 被认为可能导致损伤。
S1 IS 螺钉的螺钉起始点到 SGA 的平均距离为 23.0±7.9mm，S2 TS 螺钉为 14.3±6.4mm，S3 TS 螺钉为 25.9±6.5mm。没有 S1 IS 螺钉，5 个 S2 TS 螺钉（10%）和没有 S3 TS 螺钉预计会损伤 SGA。
S3 TS 螺钉的骨性起始点和软组织路径远离 SGA。S1 IS 和 S3 TS 途径离 SGA 更远，而 S2 TS 途径更近，理论上在有可用 S3 OFP 的患者中可能具有更高的损伤风险。
