Wang Miqi, Jacobs Robert C, Bartlett Craig S, Schottel Patrick C
Department of Orthopaedic Surgery, Duke University, DUMC Box 104002, Durham, NC, 27710, USA.
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave South, R200, Minneapolis, MN, 55454, USA.
Arch Orthop Trauma Surg. 2023 Apr;143(4):1841-1847. doi: 10.1007/s00402-022-04376-7. Epub 2022 Feb 17.
Insertion of iliac wing implants requires understanding of the curvilinear shape of the ilium. This study serves to quantitatively identify the area of iliac inner-outer table convergence (IOTC), characterize the iliac wing osseous corridor, and define the gluteal pillar osseous corridor.
Computed tomography scans of 100 male and 100 female hemipelves were evaluated. The iliac wing was studied using manual best-fit analysis of the bounds of the inner and outer cortices. The IOTC was defined as the location of the iliac wing with an intercortical width less than 5 mm. The shortest distance from the apex of the iliac crest to the superior border of the IOTC was defined as the iliac wing osseous corridor. Finally, the width of the gluteal pillar corridor from the gluteus medius tubercle to the ischial tuberosity was measured.
The IOTC is an elliptical area measuring 22.3 cm. All ilia had an area where the inner and outer cortices converged to an intercortical width of less than 5 mm; 48% converged to a single cortex. The shortest mean distance from the superior edge of the iliac crest to the beginning of the IOTC was 20.3 mm in men and 13.8 mm in women (p < 0.001). The gluteal pillar diameter averaged 5.3 mm in men and 4.3 mm in women (p < 0.001).
All ilia converge to a thin and frequently unicortical central region. A 4.5 mm iliac wing lag screw will not breach the cortex if it remains within 20 mm or 14 mm distal to the cranial aspect of the iliac crest in males and females, respectively. Not only is the gluteal pillar smaller than previously thought, in 41% of males and 73% of females, it is not be large enough for 5 mm implants.
This study quantitatively assesses the dimensions of the IOTC, the iliac crest osseous corridor, and the gluteal pillar. Overall, our findings provide improved understanding of the limits for implant use in the iliac wing as well as better appreciation of the complex osteology of the ilium. This will help surgeons to identify safe areas for implant placement and avoid inadvertent cortical penetration.
髂骨翼植入物的置入需要了解髂骨的曲线形状。本研究旨在定量确定髂骨内外板汇合区（IOTC）的面积，描述髂骨翼骨通道的特征，并定义臀柱骨通道。
对100例男性和100例女性半骨盆的计算机断层扫描进行评估。使用手动最佳拟合分析髂骨内外皮质边界来研究髂骨翼。IOTC被定义为髂骨翼皮质间宽度小于5毫米的位置。从髂嵴顶点到IOTC上缘的最短距离被定义为髂骨翼骨通道。最后，测量从臀中肌结节到坐骨结节的臀柱通道宽度。
IOTC是一个椭圆形区域，面积为22.3平方厘米。所有髂骨都有一个内外皮质汇合至皮质间宽度小于5毫米的区域；48%汇合为单一皮质。男性从髂嵴上缘到IOTC起点的最短平均距离为20.3毫米，女性为13.8毫米（p<0.001）。男性臀柱直径平均为5.3毫米，女性为4.3毫米（p<0.001）。
所有髂骨都汇聚到一个薄的且通常为单皮质的中央区域。如果分别在男性髂嵴颅侧20毫米或女性14毫米以内，一枚4.5毫米的髂骨翼拉力螺钉不会穿透皮质。不仅臀柱比之前认为的小，在41%的男性和73%的女性中，其大小不足以容纳5毫米的植入物。
本研究定量评估了IOTC、髂嵴骨通道和臀柱的尺寸。总体而言，我们的研究结果有助于更好地理解髂骨翼植入物使用的限制，以及对髂骨复杂骨学的更好认识。这将有助于外科医生确定植入物放置的安全区域并避免意外穿透皮质。
