Neurosurgical Associates of Lancaster, Lancaster, PA.
SEA, Ltd., Columbus, OH.
Pain Physician. 2022 May;25(3):E469-E479.
Despite minimally invasive techniques for sacroiliac joint fixation, clinical challenges remain. The investigators hypothesized the studied technique will transfix the sacroiliac joint to a level comparable to the intact sacroiliac joint.
The study objective was to determine the dynamic stability of a square inter-joint implant using a triangular notch in opposing bone segments spanning the joint space.
Stability was assessed by measuring micromotion using contralaterally placed transducers spanning the sacroiliac joint of a specimen during cyclic loading.
A porcine in-vitro model was equipped with micromotion transducers on the intact and surgically implanted sacroiliac joint. Cyclic loading was applied on the L4 vertebra and the recorded micromotion data at each sacroiliac joint was analyzed.
Porcine specimens from L3 to the sacrum including the pelvic ring were used to biomechanically evaluate the implantation technique. A novel technique consisting of a square inter-joint implant was placed so as to create a triangular stabilization notch within adjacent boney components of the sacroiliac joint. Displacement transducers were placed across implanted and contralateral porcine sacroiliac joint. Specimens were subjected to compressive loading between -10N and -100N followed by bending/rotation between 0.4Nm and 4.0Nm. Tests were conducted at 0.5Hz for 200 cycles. For each loading mode, transducer deflections (or rotations) were averaged at five-cycle intervals. Student's t-tests were used to compare fitted parameters between implanted and intact sacroiliac joint.
In compression, implanted SIJ displayed reduced deflection compared to intact sacroiliac joint (P < 0.0001). In bending/rotation, initial rotation for the intact sacroiliac joint was increased compared to implanted sacroiliac joint (P < 0.0001). The computed Half-Life parameter represents the number of cycles at which the initial rotation decreases by 50% and was found to be statistically reduced for implanted sacroiliac joint as compared to intact sacroiliac joint.
The use of porcine specimens resulted in uniform and good quality bone purchase. Further study may be required to evaluate the technique in older patients where bone quality is reduced.
Compared to the intact sacroiliac joint, the implant and procedure in this study demonstrated decreased motion under cyclic compression. Under rotation, the implanted sacroiliac joint displayed increased initial stability that subsequently normalized to intact sacroiliac joint values.
尽管采用了微创技术进行骶髂关节固定，但仍存在临床挑战。研究人员假设所研究的技术将穿过骶髂关节至与完整骶髂关节相当的水平。
本研究的目的是确定在关节间隙中跨越对侧骨段的三角形切口中使用方形关节内植入物的动态稳定性。
稳定性通过在循环加载过程中在标本的骶髂关节上放置相反位置的传感器来测量微运动来评估。
猪体外模型在完整和手术植入的骶髂关节上配备微运动传感器。在 L4 椎骨上施加循环载荷，并分析每个骶髂关节的记录微运动数据。
使用包括骨盆环在内的 L3 至骶骨的猪标本对植入技术进行生物力学评估。一种新的技术包括放置一个方形关节内植入物，以在骶髂关节相邻骨成分内创建一个三角形稳定切槽。将位移传感器放置在植入和对侧猪骶髂关节上。标本在-10N 至-100N 之间承受压缩载荷，然后在 0.4Nm 和 4.0Nm 之间承受弯曲/旋转。在 0.5Hz 下进行 200 个循环的测试。对于每种加载模式，在五个循环间隔处平均传感器挠度（或旋转）。使用学生 t 检验比较植入和完整骶髂关节的拟合参数。
在压缩中，植入的 SIJ 显示出与完整骶髂关节相比，挠度减小（P < 0.0001）。在弯曲/旋转中，与植入的骶髂关节相比，完整骶髂关节的初始旋转增加（P < 0.0001）。计算的半衰期参数表示初始旋转减少 50%的循环数，并且发现与完整的骶髂关节相比，植入的骶髂关节的半衰期参数具有统计学意义的降低。
使用猪标本导致均匀且高质量的骨结合。可能需要进一步的研究来评估该技术在骨质减少的老年患者中的应用。
与完整的骶髂关节相比，本研究中的植入物和程序在循环压缩下显示出运动减少。在旋转下，植入的骶髂关节显示出初始稳定性增加，随后恢复到与完整骶髂关节相同的值。
