Zuelzer David A, Ryan Lunden, Westbrooks Tim, Routt Milton L Chip
Department of Orthopaedic and Sports Medicine, University of Kentucky, Lexington, KY; and.
Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX.
J Orthop Trauma. 2023 Dec 1;37(12):607-613. doi: 10.1097/BOT.0000000000002698.
To determine (1) the natural incidence of sacral inlet angle differences between S1 and S2 and (2) implications for iliosacral screw placement with a technique to improve the accuracy of the intraoperative fluoroscopic inlet for S1 and S2.
Combined retrospective and prospective cohort reviews.
Regional Level 1 trauma center.
PATIENTS/PARTICIPANTS: After exclusion criteria, 300 patients with uninjured pelvic rings to determine the natural incidence of S1-S2 angle differences and 33 patients treated with iliosacral screws over the study period.
None in the retrospective cohort. In the prospective cohort, all patients underwent fluoroscopically assisted iliosacral screw fixation.
Radiographic determination of S1-S2 angle differences above 10 degrees in a natural population for the retrospective cohort. In the prospective, operative cohort, the outcome of interest was the safety of iliosacral screws in S1 and S2 as determined on intraoperative fluoroscopy and postoperative CT scan.
In the retrospective cohort, 180 of 300 (60.0%) had S1-S2 inlet angle differences above 10 degrees. In the operative cohort, 19 of 33 (57.6%) had S1-S2 inlet angle differences above 10 degrees. Of the iliosacral screws in S1 and S2 placed using the described imaging technique, all (69/69, 100%) were safe.
A normal population determined that differences in the inlet angle between S1 and S2 are common. An operative cohort was treated using preoperative CT-based planning to define different intraoperative fluoroscopic inlet views for S1 and S2, if a larger difference existed. Using this technique, 69 of 69 (100%) iliosacral screws were safe.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
确定（1）S1和S2之间骶骨入口角差异的自然发生率，以及（2）采用一种提高S1和S2术中透视入口准确性的技术对髂骶螺钉置入的影响。
回顾性和前瞻性队列联合研究。
地区一级创伤中心。
患者/参与者：排除标准确定后，300例骨盆环未受伤的患者用于确定S1 - S2角差异的自然发生率，以及研究期间33例接受髂骶螺钉治疗的患者。
回顾性队列中无干预措施。在前瞻性队列中，所有患者均接受透视辅助下的髂骶螺钉固定。
回顾性队列中自然人群中S1 - S2角差异大于10度的影像学测定。在前瞻性手术队列中，感兴趣的结果是术中透视和术后CT扫描确定的S1和S2中髂骶螺钉的安全性。
回顾性队列中，300例患者中有180例（60.0%）S1 - S2入口角差异大于10度。手术队列中，33例患者中有19例（57.6%）S1 - S2入口角差异大于10度。使用所述成像技术在S1和S2中置入的髂骶螺钉全部（69/69，100%）安全。
正常人群中S1和S2之间入口角的差异很常见。手术队列采用基于术前CT的规划进行治疗，如果存在较大差异，则为S1和S2定义不同的术中透视入口视图。使用该技术，69枚髂骶螺钉全部（100%）安全。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
