Orthopaedic and Trauma Surgery Department, Independent Public Healthcare Center Rypin, Rypin, Poland.
Clinical Department of Trauma and Hand Surgery, Jan Mikulicz-Radecki University Clinical Hospital in Wroclaw, Wroclaw, Poland.
PLoS One. 2023 Oct 19;18(10):e0292620. doi: 10.1371/journal.pone.0292620. eCollection 2023.
Dislocations of the sacroiliac joint (SIJ) are treated with iliosacral screws or anterior plating. The study aimed to investigate the course of the lumbosacral trunk with reference to SIJ and determine whether is there sufficient space for two screws through the sacrum while performing anterior plating. Sixty patients, who underwent an MRI of the lumbar spine were included in our study. The three transverse LT-SIJ distances were measured at the three points (A, B, and C). We also analyzed 60 CT pelvic scans at points A, B, and C in order to measure: the vertebral canal-to-SIJ distance, the sacrum's pelvic-to-dorsal surface sagittal distance, and the median plane-to-SIJ angle. The mean transverse LT-SIJ distances at points A, B, and C were 20.0 ± 3.05 mm, 17.9 ± 3.20 mm, and 12.3 ± 2.49 mm, respectively. Based on CT analyses, the vertebral canal-to-SIJ distances were 30.5 ± 7.65 mm at point A, 21.4 ± 5.05 mm at point B and 15.7 ± 6.05 mm at point C. The sacrum's pelvic-to-dorsal surface sagittal distances reached values: 35.1 ± 11.62 mm at point A, 52.5 ± 10.58 mm at point B, and 57.5 ± 7.79 mm at point C. The median plane-to-SIJ angles measured 31.4 ± 4.82 degrees at point A, 26.6 ± 3.77 degrees at point B and 21.3 ± 3.25 mm at point C. Proximally, the safe zone for applying an anterior plate of SIJ is 20.0 mm. Since both the safe zone and safe corridor taper distally, surgeons may securely use one screw of gradually increased length towards the distal direction of SIJ, with inclination of 30 degrees in relation to the median plane of the lesser pelvis.
骶髂关节（SIJ）脱位采用髂骨螺钉或前路钢板固定。本研究旨在探讨腰骶干与 SIJ 的关系，并确定在前路钢板固定时通过骶骨是否有足够的空间放置两根螺钉。我们纳入了 60 例接受腰椎 MRI 检查的患者。在三个点（A、B 和 C）测量了三条横向 LT-SIJ 距离。我们还分析了 60 例 CT 骨盆扫描在 A、B 和 C 点的测量值：椎管至 SIJ 距离、骶骨骨盆至背表面矢状距离和正中平面至 SIJ 角度。A、B 和 C 点的 LT-SIJ 横向平均距离分别为 20.0 ± 3.05mm、17.9 ± 3.20mm 和 12.3 ± 2.49mm。基于 CT 分析，A 点的椎管至 SIJ 距离为 30.5 ± 7.65mm，B 点为 21.4 ± 5.05mm，C 点为 15.7 ± 6.05mm。骶骨骨盆至背表面矢状距离达到：A 点 35.1 ± 11.62mm，B 点 52.5 ± 10.58mm，C 点 57.5 ± 7.79mm。A 点正中平面至 SIJ 角度为 31.4 ± 4.82 度，B 点为 26.6 ± 3.77 度，C 点为 21.3 ± 3.25 度。近端，SIJ 前路钢板应用的安全区为 20.0mm。由于安全区和安全通道都向远端逐渐变细，因此外科医生可以安全地使用一根逐渐增加长度的螺钉，朝向 SIJ 的远端方向，与小骨盆的正中平面成 30 度角倾斜。
