Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
Department of Orthopaedic Surgery, Second Hospital of Tangshan, Tangshan, Hebei, People's Republic of China.
J Bone Joint Surg Am. 2024 Jan 17;106(2):129-137. doi: 10.2106/JBJS.23.00397. Epub 2023 Nov 22.
Sacral dysmorphism is not uncommon and complicates S1 iliosacral screw placement partially because of the difficulty of determining the starting point accurately on the sacral lateral view. We propose a method of specifying the starting point.
The starting point for the S1 iliosacral screw into the dysmorphic sacrum was specifically set at a point where the ossification of the S1/S2 intervertebral disc (OSID) intersected the posterior vertebral cortical line (PVCL) on the sacral lateral view, followed by guidewire manipulation and screw placement on the pelvic outlet and inlet views. Computer-simulated virtual surgical procedures based on pelvic computed tomography (CT) data on 95 dysmorphic sacra were performed to determine whether the starting point was below the iliac cortical density (ICD) and in the S1 oblique osseous corridor and to evaluate the accuracy of screw placement (with 1 screw being used, in the left hemipelvis). Surgical procedures on 17 patients were performed to verify the visibility of the OSID and PVCL, to check the location of the starting point relative to the ICD, and to validate the screw placement safety as demonstrated with postoperative CT scans.
In the virtual surgical procedures, the starting point was consistently below the ICD and in the oblique osseous corridor in all patients and all screws were Grade 1. In the clinical surgical procedures, the OSID and PVCL were consistently visible and the starting point was always below the ICD in all patients; overall, 21 S1 iliosacral screws were placed in these 17 patients without malpositioning or iatrogenic injury.
On the lateral view of the dysmorphic sacrum, the OSID and PVCL are visible and intersect at a point that is consistently below the ICD and in the oblique osseous corridor, and thus they can be used to identify the starting point.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
骶骨畸形并不少见，这使得 S1 骶髂螺钉的置入变得复杂，部分原因是难以准确确定骶骨侧位上的起始点。我们提出了一种确定起始点的方法。
在骶骨侧位片上，S1 骶髂螺钉进入畸形骶骨的起始点被具体设定在 S1/S2 椎间盘（OSID）的骨化与骶骨后皮质线（PVCL）相交的点，随后在骨盆出口和入口位进行导丝操作和螺钉置入。对 95 例畸形骶骨的骨盆 CT 数据进行计算机模拟虚拟手术，以确定起始点是否低于髂皮质密度（ICD），并位于 S1 斜形骨道内，评估螺钉置入的准确性（使用 1 枚螺钉，在左半骨盆）。对 17 例患者进行手术，以验证 OSID 和 PVCL 的可观察性，检查起始点相对于 ICD 的位置，并通过术后 CT 扫描验证螺钉置入的安全性。
在虚拟手术中，所有患者的起始点均始终低于 ICD，且均位于斜形骨道内，所有螺钉均为 1 级。在临床手术中，OSID 和 PVCL 始终可见，且所有患者的起始点均始终低于 ICD；总的来说，17 例患者共置入 21 枚 S1 骶髂螺钉，均未出现错位或医源性损伤。
在畸形骶骨的侧位片上，OSID 和 PVCL 是可见的，且相交于始终低于 ICD 且位于斜形骨道内的一点，因此可以用于确定起始点。
治疗性 III 级。欲了解完整的证据水平描述，请参见作者须知。
