骶髂关节固定技术中 S1AI S 植入应优先考虑。

Implantation of S1AIS has priority as a sacroiliac joint fixation technique.

机构信息

Department of Orthopaedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China.

Department of Radiology, Liyang Peoples's Hospital, Changzhou, 213000, Jiangsu, China.

出版信息

Eur Spine J. 2024 Sep;33(9):3567-3575. doi: 10.1007/s00586-024-08423-2. Epub 2024 Jul 29.

DOI:10.1007/s00586-024-08423-2

PMID:39073459

Abstract

PURPOSE

The sacral alar-iliac screw (SAIS) fixation technique has evolved from spinopelvic fixation which originated from S2AIS to sacroiliac joint fixation, with more reports regarding its application of S2AIS than S1AIS. However, there is a lack of comparative evidence to determine which technique is superior for sacroiliac joint fixation. This study aimed to determine which of the screws was superior in terms of implantation safety and biomechanical stability for sacroiliac joint fixation.

METHODS

CT data of 80 normal pelvises were analyzed to measure the insertable range, trajectory lengths and widths of both S1AIS and S2AIS on 3D reconstruction models. Φ 6.5 mm and 8.0 mm screws were implanted on the left and right sides of fifty 3D printed pelvic models respectively to observe for breach of screw implantation. Ten synthetic pelvis models were used to simulate type C Tile injuries, and divided into 2 groups with an anterior plate and posterior fixation using one S1AIS or S2AIS on each side. The stiffness and maximum load of the plated and fixated models were measured under vertical loading.

RESULTS

The trajectory lengths and widths of the S1AIS and S2AIS were similar (p > 0.05) and there was no breach for Φ 6.5 mm SAIS. However, both the insertable range and trajectory length on the sacral side of S2AIS (234.56 ± 10.06 mm, 40.97 ± 2.81 mm) were significantly less, and the breach rate of the posterior lateral cortex of the Φ 8.0 mm S2AIS (46%) was significantly higher than the S1AIS (307.55 ± 10.42 mm, 42.16 ± 3.06 mm, and 2%, p < 0.05). The stiffness and maximum load of S2AIS were less than S1AIS but the difference was not statistically significant (p > 0.05).

CONCLUSION

S1AIS and S2AIS have similar screw trajectories and stability. However, S1AIS has a larger insertable range, less breach of the posterior lateral sacral cortex and longer trajectory length on the sacral side than S2AIS, which indicates S1AIS has higher implantation safety and a trend of better mechanical performance over S2AIS for sacroiliac joint fixation. Furthermore, S2AIS with an excessively large diameter should be used with caution for sacroiliac joint fixation.

摘要

目的

骶髂螺钉（SAIS）固定技术是从起源于 S2AIS 的脊柱骨盆固定发展而来的，用于骶髂关节固定的 S2AIS 报道比 S1AIS 更多。然而，缺乏比较证据来确定哪种技术更适合用于骶髂关节固定。本研究旨在确定哪种螺钉在骶髂关节固定方面具有更好的植入安全性和生物力学稳定性。

方法

对 80 例正常骨盆的 CT 数据进行分析，在三维重建模型上测量 S1AIS 和 S2AIS 的可插入范围、轨迹长度和宽度。分别在 50 个 3D 打印骨盆模型的左右两侧植入Φ 6.5mm 和 8.0mm 螺钉，观察螺钉植入是否有突破。使用 10 个合成骨盆模型模拟 C 型 Tile 损伤，将其分为两组，每组在两侧使用一个 S1AIS 或 S2AIS 进行前板和后固定。在垂直加载下测量固定模型的刚度和最大载荷。

结果

S1AIS 和 S2AIS 的轨迹长度和宽度相似（p>0.05），且 Φ 6.5mm SAIS 无突破。然而，S2AIS 骶骨侧的可插入范围和轨迹长度（234.56±10.06mm，40.97±2.81mm）明显较小，而 Φ 8.0mm S2AIS 后外侧皮质突破率（46%）明显高于 S1AIS（307.55±10.42mm，42.16±3.06mm，2%，p<0.05）。S2AIS 的刚度和最大载荷均小于 S1AIS，但差异无统计学意义（p>0.05）。