Kułakowski Michał, Elster Karol, Janiak Michał, Kułakowska Julia, Żuchowski Paweł, Wojciechowski Rafał, Dura Marta, Lech Marcin, Korolczuk Krzysztof, Grzonkowska Magdalena, Szpinda Michał, Baumgart Mariusz
Clinical Department of Orthopedics and Traumatology, Jan Biziel University Hospital No. 2 in Bydgoszcz, 85-168 Bydgoszcz, Poland.
Faculty of Medicine and Health Sciences, Medical College, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland.
J Clin Med. 2024 Oct 11;13(20):6063. doi: 10.3390/jcm13206063.
Operative treatment of fragility fractures of the pelvis has become a gold standard. Preoperative planning, including the assessment of the pathway for iliosacral screws, is crucial. The anchorage of the screw depends on the bone quality. Some recent studies have concentrated on assessing bone mineral density (BMD) with the use of Hounsfield unit (HU) values obtained from CT scans. The aim of the present study is to determine the best sacral levels of S1-S3 on the pathway of iliosacral screws for sacroiliac joint fixation. Patients admitted to the Independent Public Healthcare Center in Rypin between 1 of September and 1 of December in 2023, who had CT scans of the pelvis performed on them for different reasons, were included in this study. In total, 103 patients-56 men and 47 women-were enrolled in the study and consecutively separated into two groups of different ages: 18-60 years old (group A) and above 60 years old (group B). The volumetric bone density expressed in HU values was measured with sacral levels of S1, S2 and S3. Apart from the bodies of sacral vertebrae S1-S3, our measurements involved the ala of the ilium in the vicinity of the sacroiliac joint and the wing of the sacrum. All the measurements were performed on the pathway of presumptive iliosacral screws to stabilize the sacroiliac joint. In group A (58 patients) the highest bone density in sacral bodies was found in S1 that gradually decreased to S3, while the opposite tendency was demonstrated in the ala of ilium. The HU values in the wing of the sacrum did not display statistical significance. In group B (45 patients), the highest bone density was also found in the sacral body S1 that decreased toward S3 but in the ala of ilium, the highest bone density was found with level S1 and lowest with level S2. In both groups, the highest bone density referred to the wing of the sacrum. While the perfect construct for posterior pelvic ring fixation remains unclear, our findings may imply that sacroiliac joint screws inserted into the wing of the sacrum of greater bone density could provide much more successful fixation in comparison to those anchored in the body of sacral vertebra of lesser bone density.
骨盆脆性骨折的手术治疗已成为金标准。术前规划，包括评估髂骶螺钉的置入路径，至关重要。螺钉的锚固取决于骨质。最近一些研究集中于利用CT扫描获得的亨氏单位（HU）值评估骨密度（BMD）。本研究的目的是确定用于骶髂关节固定的髂骶螺钉路径上S1 - S3的最佳骶骨水平。纳入了2023年9月1日至12月1日期间因不同原因在里平独立公共医疗中心接受骨盆CT扫描的患者。本研究共纳入103例患者，其中56例男性和47例女性，并连续分为两组不同年龄组：18 - 60岁（A组）和60岁以上（B组）。用S1、S2和S3的骶骨水平测量以HU值表示的体积骨密度。除了骶骨椎体S1 - S3的主体部分，我们的测量还涉及骶髂关节附近的髂骨翼和骶骨翼。所有测量均在假定的髂骶螺钉路径上进行，以稳定骶髂关节。在A组（58例患者）中，骶骨主体中最高骨密度见于S1，且逐渐降至S3，而髂骨翼则呈现相反趋势。骶骨翼的HU值无统计学意义。在B组（45例患者）中，骶骨主体中最高骨密度同样见于S1且向S3降低，但在髂骨翼中，最高骨密度见于S1水平，最低见于S2水平。在两组中，最高骨密度均见于骶骨翼。虽然骨盆后环固定的理想结构尚不清楚，但我们的研究结果可能意味着，与锚固在骨密度较低的骶骨椎体主体中的螺钉相比，插入骨密度较高的骶骨翼中的骶髂关节螺钉可能提供更成功的固定。
