Raji Oluwatodimu Richard, Pope Jason E, Falowski Steven M, Stoffman Michael, Leasure Jeremi M
Medical Device Development, San Francisco, CA, USA.
UCSF Health St. Mary's Hospital, San Francisco, CA, USA.
Neurospine. 2025 Mar;22(1):185-193. doi: 10.14245/ns.2448940.470. Epub 2025 Mar 31.
Our study aimed to compare the posterior interposition technique against the posterolateral transosseous technique in the same cadaver specimens.
Computer and cadaver models of 2 fixation techniques were developed. The computer model was constructed to analyze bone volume removed during implant placement and the bony surface area available for fusion. The cadaver model included quasi-static multidirectional bending flexibility and dynamic fatigue loading. Relative motions between the sacrum and ilium were measured intact, after joint destabilization, after fixation with direct-posterior and posterolateral techniques, and after 18,500 cycles of fatigue loading. Relative positions between each implant and the sacrum and ilium were measured after fixation and fatigue loading to ascertain the quality of the bone-implant interface. The 2 techniques were randomized to the left and right sacroiliac joints of the same cadavers.
The posterior interposition technique removed less bone volume and facilitated a larger surface area available for bony fusion. Posterior interposition significantly reduced the nutation/counternutation motion of the sacroiliac joint (42% ± 8%) and reduced it more than the posterolateral transosseous technique (14% ± 4%). Upon fatigue loading, the posterior interposition implant maintained the bone-implant interface across all specimens, while the posterolateral transosseous implant migrated or subsided in 20%-50% of specimens.
Posterior interposition fixation of the sacroiliac joint reduces joint motion. The amount of fixation from the posterior technique is superior and more durable than the amount of fixation achieved by the posterolateral technique.
我们的研究旨在比较在相同尸体标本中后插入技术与后外侧经骨技术。
开发了两种固定技术的计算机模型和尸体模型。构建计算机模型以分析种植体植入过程中去除的骨体积以及可用于融合的骨表面积。尸体模型包括准静态多向弯曲灵活性和动态疲劳加载。在完整状态下、关节失稳后、采用直接后路和后外侧技术固定后以及在18500次疲劳加载循环后，测量骶骨和髂骨之间的相对运动。在固定和疲劳加载后，测量每个植入物与骶骨和髂骨之间的相对位置，以确定骨-植入物界面的质量。将这两种技术随机分配到同一尸体的左右骶髂关节。
后插入技术去除的骨体积较少，并促进了更大的可用于骨融合的表面积。后插入显著降低了骶髂关节的前屈/后伸运动（42%±8%），且比后外侧经骨技术降低得更多（14%±4%）。在疲劳加载时，后插入植入物在所有标本中均维持了骨-植入物界面，而后外侧经骨植入物在20%-50%的标本中发生了迁移或下沉。
骶髂关节后插入固定可减少关节运动。后路技术的固定量优于后外侧技术，且更持久。
