Fritzsche Carina, Mahjoub Samy, Hüfner Tobias, Sehmisch Stephan, Decker Sebastian
Department of Trauma Surgery, Hannover Medical School, Hannover, Germany;
Department of Urology, Vivantes Humboldt-Klinikum, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Berlin, Germany.
In Vivo. 2025 May-Jun;39(3):1514-1523. doi: 10.21873/invivo.13951.
BACKGROUND/AIM: Iliac screws provide strong caudal anchorage for both long spinal fusions as well as short lumbopelvic fixations. However, anatomic based placement can be challenging, and complication rates are often underestimated.
We analysed 47 iliac screws being placed in 24 patients. Using postoperative computed tomography (CT), iliac screw placement was analysed with reference to anatomic landmarks. Iliac narrowings were described with regard to their relevance for iliac screw placement. Moreover, we analyzed clinical records for clinical complications. The latter were classified as intraoperative, postoperative, and radiological.
From starting points, described by distance to the posterior superior iliac spine (PSIS), the average iliac screw length was 71.2±13.7 mm, and the diameter was as wide as 7.9±0.7 mm. Divergence was 30.7±12.6° (transverse plane) and caudal orientation was 34.2±13.0° (sagittal orientation). General pelvic dimensions correlated significantly with each other, and certainly with the length of implanted screws. Different adverse events and complications occurred. A total of 20% of patients were found with at least partial extracortical malpositioning. The main group of complications were postoperative with painful prominence in 20% of cases, wound infection in 8.9% and wound healing disorders in 6.7%. Further complications were radiological screw loosening (11.1%). No complications were detected in 33.3% of patients.
Optimal iliac screw size relative to the individual anatomy in general is not achieved. In most cases compared to the literature, iliac screw dimensions could be both longer and thicker. Perfect anatomic placement can be challenging, which highlights the need for individual preoperative CT-based surgical planning to achieve a strong caudal anchorage in lumbopelvic fixations. In general, the diameter seems to be more important than the screw length.
背景/目的：髂骨螺钉为长节段脊柱融合术和短节段腰骶部固定术提供了强大的尾侧固定。然而，基于解剖结构的置入操作具有挑战性，且并发症发生率常常被低估。
我们分析了24例患者置入的47枚髂骨螺钉。利用术后计算机断层扫描（CT），参照解剖标志分析髂骨螺钉的置入情况。描述了髂骨狭窄与髂骨螺钉置入的相关性。此外，我们分析了临床记录以查找临床并发症。后者分为术中、术后及影像学并发症。
以距后上棘（PSIS）的距离描述起始点，髂骨螺钉平均长度为71.2±13.7mm，直径达7.9±0.7mm。横向发散角为30.7±12.6°，尾侧方向为34.2±13.0°（矢状面方向）。骨盆的一般尺寸彼此显著相关，当然也与植入螺钉的长度相关。发生了不同的不良事件和并发症。共发现20%的患者至少存在部分皮质外位置不当。主要并发症为术后并发症，20%的病例出现疼痛性隆起，8.9%出现伤口感染，6.7%出现伤口愈合障碍。其他并发症为影像学螺钉松动（11.1%）。33.3%的患者未检测到并发症。
一般而言，尚未实现与个体解剖结构相匹配的最佳髂骨螺钉尺寸。与文献报道的大多数病例相比，髂骨螺钉的尺寸可能更长、更粗。完美的解剖学置入具有挑战性，这凸显了术前基于CT进行个体化手术规划以在腰骶部固定中实现强大尾侧固定的必要性。总体而言，直径似乎比螺钉长度更重要。
