Ramadanov Nikolai, Zabler Simon
Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, 14770 Brandenburg, Germany.
Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, 14770 Brandenburg, Germany.
J Clin Med. 2025 May 20;14(10):3567. doi: 10.3390/jcm14103567.
: Posterior pelvic ring fractures are severe injuries requiring surgical stabilization, often through sacroiliac (SI) screw fixation. However, improper screw placement poses risks of neurovascular injury and implant failure. Defining a precise safe zone for screw placement is crucial to improving surgical accuracy and reducing complications. : A computational study was conducted using a CT scan of a 75-year-old male patient to establish a safe zone for SI screw placement. Manual segmentation and 3D modeling techniques were used to analyze bone density distribution. A 2D lateral projection of the sacrum was generated to identify high-density regions optimal for screw placement. While the general principle of targeting areas of higher bone density for screw insertion is well established, this study introduces a novel computational method to define and visualize such a safe zone. The resulting region, termed the Ramadanov-Zabler Safe Zone, was delineated based on this analysis to ensure maximal intraosseous fixation with minimal risk of cortical breaches. : A high-resolution 3D model of the sacral region was successfully generated. Standard thresholding methods for segmentation proved ineffective due to low bone density, necessitating a freehand approach. The derived 2D projection revealed regions of higher bone density, which were defined as the Ramadanov-Zabler Safe Zone for screw insertion. This zone correlates with areas providing the best structural integrity, thereby reducing risks associated with screw misplacement. Additionally, intraoperative and postoperative imaging from a representative case is included to illustrate the translational feasibility of the proposed technique. : The Ramadanov-Zabler Safe Zone offers a reproducible, CT-based computational approach to guide for SI screw placement, enhancing surgical precision and patient safety. This CT-based computational approach provides a standardized reference for preoperative planning, minimizing neurovascular complications and improving surgical outcomes. This pilot technique is supported by preliminary clinical imaging that demonstrates feasibility for intraoperative application. Further validation across diverse patient populations is recommended to confirm its clinical applicability.
骨盆后环骨折是严重损伤，通常需要通过骶髂螺钉固定进行手术稳定。然而，螺钉放置不当会带来神经血管损伤和植入物失败的风险。确定精确的螺钉放置安全区对于提高手术准确性和减少并发症至关重要。
使用一名75岁男性患者的CT扫描进行了一项计算研究，以建立骶髂螺钉放置的安全区。采用手动分割和3D建模技术分析骨密度分布。生成骶骨的二维侧位投影以识别最适合螺钉放置的高密度区域。虽然将螺钉插入更高骨密度区域的一般原则已得到充分确立，但本研究引入了一种新颖的计算方法来定义和可视化这样的安全区。根据该分析划定的所得区域，称为拉马丹诺夫-扎布勒安全区，以确保最大程度的骨内固定，同时将皮质破裂风险降至最低。
成功生成了骶骨区域的高分辨率3D模型。由于骨密度低，标准的分割阈值方法证明无效，因此需要徒手方法。导出的二维投影显示了更高骨密度的区域，这些区域被定义为螺钉插入的拉马丹诺夫-扎布勒安全区。该区域与提供最佳结构完整性的区域相关，从而降低了与螺钉误置相关的风险。此外，还包括一个代表性病例的术中及术后影像，以说明所提出技术的转化可行性。
拉马丹诺夫-扎布勒安全区提供了一种基于CT的可重复计算方法来指导骶髂螺钉放置，提高手术精度和患者安全性。这种基于CT的计算方法为术前规划提供了标准化参考，最大限度地减少神经血管并发症并改善手术结果。这项初步技术得到了初步临床影像的支持，这些影像证明了其在术中应用的可行性。建议在不同患者群体中进行进一步验证，以确认其临床适用性。
