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用于微创骶髂关节融合的单切口腹外侧至后内侧（PML）手术技术

Single Incision Posteromedial to Ventrolateral (PML) Surgical Technique for Minimally Invasive Sacroiliac Joint Fusion.

作者信息

Ogunseinde Babajide

机构信息

Longview Orthopedic Regional Spine Clinic, Longview, Texas.

出版信息

Clin Spine Surg. 2025 Aug 1;38(7):319-325. doi: 10.1097/BSD.0000000000001867. Epub 2025 Jun 20.

DOI:10.1097/BSD.0000000000001867
PMID:40539626
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12278755/
Abstract

SUMMARY OF BACKGROUND DATA

Sacroiliac joint fusion transfixing procedures place implants across 3 bone cortices. The most studied trajectory is lateral to medial. While the safety and effectiveness of this trajectory have been well documented, concerns of vascular injury involving the branches of the SGA over the lateral ilium have been raised. In heavier patients, a straight lateral-to-medial trajectory frequently requires traversing through a significant amount of soft tissue. While the posterolateral transfixing trajectory decreases the amount of soft tissue dissection, concerns of inferior patient outcomes and biomechanical stability have been published. Herein, we describe a new transfixing procedure for SIJ fusion with implants starting on the dorsal sacrum with a posteromedial to ventrolateral (sacro-alar iliac) implant trajectory.

METHODS

A case video of posteriomedial to ventrolateral SIJ fusion demonstrates the operative technique and is accompanied by a step-by-step description of this technique. Four cases are presented.

CONCLUSIONS

The posteromedial to ventrolateral operative trajectory allows for minimally invasive bilateral SIJ fusion through a single incision with minimal tissue disruption and avoids branches of the superior gluteal artery.

摘要

背景数据总结

骶髂关节融合固定手术需将植入物穿过三层骨皮质。研究最多的路径是从外侧到内侧。虽然该路径的安全性和有效性已有充分记录，但有人提出了涉及髂骨外侧臀上动脉分支的血管损伤问题。在肥胖患者中，直接从外侧到内侧的路径通常需要穿过大量软组织。虽然后外侧固定路径减少了软组织分离量，但已发表了关于患者预后较差和生物力学稳定性的担忧。在此，我们描述一种用于骶髂关节融合的新固定手术，植入物从骶骨背侧开始，采用后内侧到腹外侧（骶骨-髂骨翼）的植入路径。

方法

一段后内侧到腹外侧骶髂关节融合的病例视频展示了手术技术，并附有该技术的分步描述。展示了4个病例。

结论

后内侧到腹外侧的手术路径允许通过单一切口进行微创双侧骶髂关节融合，组织破坏最小，并避免了臀上动脉分支。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/9cee071bb7ed/bsd-38-319-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/a636a1e656b8/bsd-38-319-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/155b8a5a904b/bsd-38-319-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/2f5a96ab17e0/bsd-38-319-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/a3f8bec877ad/bsd-38-319-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/8053ea3d2e6e/bsd-38-319-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/9cee071bb7ed/bsd-38-319-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/a636a1e656b8/bsd-38-319-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/155b8a5a904b/bsd-38-319-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/2f5a96ab17e0/bsd-38-319-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/a3f8bec877ad/bsd-38-319-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/8053ea3d2e6e/bsd-38-319-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e480/12278755/9cee071bb7ed/bsd-38-319-g006.jpg

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J Pain Res. 2024 Mar 20;17:1209-1222. doi: 10.2147/JPR.S458334. eCollection 2024.
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Randomized Trial of Augmented Pelvic Fixation in Patients Undergoing Thoracolumbar Fusion for Adult Spine Deformity: Initial Results from a Multicenter Randomized Trial.随机对照试验：对接受胸腰椎融合术治疗成人脊柱畸形的患者行增强骨盆固定的效果：一项多中心随机试验的初步结果。
World Neurosurg. 2024 Jul;187:e15-e27. doi: 10.1016/j.wneu.2024.01.156. Epub 2024 Feb 3.
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Minimally Invasive SI Joint Fusion Procedures for Chronic SI Joint Pain: Systematic Review and Meta-Analysis of Safety and Efficacy.慢性骶髂关节疼痛的微创骶髂关节融合手术：安全性和有效性的系统评价与荟萃分析
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