Ebraheim N A, Padanilam T G, Waldrop J T, Yeasting R A
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo.
Spine (Phila Pa 1976). 1994 Mar 15;19(6):721-5. doi: 10.1097/00007632-199403001-00014.
Anatomical study of L4 nerve branch, L5 nerve root, and bony stock in the sacroiliac region was performed in cadaveric specimens to provide anatomical references for anterior fixation of the sacroiliac joint. At 1 cm intervals along the sacro-iliac joint, the distance to the lateral border of the L4 nerve branch (to the lumbosacral trunk) and the L5 nerve root was measured. Computed tomography scans and cadaveric sectioning of the sacro-iliac region were performed to evaluate the bony stock available for fixation and the optimal screw direction to prevent neurologic damage. At 4 cm above the pelvic brim, the L4 nerve branch was a mean distance of 23 mm medial to the sacro-iliac joint, whereas the L5 nerve root was 26 mm. At the pelvic brim, those distances decreased to 10 mm for both structures. Four centimeters cephalad to the pelvic brim, the AP dimension of Sl complex was decreased. Screws that were 1 cm medial to the Sl joint and directed posteriorly and parallel to the joint did not endanger neurologic structures. At four centimeters above the pelvic brim, there is less danger of neurologic injury; however, a decrease in sacral bony stock may affect fixation.
对尸体标本的骶髂区域进行L4神经分支、L5神经根和骨储备的解剖学研究，为骶髂关节前路固定提供解剖学参考。沿骶髂关节以1厘米的间隔测量至L4神经分支（至腰骶干）和L5神经根外侧缘的距离。对骶髂区域进行计算机断层扫描和尸体切片，以评估可用于固定的骨储备以及防止神经损伤的最佳螺钉方向。在骨盆边缘上方4厘米处，L4神经分支距骶髂关节内侧平均距离为23毫米，而L5神经根为26毫米。在骨盆边缘处，这两个结构的距离均降至10毫米。在骨盆边缘上方4厘米处，S1复合体的前后径减小。位于S1关节内侧1厘米处、向后并与关节平行的螺钉不会危及神经结构。在骨盆边缘上方4厘米处，神经损伤的风险较小；然而，骶骨骨储备的减少可能会影响固定。
