髂后上棘内侧入路置入髂骨螺钉行脊柱骨盆内固定术的可行性分析及临床验证

Feasibility analysis and clinical validation of iliac screw placement medial to the posterior superior iliac spine in lumbopelvic fixation

中文关键词:  脊柱骨盆固定  影像学特征  髂后上棘内侧入路  髂骨螺钉置入  手术方式  手术效果

英文关键词:Spinopelvic fixation  Imaging characteristics  Medial approach of the posterior superior iliac  Iliac screw placement  Surgical technique  Surgical outcomes

中文摘要:

  【摘要】 目的：基于影像学及解剖学探讨髂后上棘内侧入路髂骨螺钉（medialized entry iliac screw，MEIS）置入行脊柱骨盆内固定的可行性及理想路径，并进行临床验证。方法：收集2022年6月~2024年9月在我院医学影像科行骨盆CT平扫的非脊柱骨盆病变的90例患者的影像学资料，男45例，女45例；年龄57.5±1.6岁。使用Mimics 21.0软件进行骨盆三维重建，测量并比较男性和女性髂骨骨性通道数据，包括泪滴截面短轴和长轴、钉道最窄距离和最宽距离、骶髂关节角度、螺钉与矢状面夹角，根据影像学及解剖学特征确定MEIS的理想钉道路径，并制定标准手术步骤，在5例患者中应用。结果：男性和女性的钉道最窄距离分别为15.19±1.81mm和15.01±2.24mm，钉道最宽距离分别为24.16±1.66mm和24.44±2.92mm，骶髂关节角度分别39.63°±4.13°和40.76°±2.94°，男性与女性比较均无统计学差异（P>0.05）；螺钉与矢状面夹角分别为30.38°±3.15°和26.72°±5.64°，泪滴截面短轴分别为22.00±1.25mm和20.47±1.73mm，泪滴截面长轴分别为32.92±2.85mm和30.80±1.48mm，男性与女性比较均有统计学差异，男性骨盆的螺钉与矢状面夹角更大，泪滴截面短轴以及泪滴截面长轴均较女性长（P＜0.05）。男性与女性的钉道最窄距离、最宽距离、泪滴短轴和泪滴长轴均大于髂骨螺钉（直径9mm），且存在统计学差异（P＜0.001）。5例实施该术式的患者术后影像学检查显示所有固定物均稳定在位，症状及功能改善满意。结论：MEIS置入安全可行，可以作为脊柱骨盆固定术中髂骨螺钉置入路径的新选择。

英文摘要:

  【Abstract】 Objectives: To investigate the feasibility and ideal trajectory of medialized entry iliac screws(MEIS) placed in the posterior superior iliac in spinopelvic fixation through imaging and anatomic analyses, and to validate in clinical practice. Methods: The imaging data of 90 patients(45 males, 45 females; 57.5±1.6 years) without spinal or pelvic pathology who underwent pelvic CT scan in the radiology department of our hospital between June 2022 and September 2024 were collected. Three-dimensional pelvic reconstruction was performed using Mimics 21.0 software. The parameters of the bony channels of the iliac were measured and compared between males and females, including short and long axes of teardrop cross-section, the narrowest and widest inter-cortical distances of the iliac corridors, sacroiliac joint angles, and screw-to-sagittal plane angles. The ideal screw trajectory for MEIS was determined based on imaging and anatomical characteristics, and standard surgical procedures were formulated, which were applied in 5 patients. Results: No significant gender differences were observed in the narrowest iliac corridor width(males: 15.19±1.81mm vs. females: 15.01±2.24mm, P>0.05), widest corridor width(males: 24.16±1.66mm vs. females: 24.44±2.92mm, P>0.05), or sacroiliac joint angle(males: 39.63°±4.13° vs. females: 40.76°±2.94°, P>0.05). However, significant gender differences were found in the screw-to-sagittal angle(males: 30.38°±3.15° vs. females: 26.72°±5.64°, P<0.05), as well as in the teardrop short axis(males: 22.00±1.25mm vs. females: 20.47±1.73mm, P<0.05) and long axis(males: 32.92±2.85mm vs. females: 30.80±1.48mm, P<0.05). Notably, the narrowest and widest inter-cortical distances of the iliac corridors, and short and long axes of teardrop cross-section exceeded the diameter(9mm) of a iliac screw(P<0.001). Postoperative imaging examinations of the 5 patients who underwent this surgical procedure showed that all implants were stably positioned, with satisfactory improvement in symptoms and functional outcomes.Conclusions: The MEIS placement in the posterior superior iliac is safe and feasible, which can serve as a new option for iliac screw placement trajectory in spinopelvic fixation.