Sacral dysmorphism and gender-specific variations: A CT-Based approach to safe percutaneous sacral screw placement – An ambispective study

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-21 DOI:10.1016/j.jcot.2025.103026

Dinesh Kale , Shubham Gupta , Sahil Kale , Dharmendra Kumar

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引用次数: 0

Abstract

Background

Sacral fractures are associated with high-energy trauma and pose challenging surgical conditions due to anatomical variability. The presence of sacral dysmorphism with narrow corridors, acute alar slopes, and non-circular foramina further complicates the placement of ilio-sacral and trans-sacral screws. Gender-related differences also exist in sacral morphology, which can impact surgical planning and screw trajectory.

Methods

We reviewed data from 1000 pelvic CT scans among 652 males and 348 females aged 18–65 years from multiple centers to measure sacral morphometry along with the safe screw placement corridors. Quantification of S1 and S2 sacral segments was done using HOROS, Radiant, Iplan software tools in terms of anteroposterior breadth, height, and width of sacral corridors. The safe screw trajectory for 6.5 mm and 7.3-mm screws was established from the vestibular concept with 2 mm of safety margin. SPSS v22.0 was used for statistical analysis.

Results

Sacral dysmorphism was found in 31.58 % males and 18.42 % females. Male dimensions of the sacrum were higher, more sagittal height at S1 (12.01 ± 1.83 mm vs. 10.76 ± 1.13 mm, p < 0.001), and axial width (23.66 ± 3.32 mm vs. 13.3 ± 2.9 mm, p < 0.001), compared to women. Measurements made at S2 were similar among genders. Safe placement of 7.3 mm S1 trans-sacral screws was possible in 84.21 % males and 47.37 % females, and 6.5 mm screws were applicable in 10.53 % of males and 26.32 % of females. For S2, 68.42 % of males and 31.58 % females were amenable to 7.3 mm screws, while 6.5 mm screws were feasible in 10.53 % of males and 23.68 % of females. Dysmorphic sacrum required a specific approach with a bias towards the use of 6.5 mm screws.

Conclusion

The study highlights gender variations and sacral dysmorphism impacts the safety of screw placement in Indian patients. The possibility of individualized planning before surgery by CT-based morphometry will improve safety as well as effectiveness in sacral fracture fixation.

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骶骨畸形和性别特异性变异：一种基于ct的安全经皮骶骨螺钉置入方法-一项双视角研究

背景：骶骨骨折与高能创伤有关，由于解剖结构的差异，手术条件具有挑战性。骶骨畸形伴狭窄通道、急性鼻翼倾斜和非圆形椎间孔的存在进一步使髂骶螺钉和经骶螺钉的置入复杂化。两性在骶骨形态上也存在差异，这会影响手术计划和螺钉轨迹。方法我们回顾了来自多个中心的1000例骨盆CT扫描数据，其中652例男性和348例女性，年龄在18-65岁之间，测量了骶骨形态测量和安全螺钉放置通道。使用HOROS、Radiant、Iplan软件工具对骶S1和骶S2段进行骶走廊的前后宽度、高度和宽度量化。根据前庭概念建立了6.5 mm和7.3 mm螺钉的安全螺钉轨迹，安全裕度为2mm。采用SPSS v22.0进行统计分析。结果骶骨畸形男占31.58%，女占18.42%。男性骶骨尺寸较高，骶S1处矢状高度较多(12.01±1.83 mm vs. 10.76±1.13 mm, p <；0.001)和轴向宽度(23.66±3.32毫米和13.3±2.9毫米,p & lt;0.001)，与女性相比。S2时的测量结果在性别之间是相似的。84.21%的男性和47.37%的女性可安全放置7.3 mm S1经骶骨螺钉，而10.53%的男性和26.32%的女性可安全放置6.5 mm螺钉。对于S2, 68.42%的男性和31.58%的女性适合使用7.3 mm螺钉，而6.5 mm螺钉的男性和女性分别为10.53%和23.68%。畸形骶骨需要特殊入路，偏向于使用6.5 mm螺钉。结论性别差异和骶骨畸形影响印度患者螺钉置入的安全性。基于ct的形态测量术在手术前进行个体化计划的可能性将提高骶骨骨折固定的安全性和有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.