简化 S1 髂骶螺钉在畸形骶骨中的放置方向。

Hongmin Cai,Yingchao Yin,Ruipeng Zhang,Lin Liu,Tao Wang,Zhiyong Hou
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引用次数: 0

摘要

背景使用 C 型臂确定畸形 S1 骶段的正确髂骶螺钉方向十分困难,通常需要通过骨盆计算机断层扫描(CT)进行术前规划。在术前骨盆轴向 CT 断面图上,可以沿着斜骨走廊的轴线在骨内侧划出预期的螺钉轨迹。精确的方向由两个因素决定:(1) 螺钉轨迹位于骨盆横向平面内,(2) 螺钉轨迹与冠状面的相对方向成特定角度,该角度应在术前测量。方法在骶骨侧视图上确定起点后,我们测试了一种简化导丝方向的方法:将导丝放置在骨盆横向平面上,然后按照术前测量的患者特异角度调整导丝与冠状面的相对角度。这样,骨盆出口和入口切面上的导丝方向就能重复精确。通过对 95 名畸形骶骨患者的计算机模拟虚拟手术过程和 12 名患者的临床手术过程,验证了我们方法的可行性和安全性。结果使用我们的方法,在所有虚拟和临床手术过程中,骨盆出口和入口视图上的 S1 导丝方向都非常准确。在骨盆横切面上骨盆内放置了 95 颗虚拟 S1 螺钉(左半骨盆各 1 颗)。结论将导丝置于骨盆横向平面并复制术前测得的导丝与冠状面之间的患者特异性角度可简化导丝定位。在骶骨侧视图上确定起点后,我们的简化操作可在骨盆出口和入口视图上获得可重复的精确定位。有关证据等级的完整描述,请参阅 "作者须知"。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Simplifying the Orientation of S1 Iliosacral Screws for Placement in the Dysmorphic Sacrum.
BACKGROUND Determining the proper iliosacral screw orientation in a dysmorphic S1 sacral segment using a C-arm is difficult, and pelvic computed tomography (CT) is often necessary for the preoperative planning. On the preoperative pelvic axial CT section, the intended screw trajectory can be delineated intraosseously along the axis of the oblique osseous corridor. An inherently accurate orientation would be determined by 2 factors: (1) the trajectory is in the pelvic transverse plane, and (2) it is oriented relative to the coronal plane at a patient-specific angle, which should be measured preoperatively. Based on the above reasoning, we aimed to simplify and verify the orientation. METHODS After establishing the starting point on the sacral lateral view, we tested a method of simplifying the guidewire orientation: placing the guidewire in the pelvic transverse plane and then manipulating it to be angled relative to the coronal plane at the preoperatively measured patient-specific angle. The guidewire orientation should then be reproducibly accurate on the pelvic outlet and inlet views. The feasibility and safety of our method were verified through computer-simulated virtual surgical procedures in 95 dysmorphic sacra and clinical surgical procedures in 12 patients. The primary outcome parameters were the guidewire orientation and screw placement accuracy. RESULTS Using our method, the S1 guidewire orientation was reproducibly accurate on the pelvic outlet and inlet views in all of the virtual and clinical surgical procedures. Ninety-five virtual S1 screws (1 screw in each left hemipelvis) were placed intraosseously in the pelvic transverse plane. Fourteen unilateral S1 screws were placed intraosseously in the pelvic transverse plane in the 12 patients (2 patients had double screws) without iatrogenic injuries. CONCLUSIONS The guidewire orientation can be simplified by placing the guidewire in the pelvic transverse plane and replicating the preoperatively measured patient-specific angle between the guidewire and the coronal plane. After establishing the starting point on the sacral lateral view, our simplified manipulation yields a reproducibly accurate orientation on the pelvic outlet and inlet views. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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