An anatomic study on the placement of the second sacral screw and its clinical applications

详细信息    查看全文

• 作者：Jingchen Liu (1)
  Ye Li (1)
  Yuntao Wu (1)
  Qingsan Zhu (1)
  
• 关键词：Sacrum ; Screw fixation ; Anatomy ; Clinical application
• 刊名：Archives of Orthopaedic and Trauma Surgery
• 出版年：2013
• 出版时间：July 2013
• 年：2013
• 卷：133
• 期：7
• 页码：911-920
• 全文大小：903KB
• 参考文献：1. Horowitch A, Peek RD, Thomas JC Jr et al (1989) The Wiltse pedicle screw fixation system. Early clinical results. Spine 14:461-67 CrossRef
  2. Bernhardt M, Swartz DE, Clothiaux PL et al (1992) Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation. Clin Orthop Relat Res 284:109-15
  3. Rechtine GR, Sutterlin CE, Wood GW et al (1996) The efficacy of pedicle screw/plate fixation on lumbar/lumbosacral autogenous bone graft fusion in adult patients with degenerative spondylolisthesis. J Spinal Disord 9:382-91 CrossRef
  4. Molinari RW, Bridwell KH, Lenke LG et al (1999) Complications in the surgical treatment of pediatric high-grade isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. Spine 24:1701-711 CrossRef
  5. Camp JF, Caudle R, Ashmun RD, Roach J (1990) Immediate complications of Cotrel-Dubousset instrumentation to the sacro-pelvis. A clinical and biomechanical study. Spine 15:932-41 CrossRef
  6. Weistroffer JK, Perra JH, Lonstein JE et al (2008) Complications in long fusions to the sacrum for adult scoliosis: minimum five-year analysis of fifty patients. Spine 33:1478-483 CrossRef
  7. Lu WW, Zhu Q, Holmes AD et al (2000) Loosening of sacral screw fixation under in vitro fatigue loading. J Orthop Res 18:808-14 CrossRef
  8. Allen BL Jr, Ferguson RL (1984) The Galveston technique of pelvic fixation with L-rod instrumentation of the spine. Spine 9:388-94 CrossRef
  9. Zindrick MR, Wiltse LL, Widell EH et al (1986) A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res 203:99-12
  10. Mirkovic S, Abitobol JJ, Steinman J et al (1991) Anatomic considerations for sacral screw placement. Spine 16(6S):289-94
  11. Ebraheim NA, Lu J, Yang H et al (1997) Anatomic considerations of the second sacral vertebra and dorsal screw placement. Surg Radiol Anat 19:353-57 CrossRef
  12. Peelle MW, Lenke LG, Bridwell KH et al (2006) Comparison of pelvic fixation techniques in neuromuscular spinal deformity correction: Galveston rod versus iliac and lumbosacral screws. Spine 31:2392-398 CrossRef
  13. Tsuchiya K, Bridwell KH, Kuklo TR et al (2006) Minimum 5-year analysis of L5–S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine 31:303-08 CrossRef
  14. Chang T, Sponseller PD, Kchaish KM et al (2009) Low profile pelvic fixation: anatomic parameters for sacral alar-iliac fixation versus traditional iliac fixation. Spine 34:436-40 CrossRef
  15. Ziran BH, Smith WR, Towers J, Morgan SJ (2003) Iliosacral screw fixation of the posterior pelvic ring using local anesthesia and computerised tomography. J Bone Joint Surg Br 85:411-18 CrossRef
  16. Emami A, Deviren V, Berven S et al (2002) Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine 27:776-86 CrossRef
  17. McCord DH, Cunningham BW, Shono Y et al (1992) Biomechanical analysis of lumbosacral fixation. Spine 17:S235–S243 CrossRef
  18. Kuklo TR, Bridwell KH, Lewis SJ et al (2001) Minimum 2-year analysis of sacropelvic fixation and L5–S1 fusion using S1 and iliac screws. Spine 26:1976-983 CrossRef
  19. Nottmeier EW, Pirris SM, Balseiro S et al (2010) Three-dimensional image-guided placement of S2 alar screws to adjunct or salvage lumbosacral fixation. Spine J 10:595-01 CrossRef
  20. Kim JH, Horton W, Hamasaki T et al (2010) Spinal instrumentation for sacral-pelvic fixation: a biomechanical comparison between constructs ending with either S2 bicortical, bitriangulated screws or iliac screws. J Spinal Disord Tech 23:506-12 CrossRef
  21. O’Brien JR, Yu WD, Bhatnagar R et al (2009) An anatomic study of the S2 iliac technique for lumbopelvic screw placement. Spine 34:439-42 CrossRef
  22. Kwan MK, Jeffry A, Chan CY, Saw LB (2012) A radiological evaluation of the morphometry and safety of S1, S2 and S2-ilium screws in the Asia population using three dimensional computed tomography scan: an analysis of 180 pelvis. Surg Radiol Anat 34:217-27 CrossRef
  
• 作者单位：Jingchen Liu (1)
  Ye Li (1)
  Yuntao Wu (1)
  Qingsan Zhu (1)
  
  1. Department of Spine Surgery, The First Bethune Hospital, Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
  
• ISSN：1434-3916

文摘

Background The fixation of lumbosacral and sacral pelvis can be performed on the ilium and the Second Sacrum Vertebrae (S2). Although several studies on the anatomical and biomechanical features of S2 screw fixation have been published, little clinical application has been reported, especially combination of anatomical investigation and clinical study. This study was performed to design and optimize the method of pedicle screw placement for S2. Materials and methods Fifteen adult dry sacrum specimens were prepared and truncated from the S1–S2 and S2–S3 vertebral fusion remnants, and the morphology of the S2 vertebral body was observed from this section. The intersection of the horizontal line through the lowest point of the inferior edge of the first posterior sacral foramen and the lateral sacral crest was the entry point (Point X). The screws were inserted anterolaterally or anteromedially at Point X in 10 cadavers, with all of the screws penetrating the sacrum. Finally, the S2 sacral screw fixation technique was applied to a total of 13 patients with lumbosacral lesions, and the clinical outcome was evaluated at a minimum follow-up of 1?year. Results Two S2 sacral screw placement methods were developed, i.e., the anterolateral and anteromedial insertions. Seven patients had complete preoperative, postoperative, and follow-up data. In all cases, the bilateral S2 screws were placed in good position and the fixation was firm. There was no surgical wound infection or internal fixation loosening. All the patients achieved partial bone graft healing, which was verified by computed tomography. Conclusions The intersection of the horizontal line through the lowest point of the inferior edge of the first posterior sacral foramen and the lateral sacral crest can be used as the entry point for S2 sacral screw fixation. The S2 pedicle screw fixation shows good clinical effectiveness and safety for stable reconstruction of lumbosacral lesions.