The usefulness of reformatting CT scanning plane to distinguish sacral dysmorphism and introducing the variable of elevated height for predicting the possibility of trans-sacral screw fixation

Chung, Hyemoon; Park, Jisu; Sohn, Hong Gyoo; Jung, Gu-Hee

doi:10.1016/j.otsr.2019.11.009

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…The CT data of 112 cadavers were investigated and the ideal placement of sacral screws were measured. According to their study, cortical violation around the screw was shown in sacral dysmorphism, if the violated (elevated) height exceeds 13 mm, traditional trans-sacral screw fixation should not be performed as this may cause neurological damage (20).…”

Section: Discussionmentioning

confidence: 99%

Muğla Bölgesinde Sakral Dismorfizim Bulgularının Sıklığı

Kılınç

Can

et al. 2021

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

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ÖzThis retrospective study aims to reveal the prevalence of sacral dysmorphism, the proportion of its findings and signs and its clinical importance in pelvic surgeries. 1753 nontraumatic pelvic and lower abdominal CT images were analyzed to reveal the sacral abnormal anatomy and dysmorphic signs in nontraumatic patients. Of the patients included in the study; S1-S2 residual disc in 879 (50.60%), the presence of mammillary body or mammillary process in 209 (12%), acute ascending descent in 182 (10.47%), tongue-in-grove sign in 178 (10.25%), deformity in the neural foramen in 168 (9.67%), and collinearity in 121 patients (7%) were detected. The parameters of non-circular amorphous first sacral foramen and lumbosacral disc distance being close to the iliac wing (collinearity) parameters were statistically significantly higher in women than in men (p=0.027; p=0.005). There was no statistically significant correlation between non-circular amorphous first sacral foramen and collinearity parameters and gender (phi=0.149, p=0.027; phi=-0.188, p=0.005). Noncircular amorphous first sacral foramen and residual disc distance between S1 and S2 were found to be statistically significantly higher in the cases (p=0.039). Sacral dysmorphism is an abnormal anatomy that is seen much more common than it is thought in the population and plays an important role in clinical interventions. Keeping this anatomical difference in mind during surgical procedures involving sacrum reduces the possibility of encountering unwanted complications.

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Section: Discussionmentioning

confidence: 99%

Muğla Bölgesinde Sakral Dismorfizim Bulgularının Sıklığı

Kılınç

Can

et al. 2021

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

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“…Therefore, TSSs are favored because of their superior mechanical properties; 15 additionally, they can be easily identified by intraoperative fluoroscopy at the inlet and outlet of the pelvis or the lateral position of the sacrum. However, TSS or TTS cannot be accommodated in the S1 segment for patients with very high oblique sacral wings 16–21 . For these patients, we inserted an OSS in the S1 segment combined with a TTS in the S2 segment; whether this is the best method of internal fixation is an urgent question.…”

Section: Discussionmentioning

confidence: 99%

“…However, TSS or TTS cannot be accommodated in the S1 segment for patients with very high oblique sacral wings. 16 , 17 , 18 , 19 , 20 , 21 For these patients, we inserted an OSS in the S1 segment combined with a TTS in the S2 segment; whether this is the best method of internal fixation is an urgent question. Due to the scarcity of cadavers, FEA has become the preferred method of mechanical analysis in orthopedic internal fixation research.…”

Section: Discussionmentioning

confidence: 99%

Finite Element Analysis and Transiliac‐Transsacral Screw Fixation for Posterior Pelvic Ring with Sacrum Dysplasia

Zeng

Deng³

et al. 2022

Orthopaedic Surgery

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Objective Posterior pelvic ring sacroiliac screws are preferred by clinicians for their good biomechanical performance. However, there are few studies on mechanical analysis and intraoperative screw insertion of the dysplastic sacrum and sacroiliac screw. This study investigated the biomechanical performance of oblique sacroiliac screws (OSS) in S1 combined with transiliac‐transsacral screws (TTSs) in S2 for pelvic fracture or sacroiliac dislocation with dysplastic sacrum and evaluated the safety of screw placement assisted by the navigation template. Methods Six models were established, including one OSS fixation in the S2 segment, one transverse sacroiliac screw (TSS) fixation in the S2 segment, one TTS fixation in the S2 segment, one OSS fixation in the S1 and S2 segments, one OSS fixation in the S1 segment and one TSS fixation in the S2 segment, one OSS fixation in the S1 segment and one TTS fixation in the S2 segment. Then, finite element analysis (FEA) was performed. Twelve dysplastic sacrum patients with pelvis fracture or sacroiliac dislocation underwent OSS insertion in the S1 combined with TTS insertion in the S2 under the assistance of the patient‐specific locked navigation template. Grading and Matta scores were evaluated after surgery. Results In the one‐screw fixation group, the vertical displacements of the sacrum surface of S2 OSS, S2 TSS and S2 TTS were 1.23, 1.42, and 1.22 mm, respectively, and the maximum stress of screw were 139.45 MPa, 144.81 MPa, 126.14 MPa, respectively. In the two‐screw fixation group, the vertical displacements of the sacrum surface of the S1 OSS + S2 OSS, S1 OSS + S2 TSS and S1 OSS + S2 TTS were 0.91, 1.06, and 0.75 mm, respectively, and the maximum stress of screw were 149.26 MPa, 167.13 Pa, 136.76 MPa, respectively. Clinically, a total of 12 TTS and OSS were inserted under the assistance of navigation templates, with a surgical time of 55 ± 7.69 min, bleeding of 57.5 ± 18.15 ml and radiation times of 14.5 ± 4.95. One of the TTS and one of the OSS were grade 1, and the other screws were grade 0. The Matta scores of nine patients were excellent, and three patents were good. Conclusion OSS in the S1 combined with TTS in the S2 had the best mechanical stability in six models, and it is safe for screw insertion assisted by the patient‐specific locked navigation template.

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