Lateral sakral kitlenin morfolojik ve radyolojik değerlendirilmesi

Year 2003, Volume: 37 Issue: 4, 330 - 339, 11.09.2006

Irfan Esenkaya Ahmet Kavakli H. Bulut

Abstract

Amaç: İliosakral vida uygulamalarında bölgenin yeterliliğini değerlendirmek için, kuru sakrum kemik örneklerinde, lateral sakral kitle (LSK) ve komşulukları morfolojik ve bilgisayarlı tomografi (BT) kesitlerinde radyolojik ölçümlerle incelendi.
Çalışma planı: Otuz adet kuru sakrum kemik örneğinde LSK’nin morfolojik ölçümleri, milimetre duyarlı kompas kullanılarak yapıldı. Aynı kemiklerin S1 ve S2 pedikül-cisim ve intervertebral foramina hizalarında çekilen BT kesitlerinde, LSK’nin nöral kanal ve intervertebral foramina ile ilişkisi milimetre duyarlılığındaki cetvel ile ölçülerek değerlendirildi.
Sonuçlar: Lateral sakral kitlenin posterior yüzdeki genişliği, sağda S1 düzeyinde 24.1 mm, S2 düzeyinde 18.4 mm, solda S1 düzeyinde 24.5 mm, S2 düzeyinde 18.8 mm; anterior yüzdeki genişliği sağda S1 düzeyinde 28.9 mm, S2 düzeyinde 22.6 mm, solda S1 düzeyinde 29.1 mm, S2 düzeyinde 23 mm; postero-lateral yerleşimli (oblik) yüksekliği sağda S1 düzeyinde 39 mm, S2 düzeyinde 28.6 mm; solda S1 düzeyinde 37.4 mm S2 düzeyinde 27.6 mm ölçüldü. Sakral ala’nın derinliği sağda ortalama 50.6 mm, solda 50.7 mm; posterior yüksekliği sağda ve solda ortalama 26 mm bulundu. Radyolojik değerlendirmede, S1 pedikül-cisim seviyesinde pedikül+sakral ala’nın ortalama genişliği sağda 37.6 mm, solda 36.3 mm; LSK’nin S1 intervertebral foramina seviyesindeki genişliği sağda 22 mm, solda 22.3 mm; S2 pedikül-cisim seviyesinde pedikül+LSK’nin ortalama genişliği sağda 27.8 mm, solda 26.4 mm; S2 intervertebral foramina seviyesinde LSK’nin ortalama genişliği sağda 15.9 mm, solda 16.3 mm bulundu.
Çıkarımlar: Ameliyat öncesinde yapılacak BT incelemeleriyle LSK’nin büyüklüğü belirlendikten sonra, özellikle S1 pedikül-cisim düzeyinde ve sakral nöral kanal ve intervertebral foramina lateralinde kalacak şekilde, nöral doku ve çevre yapılara zarar vermeden iliosakral vida uygulanabilir.

Keywords

bone screws;cadaver;ilium;ilium/anatomy&histology;sacroiliac joint;sacroiliac joint/anatomy&histology;sacrum/radiography;sacrum/surgery;tomography, x-ray computed

Radiologic and morphologic evaluation of the lateral sacral mass

Abstract

Objectives: Morphologic measurements of the lateral sacral mass (LSM) and adjacent bone structures were made on dried sacrum specimens, together with radiologic evaluations on computed tomography (CT) scans in order to assess the appropriateness of this area in iliosacral screw applications.
Methods: On thirty dried human sacral bone specimens, morphologic measurements of the LSM were made by a compass sensitive to millimeters. Computed tomographic views of S1 and S2 pedicle-bodies and intervertebral foramina were obtained to make radiologic measurements by a millimeter-sensitive ruler to examine the relationship between LSM and the neural canal and intervertebral foramina.
Results: The average widths of the LSM on the posterior and anterior surfaces of the sacrum were as follows. Posterior aspect: 24.1 mm on S1, 18.4 mm on S2 levels on the right; 24.5 mm on S1 and 18.8 mm on S2 levels on the left. Anterior aspect: 28.9 mm on S1, 22.6 mm on S2 levels on the right; 29.1 mm on S1 and 23 mm on S2 levels on the left. The average (oblique) heights of LSM on the postero-lateral surface were 39 mm on S1, 28.6 mm on S2 levels on the right; 37.4 mm on S1, 27.6 mm on S2 levels on the left. The average depth of the sacral ala was 50.6 mm on the right, 50.7 mm on the left. The average posterior alar height was 26 mm on both sides. On CT scans, the average widths of pedicle+sacral ala were measured as 37.6 mm (right) and 36.3 mm (left) at the S1 pedicle-body level. The average widths of LSM were 22 mm (right) and 22.3 mm (left) at the S1 intervertebral foramina level. The average widths of pedicle+LSM were 27.8 mm (right) and 26.4 mm (left) at the S2 pedicle-body level. The average widths of LSM at the S2 intervertebral foramina level were 15.9 mm (right) and 16.3 mm (left).
Conclusion:Our results suggest that iliosacral screw fixation may be more safely performed, especially at the S1 pedicle-body level and lateral to the sacral neural canal and intervertebral foramina. Injury to the neural tissues and surrounding structures is more unlikely if preoperative measurements of LSM are made on CT scans.

Keywords

Bone screws, cadaver, ilium/anatomy & histology, sacroiliac joint/anatomy & histology, sacrum/anatomy & histology/radiography/surgery, tomography, X-ray computed