THE IMPORTANCE OF SACRUM MORPHOLOGY IN TRANSSACRAL AND ILIOSACRAL SCREW FIXATION

Öz

Objective: In this study, it was aimed to put forward the effects of the morphological characteristics of the sacrum on the choice of iliosacral or transsacral screwing.

Material and Methods: The study was carried out on 224 patients who underwent computerized tomographic imaging of the pelvis between May 2016 and May 2019. By reviewing the images of the patients, parameters such as sacrum types, applicability for transsacral screwing, the narrowest diameter of the bone corridor in the coronal plane where the screw was placed properly, and the anteversion angle of the screw were evaluated. Moreover, the distribution of these data according to age and gender was compared between the groups.

Results: Of the patients' sacrums; 72 (32.1%) were the ascending type, 28 (12.5%) were the descending type, 106 (47.3%) were the horizontal type, and 18 (8%) were the dysmorphic type. While transsacral screwing could be performed in 136 (60%) of the sacrums, it was not possible in 88 (40%). The width of the narrowest part where the iliosacral screw would pass was 19.52 (52 (min-max:11.8-47)) mm on average in all patient groups. There was no difference only between the horizontal and the descending types in terms of the narrowest diameter through which the iliosacral screw would pass. The anteversion angle of the iliosacral screw was 25.4 (min-max:5-52.5) degrees on average in all patients. The anteversion angle of the iliosacral screw varied between all sacrum types.

Conclusion: Differences in the sacrum morphology in patients who will undergo iliosacral or transsacral screwing affect the choice of surgery to be applied. For this reason, preoperative surgical planning is essential according to the sacrum morphology.

Anahtar Kelimeler

• Transsacral screwing
• iliosacral screwing
• screw anteversion angle
• sacral morphology
• surgery decision

Proje Numarası

YOK

Transsakral ve İliosakral Vida Tespitinde Sakrum Morfolojisinin Önemi

Öz

Amaç: Bu çalışmada; sakrumun morfolojik özelliklerinin iliosakral veya transsakral vidalama seçimi üzerine olan etkilerinin ortaya konulması amaçlanmıştır.

Gereç ve Yöntemler: Çalışma, Mayıs 2016-Mayıs 2019 yılları arasında pelvis bilgisayarlı tomografi görüntülemesi yapılan 224 hasta üzerinde yapılmıştır. Hastaların görüntülerinden yararlanılarak sakrum tipleri, transsakral vidalama için uygulanabilirlik, uygun yerleşimli vidanın yerleştiği kemik koridorun koronal plandaki en dar çapı ve vidanın anteversiyon açısı gibi parametreler değerlendirilmiştir. Ayrıca elde edilen bu verilerin yaşa ve cinsiyete göre dağılımları da gruplar arasında kıyaslanmıştır.

Bulgular: Hastaların sakrumlarının 72’si (%32,1) asendan tip; 28’i (%12,5) desendan tip; 106’sı (%47,3) horizontal tip; 18’i (%8) dismorfik tipti. Sakrumların 136’sına (%60) transsakral vidalama yapılabilirken, 88’ine (%40) transsakral vidalama yapılamıyordu. İliosakral vidanın geçeceği en dar yerin genişliği bütün hasta grubunda ortalama 19,52 (min-max:11.8-47) mm idi. İliosakral vidanın geçeceği en dar çap açısından sadece horizontal ve desenden tip arasında farklılık yoktu. İliosakral vidanın anteversiyon açısı bütün hastalarda ortalama 25,4 (min-max: 5-52.5) dereceydi. İliosakral vidanın anteversiyon açısı bütün pelvis tipleri arasında farklılık göstermekteydi.

Sonuç: İliosakral veya transsakral vidalama yapılacak hastalarda sakrum morfolojisinde görülecek farklılıklar uygulanacak cerrahi seçimi etkiler. Bundan dolayı sakrum morfolojisine göre preoperatif cerrahi planlama elzemdir.

Anahtar Kelimeler

• Transsakral vidalama
• iliosakral vidalama
• vida anteversiyon açısı
• sakrum morfolojisi
• cerrahi seçim

Destekleyen Kurum

YOK

Proje Numarası

YOK

Kaynakça

1. 1. Gardner MJ, Routt MLC. Transiliac-transsacral screws for posterior pelvic stabilization. J Orthop Trauma. 2011;25(6):378–84.
2. 2. Gras F, Hillmann S, Rausch S, Klos K, Hofmann GO, Marintschev I. Biomorphometric analysis of ilio-sacro-iliacal corridors for an intra-osseous implant to fix posterior pelvic ring fractures. J Orthop Res. 2015;33(2):254–60.
3. 3. Mendel T, Noser H, Kuervers J, Goehre F, Hofmann GO, Radetzki F. The influence of sacral morphology on the existence of secure S1 and S2 transverse bone corridors for iliosacroiliac screw fixation. Injury. 2013;44(12):1773-9.
4. 4. Trikha V, Gaba S, Kumar A, Mittal S, Kumar A. Safe corridor for iliosacral and trans-sacral screw placement in Indian population:A preliminary CT based anatomical study. J Clin Orthop Trauma. 2019;10(2):427-31.
5. 5. Goetzen M, Ortner K, Lindtner RA, Schmid R, Blauth M, Krappinger D. A simple approach for the preoperative assessment of sacral morphology for percutaneous SI screw fixation. Arch Orthop Trauma Surg. 2016;136(9):1251-7.
6. 6. Carlson DWA, Scheid DK, Maar DC, Baele JR, Kaehr DM. Safe placement of S1 and S2 iliosacral screws: The “Vestibule” concept. J Orthop Trauma. 2000;14(4):264-9.
7. 7. Krappinger D, Lindtner RA, Benedikt S. Preoperative planning and safe intraoperative placement of iliosacral screws under fluoroscopic control. Oper Orthop Traumatol. 2019;31(6):465-73.
8. 8. Bastian JD, Jost J, Cullmann JL, Aghayev E, Keel MJB, Benneker LM. Percutaneous screw fixation of the iliosacral joint: Optimal screw pathways are frequently not completely intraosseous. Injury. 2015;46(10):2003-9.

9. 9. Rommens PM, Nolte EM, Hopf J, Wagner D, Hofmann A, Hessmann M. Safety and efficacy of 2D-fluoroscopy-based iliosacral screw osteosynthesis: results of a retrospective monocentric study. Eur J Trauma Emerg Surg. 2020. Doi:10.1007/s00068-020-01362-9.
10. 10. Yinger K, Scalise J, Olson SA, Bay BK, Finkemeier CG. Biomechanical comparison of posterior pelvic ring fixation. J Orthop Trauma. 2003;17(7):481-7.
11. 11. Maslow J, Collinge CA. Risks to the superior gluteal neurovascular bundle during iliosacral and transsacral screw fixation: A computed tomogram arteriography study. J Orthop Trauma. 2017;31(12):640-3.
12. 12. Miller AN, Routt MLC. Variations in sacral morphology and implications for iliosacral screw fixation. J Am Acad Orthop Surg. 2012;20(1):8-16.
13. 13. Conflitti JM, Graves ML, Chip Routt ML. Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated iliosacral screw insertions. J Orthop Trauma. 2010;24(10):630-6.
14. 14. Gardner MJ, Morshed S, Nork SE, Ricci WM, Chip Routt ML. Quantification of the upper and second sacral segment safe zones in normal and dysmorphic sacra. J Orthop Trauma. 2010;24(10):622-9.
15. 15. Durusoy S, Paksoy AE, Korkmaz M, Solak AŞ, Dağlar B. Is pelvic mapping applicable in iliosacral screw fixation to determine screw entry point and screw trajectory? Eklem Hast ve Cerrahisi. 2019;30(3):252-8.
16. 16. Gras F, Gottschling H, Schröder M, Marintschev I, Hofmann GO, Burgkart R. Transsacral osseous corridor anatomy is more amenable to screw insertion in males: a biomorphometric analysis of 280 pelves. Clin Orthop Relat Res. 2016;474(10):2304-11.
17. 17. Weigelt L, Laux CJ, Slankamenac K, Ngyuen TDL, Osterhoff G, Werner CML. Sacral Dysmorphism and its Implication on the Size of the Sacroiliac Joint Surface. Clin Spine Surg. 2019;32(3):140-4.
18. 18. Balling H. Gender-associated differences in sacral morphology do not affect feasibility rates of transsacral screw insertion. radioanatomic investigation based on pelvic cross-sectional imaging of 200 individuals. Spine (Phila Pa 1976). 2020;45(7):421-30.