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Sağlıklı bireylerde 3D BT görüntüleme kullanılarak S1 vida parametrelerinin belirlenmesi

Yıl 2019, Cilt: 11 Sayı: 3, 224 - 230, 01.09.2019
https://doi.org/10.21601/ortadogutipdergisi.449175

Öz

Amaç: Bu çalışmanın amacı posterior superior iliak omurga (PSIO) tiplerinin antropometrisini Türk toplumunda araştırmak ve lumbosakral enstrümantasyon cerrahisinde posterior lumber yaklaşım ile sakrumun uzunluğunun ve açısının güvenli sınırlarını saptamaktır.
Gereç ve Yöntem: Sağlıklı bireylerde sakrum’un sol-sağ pedikül uzunlukları, pedikül açıları ve PSIS tipleri 3 boyutlu görüntüler kullanılarak değerlendirildi.
Bulgular: Çalışmaya 58’i erkek, 53’ü bayan toplam 111 kişi alındı. Ortalama yaş erkeklerde 46,9 ± 14,8, kadınlarda 44,3 ± 16,4 idi. Erkeklerde sağ pedikül uzunluğu 52,83 mm, sol pedikül uzunluğu 53,81 mm, sağ pedikül açısı 35,84, sol pedikül açısı 35,13, kaudal açı 39,24 derece olarak saptandı. Kadınlarda ise sağ pedikül uzunluğu 48,88 mm, sol pedikül uzunluğu 49,28 mm, sağ ve sol pedikül açısı 35.83, kaudal açı 39,24 derece idi. PSIO tip 1 % 58,6, tip 2 %32,4, tip 3 %9 oranında saptandı.
Sonuç: Posterior stabilizasyonda sakral vidalamada optimal vida uzunlukları, açıları ve uygun vida oryantasyonlarının preop yapılması ile operasyon kolay ve güvenli olabilir. Bu çalışma ile aynı zamanda sakral vida oryantasyonu ile ilgili morfometrik ve antropometrik bilgiler de saptanmıştır. Bu veriler lumbosakral cerrahi stabilizasyon işlemlerinde preop anatomik yapı hakkında cerraha katkı sağlayarak cerrahi komplikasyonları önlemede yardımcı olabilecektir.

Kaynakça

  • Ebraheim NA, Xu R, Challgren E. Location of the sacral pedicle, foramina, and ala on the lateral aspect of the sacrum: a radiographic study. Orthopedics 1998; 21: 703–6.
  • Mirkovic S, Abitbol JJ, Steinman J. Anatomic consideration for sacral screw placement. Spine 1991; 16: 289–94.
  • Morse BJ, Ebraheim NA, Jackson T. Preoperative CT determination of angles for sacral screw placement. Spine 1994; 19: 604–7.
  • Carlson GD, Abitbol JJ, Anderson DR, et al. Screw fixation in the human sacrum. An in vitro study of the biomechanics of fixation. Spine 1992 (Phila Pa 1976) 17: 196–203.
  • Weistroffer JK, Perra JH, Lonstein JE et al. Complications in long fusions to the sacrum for adult scoliosis: minimum five-year analysis of fifty. Spine 2008 (Phila Pa 1976) 33:1478– 1483.
  • Yu BS, Zhuang XM, Zheng ZM, Zhang JF, Li ZM, Lu WW. Biomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic condition. J Spinal Disord Tech 2010 23: 404–9.
  • Zindrick MR, Wiltse LL, Widell EH, et al. A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res 1986; 203: 99–112.
  • De Peretti F, Argenson C, Bourgeon A, Omar F, Eude P, Aboulker C. Anatomic and experimental basis for the insertion of a screw at the first sacral vertebra. Surg Radiol Anat 1991; 13: 133–7.
  • Sae-Jung S, Khamanarong K, Woraputtaporn W, Amarttayakong P. Awareness of the median sacral artery during lumbosacral spinal surgery: an anatomic cadaveric study of its relationship to the lumbosacral spine. Eur Spine J 2014. Doi(:10.1007/s00586-014-3641-z).
  • Arman C, Naderi S, Kiray A, et al. The human sacrum and safe approaches for screw placement. J Clin Neurosci 2009; 16: 1046–9.
  • Inoue M, Inoue G, Ozawa T, Miyagi M, Kamoda H, Ishikawa T. L5 spinal nevre injury caused by misplacement of outwardly-inserted S1 pedicle screws. Eur Spine J 2013; 22: 461–5.
  • Robertson PA, Plank LD. Pedicle screw placement at the sacrum: anatomical characterization and limitations at S1. J Spinal Disord 1999; 12: 227–33.
  • Xu R, Ebraheim NA, Mohamed A, el-Gamal H, Yeasting RA. Anatomic considerations for dorsal sacral plate-screw fixation. J Spinal Disord1995; 8: 352–6.
  • Kaptanoglu E, Okutan O, Tekdemir I, Beskonakli E, Deda H. Closed posterior superior iliac spine impeding pediculocorporeal S-1 screw insertion. J Neurosurg 2003; 19: 229–34.
  • Abdul-Jabbar A, Yilmaz E, Iwanaga J, et al. Neurovascular relationships of S2 screw placement: Anatomic Study. World Neurosurg 2018 Aug; 116: 108-12. (doi: 10.1016/j).
  • Wang Y, Hu W, Hu F, Zhang H, et al. Proper detailed parameters for S1 sacral alar iliac screw placement in the Chinese population, a 3D imaging study. J Orthop Surg Res 2018 Feb 26; 13: 39. (doi: 10.1186/s13018-018-0739-8).
  • Jain N, Yu E. ıntraoperative radiographic technique for visualization of bicortical or tricortical anteromedial sacral screw placement. Clin Spine Surg 2018 Apr; 31: 108-11. (doi: 10.1097/BSD.0000000000000561).

Determination of S1 screw adjustment parameters using by 3D CT images in healthy subjects

Yıl 2019, Cilt: 11 Sayı: 3, 224 - 230, 01.09.2019
https://doi.org/10.21601/ortadogutipdergisi.449175

Öz

Background: The aim of this study was to investigate the anthropometry of the posterior superior iliac spine (PSIS) types in the Turkish population and to determine the safe limits of the length and angle of the sacrum by the posterior lumber approach in lumbosacral instrumentation surgery.
Material and Method: Sacral regions (left and right pedicle lengths and pedicle angles) and PSIS types of healthy subjects were evaluated using 3D images.
Results: A total of 111 patients (58 males and 53 females) were included in the study. The mean age was 46.9 ± 14.8 in males and 44.3 ± 16.4 in females. In men, the right pedicle length was 52.83 mm, the left pedicle length was 53.81 mm, the right pedicle angle was 35.84, the left pedicle angle was 35.13, and the caudal angle was 39.24 degrees. In females, right pedicle length was 48.88 mm, left pedicle length was 49.28 mm, right and left pedicle angle was 35.83, and caudal angle was 39.24 degrees. PSIS type 1 was found to be 58.6%, type 2 32.4% and type 3 9%.
Conclusion: Optimal screw lengths, angles and proper screw orientations can be easily and safely operated in posterior stabilization. In this study, morphometric and anthropometric information related to sacral screw orientation were also determined. These data may help to prevent surgical complications by contributing to the surgeon about preoperative anatomical structure in lumbosacral surgery stabilization procedures.

Kaynakça

  • Ebraheim NA, Xu R, Challgren E. Location of the sacral pedicle, foramina, and ala on the lateral aspect of the sacrum: a radiographic study. Orthopedics 1998; 21: 703–6.
  • Mirkovic S, Abitbol JJ, Steinman J. Anatomic consideration for sacral screw placement. Spine 1991; 16: 289–94.
  • Morse BJ, Ebraheim NA, Jackson T. Preoperative CT determination of angles for sacral screw placement. Spine 1994; 19: 604–7.
  • Carlson GD, Abitbol JJ, Anderson DR, et al. Screw fixation in the human sacrum. An in vitro study of the biomechanics of fixation. Spine 1992 (Phila Pa 1976) 17: 196–203.
  • Weistroffer JK, Perra JH, Lonstein JE et al. Complications in long fusions to the sacrum for adult scoliosis: minimum five-year analysis of fifty. Spine 2008 (Phila Pa 1976) 33:1478– 1483.
  • Yu BS, Zhuang XM, Zheng ZM, Zhang JF, Li ZM, Lu WW. Biomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic condition. J Spinal Disord Tech 2010 23: 404–9.
  • Zindrick MR, Wiltse LL, Widell EH, et al. A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res 1986; 203: 99–112.
  • De Peretti F, Argenson C, Bourgeon A, Omar F, Eude P, Aboulker C. Anatomic and experimental basis for the insertion of a screw at the first sacral vertebra. Surg Radiol Anat 1991; 13: 133–7.
  • Sae-Jung S, Khamanarong K, Woraputtaporn W, Amarttayakong P. Awareness of the median sacral artery during lumbosacral spinal surgery: an anatomic cadaveric study of its relationship to the lumbosacral spine. Eur Spine J 2014. Doi(:10.1007/s00586-014-3641-z).
  • Arman C, Naderi S, Kiray A, et al. The human sacrum and safe approaches for screw placement. J Clin Neurosci 2009; 16: 1046–9.
  • Inoue M, Inoue G, Ozawa T, Miyagi M, Kamoda H, Ishikawa T. L5 spinal nevre injury caused by misplacement of outwardly-inserted S1 pedicle screws. Eur Spine J 2013; 22: 461–5.
  • Robertson PA, Plank LD. Pedicle screw placement at the sacrum: anatomical characterization and limitations at S1. J Spinal Disord 1999; 12: 227–33.
  • Xu R, Ebraheim NA, Mohamed A, el-Gamal H, Yeasting RA. Anatomic considerations for dorsal sacral plate-screw fixation. J Spinal Disord1995; 8: 352–6.
  • Kaptanoglu E, Okutan O, Tekdemir I, Beskonakli E, Deda H. Closed posterior superior iliac spine impeding pediculocorporeal S-1 screw insertion. J Neurosurg 2003; 19: 229–34.
  • Abdul-Jabbar A, Yilmaz E, Iwanaga J, et al. Neurovascular relationships of S2 screw placement: Anatomic Study. World Neurosurg 2018 Aug; 116: 108-12. (doi: 10.1016/j).
  • Wang Y, Hu W, Hu F, Zhang H, et al. Proper detailed parameters for S1 sacral alar iliac screw placement in the Chinese population, a 3D imaging study. J Orthop Surg Res 2018 Feb 26; 13: 39. (doi: 10.1186/s13018-018-0739-8).
  • Jain N, Yu E. ıntraoperative radiographic technique for visualization of bicortical or tricortical anteromedial sacral screw placement. Clin Spine Surg 2018 Apr; 31: 108-11. (doi: 10.1097/BSD.0000000000000561).
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma makaleleri
Yazarlar

Mehmet Hüseyin Akgül 0000-0001-5966-3042

Veysel Burulday 0000-0002-2035-5330

Mustafa Öğden 0000-0002-7129-0936

Ulaş Yüksel

Yayımlanma Tarihi 1 Eylül 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 11 Sayı: 3

Kaynak Göster

Vancouver Akgül MH, Burulday V, Öğden M, Yüksel U. Determination of S1 screw adjustment parameters using by 3D CT images in healthy subjects. otd. 2019;11(3):224-30.

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