Best screw placement parameters in S1 pedicle based on three-dimensional reconstruction

doi:10.3969/j.issn.2095-4344.0364

Abstract

Abstract:

BACKGROUND: Placement of S₁ pedicle screw is widely used in the treatment of spinal diseases. Because the sacrum itself does not have typical pedicle and lateral block, the transitional area between sacral transverse process and vertebra is defined as pedicle. The bone density of S₁ pedicle is significantly lower than that of pedicle of thoracic and lumbar vertebrae. However, the S₁ vertebra is usually the end vertebra of the spine arch screw, which suffers great stress, and there are many complications of loose and broken nail in clinical follow-up. Therefore, the fixation of the S₁ vertebrae needs to be individualized and precise to obtain the best biomechanics.

OBJECTIVE: To reconstruct the pelvic ring structure by digital technology to simulate S₁ pedicle screw placement, so as to provide anatomical reference for clinical practice.

METHODS: Pelvic CT data of 108 patients in Zigong Fourth People’s Hospital between April and August, 2017 obtained by CT thin slice scanning were included after excluding congenital malformation, and severe degeneration of the sacral and bilateral iliac bones. Three-dimensional model was reconstructed using Mimics software and optimal space nail was simulated by digital technology. S₁ screw entry point was set as the intersection of lines where extension of S₁facet joint inferior margin and lateral margin cross over. The length of the screw, screw position, tangent distance screw nail cap and the iliac wing and the distance between plane wing of ilium nail were measured.

RESULTS AND CONCLUSION: (1) The left oblique angle (α) of S₁ pedicle screws was (20.73±8.04)° in males, and (24.73±8.16)° in females (P=0.013). (2) The right α was (21.57±9.68)° in males and (26.75+7.78)° in females (P=0.003). (3) The distance between the left screw nail cap and the iliac wing (a) was (2.20±4.33) mm in males, and (8.03±8.81) mm in females (P=0.000). (4) The right a was (2.13±3.93) mm in males, and (7.57±6.70) mm in females (P=0.000). (5) The distance between planar iliac bone (b) of screw was (76.96±9.47) mm in males, and (86.52±12.56) mm in females (P=0.000). (6) There was no significant difference in the angle (β) of the left and right sides and the length (d) of screw implantation in females and males (P > 0.05). (7) Three patients could not receive vertical and medial anterior internal fixation due to iliac wing obstruction. (8) These results indicate that the anatomy of the sacral and pelvic rings in South Sichuan is described in detail. The parameters of the S₁ pedicle screw implantation can be used as a reference for clinical application.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

CLC Number:

R445

Wan Shengyu, Lin Xu, Wu Chao, Deng Jiayan. Best screw placement parameters in S₁ pedicle based on three-dimensional reconstruction[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(35): 5620-5624.

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Best screw placement parameters in S₁ pedicle based on three-dimensional reconstruction

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