目的 观察骶骨形态变化规律，探讨其与第3骶骨段骶髂螺钉通道的相关性。 方法 回顾性分析2013年12月至2023年12月本院行骨盆X线和CT检查的1264名患者，其中男性539名，女性725名，年龄18~70岁，平均（46.71±15.58）岁，根据骨盆影像解剖结构及骶骨形态不同分组，对各组中第3骶骨段通道存在的情况进行分析。 结果 各组第3骶骨段通道存在的概率为：正常骶骨组40.30%，骶骨翼急性倾斜组74.94%，腰骶椎椎间盘同髂嵴相对共线组79.84%，上位骶孔不规整组93.64%，残留骶椎椎间盘组57.21%，舌槽畸形组81.73%，腰骶移行椎组72.82%，乳突体组89.13%，骶骨脊柱裂组58.97%。 结论 异常骶骨形态会影响骶髂关节第3骶骨段通道的存在，当骶骨存在这些形态变异时，第3骶骨段骨性通道存在的可能性更大。
Abstract
Objective To examine the alterations in the shape of the sacrum and investigate its correlation with the presence of a third sacral segment sacroiliac screw pathway. Methods In a retrospective analysis involving 1,264 patients who underwent pelvic X-rays and CT scans between December 2013 and December 2023, comprising 539 males and 725 females aged 18 to 70 years with an average age of was (46.71±15.58) years, the patients were categorized into distinct groups based on their pelvic anatomy, and the presence or absence of related passages was examined within each group. Results The probability of the existence of the 3rd sacral segment channel in each group was as follows: normal sacrum was 40.30 %, acute lateral tilt of the sacral wings was 74.94 %, 79.84 % of the L5-S1 was intervertebral disk being parallel to the iliac crest, 93.64 % of the upper sacral foramen deviating from regularity, 57.21 % residual L5-S1 intervertebral disk, 81.73 % cleft of the tongue fossa, 72.82 % transitional vertebrae of the lumbar-sacral region, 89.13 % of the mastoid process, and 58.97 % of the sacral vertebral column defect. Conclusions In this study, various abnormal sacral morphologies all affect the existence of the S3 sacroiliac screw trajectory. When these morphological variations are present in the sacrum, the possibility of the presence of a bony canal in the third sacral segment is greater.
关键词
骶骨 /
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解剖 /
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骶髂关节 /
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螺钉通道
Key words
Sacrum /
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Anatomy /
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Sacroiliac joint /
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Screw pathway
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参考文献
[1] Stolberg-Stolberg J, Lodde MF, Sei D, et al. Long-term follow-up after iliosacral screw fixation of unstable pelvic ring fractures[J]. J Clin Med, 2024, 13(4): 1070. DOI: 10.3390/jcm13041070.
[2] Zhou W, Chen J, Pei X, et al. Incidence of and risk factors for screw loosening after iliosacral screw fixation for posterior pelvic ring injury[J]. Orthop Surg, 2023, 15(7): 1814-1822. DOI: 10.1111/os.13763.
[3] 阿拉木斯, 张元智, 胡旭锋, 等. 青少年骶骨骶髂螺钉钉道增龄变化的数字化评估[J]. 中国临床解剖学杂志, 2022, 40 (4): 398-403. DOI: 10.13418/j.issn.1001-165x.2022.4.05.
A Lamusi, Zhang YZ, Hu XF, et al. Digital evaluation of the age-related changes of the iliosacral screw pathway in adolescents [J]. Chin J Clin Anat, 2022, 40 (4): 398-403. DOI:10.13418/j.issn.1001-165x.2022.4.05.
[4] Zhao Y, Li W, Lian W, et al. Anatomic relationship between S2 sacroiliac screws' entry points and pelvic external branches of superior gluteal artery[J]. Eur J Trauma Emerg Surg, 2022, 48(2): 857-862. DOI: 10.1007/s00068-021-01622-2.
[5] Chen PH, Chen CY, Lin KC, et al. Quantification of the safe zone of the first to third sacral segments for transiliac-transsacral screw fixation in normal and dysmorphic sacra[J]. Orthopedics, 2024, 47(1): e13-e18. DOI: 10.3928/01477447-20230531-06.
[6] Shan T, Hanqing L, Qiuchi A, et al. Guidance for dysmorphic sacrum fixation with upper sacroiliac screw based on imaging anatomy study: techniques and indications[J]. BMC Musculoskelet Disord, 2023, 24(1): 536. DOI:10.1186/s12891-023-06655-9.
[7] Hwang JS, Reilly MC, Shaath MK, et al. Safe zone quantification of the third sacral segment in normal and dysmorphic sacra[J]. J Orthop Trauma, 2018, 32(4): 178-182. DOI:10.1097/BOT.0000000000001100.
[8] 张跃腾, 张元智. 骶骨形态变化对第3骶骨安全区影响的数字化分析[J]. 实用骨科杂志, 2024, 30(11): 979-983. DOI:10.13795/j.cnki.sgkz. 2024.11.017.
Zhang YT, Zhang YZ. Digital analysis on the impact of sacral morphological changes on the third sacral safe zone [J]. Journal of Practical Orthopaedics, 2024, 30(11): 979-983. DOI:10.13795/j.cnki.sgkz.2024.11.017.
[9] Eastman JG, Adams MR, Frisoli K, et al. Is S3 a viable osseous fixation pathway [J]. J Orthop Trauma, 2018, 32(2): 93-99. DOI:10.1097/BOT. 0000000000001036.
[10]Conflitti JM, Graves ML, Jr Routt MLC. Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated iliosacral screw insertions[J]. Orthop Trauma, 2010, 24(10): 630-636. DOI:10.1097/BOT.0b013e3181dc50cd.
[11]Miller AN, Jr Routt MLC. Variations in sacral morphology and implications for iliosacral screw fixation[J]. J Am Acad Orthop Surg, 2012, 20(1): 8-16. DOI:10.5435/JAAOS-20-01-008.
[12]Sharma A, Kumar A, Kapila A. Co-existence of spina bifida occulta and lumbosacral transitional vertebra in patients presenting with lower back pain[J]. Reumatologia, 2022, 60(1):70-75. DOI:10.5114/reum.2022. 114171.
[13]Niu S, Yang H, Gao J, et al. Correlation between sagittal parameters and disability of patients with nonspecific chronic low back pain: a cross-sectional study of 435 subjects[J]. Spine J, 2024, 24(4): 634-643. DOI:10.1016/j.spinee.2023.11.004.
[14]Zhang W, Cheng Y, Diarra MD, et al. Finite element analysis of sacral-alar-iliac screw fixation for sacroiliac joint dislocation[J]. J Orthop Res, 2023, 41(8): 1821-1830. DOI:10.1002/jor.25525.
[15]Manso MT, Matos VMJ. Spina bifida, the normal, the pathological and the in-between: first evidence from a forensic osteological collection[J]. Int J Legal Med, 2024, 138(1): 249-258. DOI:10.1007/s00414-023-03066-2.
[16]Basel SK, Barakoti RK, Chaudhary RK, et al. Lumbosacral transitional vertebra among patients visiting the department of orthopaedics in a tertiary care centre: a descriptive cross-sectional study[J]. JNMA J Nepal Med Assoc, 2023, 61(258): 102-105. DOI:10.31729/jnma.8011.
[17]Matson DM, Maccormick LM, Sembrano JN, et al. Sacral Dysmorphism and Lumbosacral Transitional Vertebrae (LSTV) Review[J]. Int J Spine Surg, 2020, 14(Suppl 1): 14-19. DOI:10.14444/6075.
[18]Chu EC. Neuromuscular scoliosis in the presence of spina bifida occulta and a transitional lumbosacral vertebra: a case report[J]. Radiol Case Rep, 2022, 17(9): 3260-3265. DOI:10.1016/j.radcr.2022.06.033.
[19]Fidan F, Çay N, Asiltürk M, et al. The incidence of congenital lumbosacral malformations in young male Turkish military school candidates population[J]. J Orthop Sci, 2022, 27(6): 1167-1171. DOI: 10.1016/j.jos.2021.07.008.
[20]Chaudhary B, Kumar P, Narayan R, et al. Spina bifida occulta with the persistent spinous process in living: a three-dimensionally reconstructed sacrum from computed tomographic imaging[J]. Clin Ter, 2023, 174(4): 313-317. DOI:10.7417/CT.2023.2542.
基金
内蒙古自治区科技成果转化项目（CGZH2018148）；内蒙古卫生健康领域应用技术研发项目（201802157）；内蒙古自治区自然科学基金项目（2019MS08151）；内蒙古医科大学面上项目（YKD2024012，YKD2025MS002）
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