Research Article
Year 2021,
Volume: 8 Issue: 1, 47 - 51, 30.04.2021
Abstract
Retrospektif olarak gerçekleştirilen bu çalışma, sakral dismorfizm prevalansını, bulgu ve belirtilerinin oranını, pelvik cerrahilerdeki klinik önemini ortaya koymayı amaçlamaktadır. Postravmatik dönemde olmayan hastalarda sakral anormal anatomi ve sakrumun dismorfik bulgularını ortaya çıkarmak için 1753 hastanın pelvik ve alt abdominal BT görüntüleri analiz edildi. Çalışmaya dahil edilen hastalardan; 879' unda (%50.60) S1-S2 rezidüel disk, 209'unda (%12) mamiller cisim veya mamiller proses varlığı, 182'sinde akut sakral iniş (%10.47), 178'inde tongue in groove işareti (%10.25), 168’inde deforme nöralforamen morfolojisi (%9.67) ve 121 hastada ise kolinearite (%7) tespit edildi. Kadınlarda dismorfik birinci sakralforamen ve colinearty erkeklere göre istatistiksel olarak anlamlı derecede yüksekti (p=0.027; p=0.005). Dismorfikbirinci sakralforamen ile colinearty parametreleri ve cinsiyet arasında istatistiksel olarak anlamlı bir ilişki yoktu (phi=0.149, phi=-0.188). Dismorfikbirinci sakralforamen ve S1 ile S2 arasındaki rezidüel disk mesafesi olgularda istatistiksel olarak anlamlı yüksek bulundu (p=0.039). Sakraldismorfizm, toplumda düşünüldüğünden çok daha sık görülen ve klinik müdahalelerde önemli rol oynayan anormal bir anatomik görünümdür. Sakrum içeren cerrahi işlemler sırasında bu anatomik farklılığın akılda tutulması, istenmeyen komplikasyonlarla karşılaşma olasılığını azaltır.
Supporting Institution
yok
References
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- 5. Cole JD, Blum DA, Ansel LJ. Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop Relat Res. 1996;(329):160-79.
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- 8. Schweitzer D, Zylberberg A, C´ordova M et.al. Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures. Injury. 2008;39(8):869-74.
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- 13. Ko PS, Kou SK. A rare complication of percutaneous iliosacral screw in a vertically unstable pelvic disruption in a child. Injury. 2001;32(2):159-61.
- 14. Peeters G, Govaers K, Himpens J. Successful laparoscopic exploration and screw extraction for intractable pain after anterior iliosacral arthrodesis. J Orthop Trauma. 2010;24(10):83-5.
- 15. Weil YA, Nousiainen MT, Helfet DL. Removal of an iliosacral screw entrapping the L5 nerve root after failed posterior pelvic ring fixation: a case report. J Orthop Trauma. 2007;21(6):414-7.
- 16. Templeman D, Schmidt A, Freese J et.al. Proximity of iliosacral screws to neurovascular structures after internal fixation. Clin Orthop Relat Res. 1996;(329):194-8.
- 17. Routt MLC, Simonian PT, Agnew SG, et al. Radiographic recognition of the sacral alar slope for optimal placement of iliosacral screws: a cadaveric and clinical study. J Orthop Trauma. 1996;(10):171–7.
- 18. Conflitti JM, Graves, ML, Routt Jr, MC. Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated iliosacral screw insertions. J Orthop Trauma. 2010;24(10):630-6.
- 19. Kaiser SP, Gardner MJ, Liu J, et.al. Anatomic determinants of sacral dysmorphism and implications for safe iliosacral screw placement. JBJS. 2014; 96(14):e120.
- 20. Chung HJ, Park J, Sohn HS, et.al. The usefulness of reformatting CT scanning plane to distinguish sacral dysmorphism and introducing the variable of elevated height for predicting the possibility of trans-sacral screw fixation. Orthop Traumatol Surg Res. 2020;106(1):109-15.
- 21. Radley JM, Hill BW, Nicolaou DA, et.al. Bone density of first and second segments of normal and dysmorphic sacra. J Orthop Traumatol. 2020;21(1):1-6.
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- 23. Hinsche AF, Giannoudis PV, Smith RM. Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res. 2002;395:135-44.
Year 2021,
Volume: 8 Issue: 1, 47 - 51, 30.04.2021
Abstract
This retrospective study aims to reveal the prevalence of sacral dysmorphism, the proportion of its findings and signs and its clinical importance in pelvic surgeries. 1753 nontraumatic pelvic and lower abdominal CT images were analyzed to reveal the sacral abnormal anatomy and dysmorphic signs in nontraumatic patients. Of the patients included in the study; S1-S2 residual disc in 879 (50.60%), the presence of mammillary body or mammillary process in 209 (12%), acute ascending descent in 182 (10.47%), tongue-in-grove sign in 178 (10.25%), deformity in the neural foramen in 168 (9.67%), and collinearity in 121 patients (7%) were detected. The parameters of non-circular amorphous first sacral foramen and lumbosacral disc distance being close to the iliac wing (collinearity) parameters were statistically significantly higher in women than in men (p=0.027; p=0.005). There was no statistically significant correlation between non-circular amorphous first sacral foramen and collinearity parameters and gender (phi=0.149, p=0.027; phi=-0.188, p=0.005). Noncircular amorphous first sacral foramen and residual disc distance between S1 and S2 were found to be statistically significantly higher in the cases (p=0.039). Sacral dysmorphism is an abnormal anatomy that is seen much more common than it is thought in the population and plays an important role in clinical interventions. Keeping this anatomical difference in mind during surgical procedures involving sacrum reduces the possibility of encountering unwanted complications.
References
- 1. Matson DM, Maccormick LM, Sembrano JN et.al. Sacral Dysmorphism and Lumbosacral Transitional Vertebrae (LSTV) Review. Int J Spine Surg. 2020;14(1):14-9.
- 2. Kılınç, C. Y. Posterior Pelvik Halka Yaralanmalarında Hangi Teknik Seçilmelidir: Perkütan Sakroiliak Vida Fiksasyonu Ya Da Posterior Perkutan Transiliak Plak Fiksasyonu? Kırıkkale Üni Tıp Fak Derg. 2019;21(1):80-4.
- 3. Enninghorst N, Toth L, King KL et.al. Acute definitive internal fixation of pelvic ring fractures in polytrauma patients: a feasible option. J Trauma. 2010;68(4):935-41.
- 4. Gardner MJ, Farrell ED, Nork SE, et al. Percutaneous placement of iliosacral screws without electrodiagnostic monitoring. J Trauma. 2009;66(5):1411-5.
- 5. Cole JD, Blum DA, Ansel LJ. Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop Relat Res. 1996;(329):160-79.
- 6. Moed BR, Geer BL. S2 iliosacral screw fixation for disruptions of the posterior pelvic ring: a report of 49 cases. J Orthop Trauma. 2006;20(6):378-83.
- 7. Routt ML Jr, Kregor PJ, Simonian PT et.al. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma.1995;9(3):207-14.
- 8. Schweitzer D, Zylberberg A, C´ordova M et.al. Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures. Injury. 2008;39(8):869-74.
- 9. Alemdaroğlu, K. B., Yücens, M., Kara, T. et.al. Pedicle axis view c ombined by sacral mapping can decrease fluoroscopic shot count in percutaneous iliosacral screw placement. Injury. 2014; 45(12):1921-7.
- 10. Tile MH, Kellam JF: Fractures of the Pelvis and Acetabulum, ed 3. Philadelphia, PA, Lippincott Williams & Wilkins, 1995; pp199-208.
- 11. Sagi HC, Lindvall EM.Inadvertent intraforaminal iliosacral screw placement despite apparent appropriate positioning on intraoperative fluoroscopy. J Orthop Trauma. 2005;19(2):130-3.
- 12. 12.Altman DT, Jones CB, Routt ML Jr. Superior gluteal artery injury during iliosacral screw placement. J Orthop Trauma. 1999;13(3):220-7.
- 13. Ko PS, Kou SK. A rare complication of percutaneous iliosacral screw in a vertically unstable pelvic disruption in a child. Injury. 2001;32(2):159-61.
- 14. Peeters G, Govaers K, Himpens J. Successful laparoscopic exploration and screw extraction for intractable pain after anterior iliosacral arthrodesis. J Orthop Trauma. 2010;24(10):83-5.
- 15. Weil YA, Nousiainen MT, Helfet DL. Removal of an iliosacral screw entrapping the L5 nerve root after failed posterior pelvic ring fixation: a case report. J Orthop Trauma. 2007;21(6):414-7.
- 16. Templeman D, Schmidt A, Freese J et.al. Proximity of iliosacral screws to neurovascular structures after internal fixation. Clin Orthop Relat Res. 1996;(329):194-8.
- 17. Routt MLC, Simonian PT, Agnew SG, et al. Radiographic recognition of the sacral alar slope for optimal placement of iliosacral screws: a cadaveric and clinical study. J Orthop Trauma. 1996;(10):171–7.
- 18. Conflitti JM, Graves, ML, Routt Jr, MC. Radiographic quantification and analysis of dysmorphic upper sacral osseous anatomy and associated iliosacral screw insertions. J Orthop Trauma. 2010;24(10):630-6.
- 19. Kaiser SP, Gardner MJ, Liu J, et.al. Anatomic determinants of sacral dysmorphism and implications for safe iliosacral screw placement. JBJS. 2014; 96(14):e120.
- 20. Chung HJ, Park J, Sohn HS, et.al. The usefulness of reformatting CT scanning plane to distinguish sacral dysmorphism and introducing the variable of elevated height for predicting the possibility of trans-sacral screw fixation. Orthop Traumatol Surg Res. 2020;106(1):109-15.
- 21. Radley JM, Hill BW, Nicolaou DA, et.al. Bone density of first and second segments of normal and dysmorphic sacra. J Orthop Traumatol. 2020;21(1):1-6.
- 22. Ozmeric A, Yucens M, Gultaç E, et.al. Are two different projections of the inlet view necessary for the percutaneous placement of iliosacral screws? Bone Joint J. 2015;97:705-10.
- 23. Hinsche AF, Giannoudis PV, Smith RM. Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res. 2002;395:135-44.
There are 23 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Original Article |
| Authors | |
| Publication Date | April 30, 2021 |
| Submission Date | January 4, 2021 |
| Published in Issue | Year 2021 Volume: 8 Issue: 1 |
