The Application Research And Transformation Of Sacroiliac Screw Director Through Pedicle Orientation

Objective: Through the radiological anatomy study of the S1 vertebral body and sacroiliac channel,on the basis of previous studies to further verfify the security of srew placement by the pedicle positioning;placing sacroiliac srew on the specimen and in actually clinical cases by using the guide apparatus,provide theoretical basis and experimental basis for its clinical application and promotion.Methods: 1? 50 normal adult pelvises(25 cases men and wemen respectively)were measured by CT imaging,indicators:(1)S1 vertebral transverse diameter;(2)S1 vertebral sagittal diameter;(3)S1 vertebral fanterior flange height;(4)S1 vertebral rear flange height;(5)the angle between the axis of the S1 pediculus arcus vertebrae and the posterior median line;(6)the distance from the external fringe of the iliac wing to the middle of the S1 vertebral body through the axis of the S1 pediculus arcus vertebrae;(7)the distance from the external fringe of the iliac wing to the S1 vertebral contrary anterior cortex;(8)the distance from the external fringe of the iliac wing to the center of S1 pedicle narrowest part;(9)the height of S1 pedicle narrowest part;(10)the width of S1 pedicle narrowest part.2? using sacroiliac screw guide apparatus place screw on the cadaver specimen(5 adult fresh cadaver specimens and 10 cases of sacroiliac joint).3? using the guide apparatus place screw in two actually clinical cases.Results: 1?(1)S1 vertebral transverse diameter: male 57.4±4.7mm,female52.9±5.4mm;(2)S1 vertebral sagittal diameter: male35.1±2.4mm,female33.3±3.7mm;(3)S1 vertebral fanterior flange height: male35.3±2.2mm,female31.8±2.3mm;(4)S1 vertebral rear flange height: male25.4±1.6mm,female23.4±2.0mm;(5)the angle between the axis of the S1 pediculus arcus vertebrae and the posterior median line: male73.1±6.3°,female68.4±7.5°;(6)the distance from the external fringe of the iliac wing to the middle of the S1 vertebral body through the axis of the S1 pediculus arcus vertebrae:male75.5±6.2mm,female70.2±6.9mm;(7)the distance from the external fringe of the iliac wing to the S1 vertebral contrary anterior cortex: male93.1±4.6mm,female90.1±4.3mm;(8)the distance from the external fringe of the iliac wing to the center of S1 pedicle narrowest part: male52.3±1.4mm,female51.8±1.3mm;(9)the height of S1 pedicle narrowest part:male21.7±3.0mm,female20.6±3.6mm;(10)the width of S1 pedicle narrowest part:male24.3±2.7mm,female23.3±3.6mm.in Gender comparison,the indicator of(1)(2)(3)(4)(5)(6)(7)has statistically significant(P < 0.05),however the indicator of(8)(9)(10)don't have statistical significance(P > 0.05).in right and left comparison,the indicator of(5)(6)(7)(8)(9)(10)also don't have statistical significance(P > 0.05).2? we successfully place 10 srew on 5 adult fresh cadaver specimens which concained 10 cases of sacroiliac joint,all of the srew were in right position and none of them failed.3? Two cases was confirmed in right and safe sacroiliac channel by intraoperative and postoperative fluoroscopy,and have no significant complcations.Conclusion: using guide apparatus by the pedicle positioning to help place sacroiliac srew was accurate and safe,simple and convenient,it need less fluoroscopy,and it can obviously shorten the operation time,and after a shortterm training,even a young doctor can master sacroiliac screw internal fixation technology,and this can shorten the learning curve of the orthopedic surgon,and it worth to popularized and application in clinic.Now,this apparatus is beginning to use in the surgery,we have not found any obvious defect at present,the current application experience is insufficient,and we need more accumulation to improve this apparatus by more application.