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Der sakroiliakale Knochenkorridor

Ein virtuelles Volumenmodell zur sicheren Implantation transartikulärer Schrauben

Bony sacroiliac corridor

A virtual volume model for the accurate insertion of transarticular screws

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Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die perkutane sakroiliakale (SI-)Verschraubung birgt ein hohes Risiko an Implantatfehllagen. Jedoch existieren bisher nur idealisierte Vorstellungen über die Form des nutzbaren Knochenkorridors.

Methodik

Anhand der 3D-CT-Rekonstruktion eines humanen Beckens wurden als Summe sämtlicher sicherer Schraubenlagen in Abhängigkeit von der Penetrationstiefe im Sakrum rechnergestützt 2 SI-Korridormodelle generiert.

Ergebnisse

Bei Schraubenplatzierung ins Zentrum des Sakralkörpers S1 waren ein Knochenvolumen von 121 cm3 und eine iliakale Eintrittsfläche von 53 cm2 nutzbar. Bei Schraubenlagen bis zum gegenseitigen Isthmus reduzierten sich diese auf 72 cm3 (60%) bzw. 20 cm2 (38%).

Schlussfolgerung

Die erarbeiteten realistischen 3D-Modelle geben exakte Hinweise auf den Einfluss knöcherner Grenzstrukturen für sichere Schraubenlagen. Durch die Implementation eines Softwarealgorithmus zur Errechnung des individuellen Korridors anhand von Fluoroskopie- oder CT-Images ist eine bessere Performance von Navigationssystemen für die SI-Verschraubung denkbar.

Abstract

Background

Minimally invasive sacroiliac (SI) screw fixation carries a high risk for implant malposition. Only idealised shape conceptions of the safe bony corridor exist.

Methods

Two SI corridor models were generated based on a 3D CT reconstruction of a human pelvis. Therefore two penetration depths of the screws into the sacrum were defined.

Results

By inserting screws into the centre of the first sacral body an osseous volume of 121 cm3 and an iliac entrance area of 53 cm2 were utilizable. Screw positioning beyond the opposite sacral isthmus leads to a reduction of the bony volume to 72 cm3 (60%) and a decrease of the iliac screw entrance to 20 cm2 (38%).

Conclusion

The computed realistic 3D models provide exact references to confining bone structures for safe screw positions. The implementation of a software algorithm for fully automated calculation of such volumes based on fluoroscopic or CT images could enhance the performance of computer-assisted navigation systems.

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Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie, BG-Kliniken Bergmannstrost, Halle (Saale), Deutschland

    T. Mendel

  2. AO Development Institute, Clavadelerstraße 8, CH-7270, Davos Platz, Schweiz

    T. Mendel, K. Appelt, P. Kuhn & N. Suhm

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  1. T. Mendel
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  2. K. Appelt
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Correspondence to T. Mendel.

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Mendel, T., Appelt, K., Kuhn, P. et al. Der sakroiliakale Knochenkorridor. Unfallchirurg 111, 19–26 (2008). https://doi.org/10.1007/s00113-007-1386-4

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