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1.
BMC Musculoskelet Disord ; 24(1): 536, 2023 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-37386420

RESUMO

OBJECTIVE: This study aimed to investigate the techniques and indications of upper sacroiliac screw fixation for the dysmorphic sacrum. METHODS: The dysmorphic sacra were selected from 267 three-dimensional pelvic models. The dysmorphic sacra which couldn't accommodate a 7.3 mm upper trans ilio-sacroiliac screw were classified as the main dysmorphic sacra. Then, the size of the bone corridor, the length of the screw in the corridor, and the orientation of the screw were measured. The insertion point on the sacrum was identified by two bone landmarks. RESULTS: totally, 30.3% of sacra were identified as the main dysmorphic sacra. The inclinations of the screw oriented from posterior to anterior were (21.80 ± 3.56)° for males and (19.97 ± 3.02)° for females (p < 0.001), and from caudal to cranial were (29.97 ± 5.38)° for males and (28.15 ± 6.21)° for females (p = 0.047). The min diameters of the corridor were (16.31 ± 2.40) mm for males and (15.07 ± 1.58) mm for females (p < 0.001). The lengths of the screw in the Denis III zone were (14.41 ± 4.40) mm for males and (14.09 ± 5.04) mm for females (p = 0.665), and in the Denis II+III zones were (36.25 ± 3.40) mm for males and (38.04 ± 4.60) mm for females (p = 0.005). The rates of LP-PSIS/LAIIS-PSIS were (0.36 ± 0.04) for males and (0.32 ± 0.03) for females (t = 4.943, p < 0.001). The lengths of LPM were (8.81 ± 5.88) for males and (-4.13 ± 6.33) for females (t = 13.434, p < 0.001). CONCLUSION: When the sacrum has the features of "sacrum not recessed" and/or "acute alar slope", the conventional trans ilio-sacroiliac screw couldn't be placed safely. The inclination oriented from posterior to anterior and from caudal to cranial are approximately 20° and 30°, respectively. The bone insertion point locates in the rear third of the anterior inferior iliac spine to the posterior superior iliac spine. The sacroiliac screw is not recommended to fix the fractures in Denis III zone.


Assuntos
Fraturas Ósseas , Sacro , Feminino , Masculino , Humanos , Sacro/diagnóstico por imagem , Sacro/cirurgia , Pelve , Parafusos Ósseos , Diagnóstico por Imagem
2.
Eur J Trauma Emerg Surg ; 47(6): 1679-1686, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33029659

RESUMO

OBJECTIVE: Investigating the anatomical characteristics of supra-acetabular screw corridor as well as comparing the biomechanical stability between semi- and full-length screw external fixations for Tile C1 pelvic fractures. METHODS: 50 male and 50 female uninjured pelvic CT data were converted into three-dimensional models and the supra-acetabular corridors were reconstructed by the Mimics software. The horizontal slice was redefined passing through the bilateral anterior inferior iliac spine and bilateral posterior superior iliac spine at the same time. On every horizontal slices, a 5 mm diameter virtual screw was placed along with the unilateral anterior narrowing to posterior narrowing of the supra-acetabular corridor, and the relevant parameters of the semi- and full-length screw fixations were measured from inferior to superior at an interval height of 2.5 mm until the width of the corridor was less than 5 mm. Thus, the insertion position was located, as well as the inclination angle ranges were measured. The same procedure was done on a bilateral supra-acetabular corridor for each patient. Last, a Tile C1 pelvic finite element model was simulated and fixed with either semi- or a full-length anterior supra-acetabular external fixator. A 500 N loading was tested on the model with three directions (cranial-caudal, anterior-posterior and lateral-medial) and the stiffness was determined by the max displacements. RESULTS: The insertion points of supra-acetabular screw for 66% (66/100) of men and 78% (78/100) of women were located at the outer lower part of the anterior inferior iliac spine (AIIS) (p < 0.001). The medial inclination angles of the screw were 29.50 ± 4.05° for men and 28.00 ± 3.78° for women (p = 0.007). The cranial inclination angles of the screw were 29.40 ± 5.38° for men and 28.57 ± 6.01° for women (p = 0.306). The safe inclination angle ranges of the semi-length screw were 3°-6° bigger than the full-length screw. For semi-length corridor, the widths were 14.07 ± 2.39 mm for men and 11.29 ± 1.81 mm for women (p < 0.001) and the depths were 71.77 ± 5.96 mm for men and 69.26 ± 5.21 mm for women (p < 0.001). For full-length corridor, the widths were 10.61 ± 2.10 mm for men and 8.44 ± 2.03 mm for women (p < 0.001) and the depths were 133.37 ± 7.60 mm for men and 129.01 ± 8.12 mm for women (p < 0.001). In the finite element analysis, the max displacements of the pelvis under three loading modes (cranial-caudal, anterior-posterior and lateral-medial) for semi-length fixation were 0.772 mm, 0.409 mm and 0.331 mm and for full-length fixation were 0.727 mm, 0.385 mm and 0.262 mm. CONCLUSION: The outer lower part of AIIS is recommended as an insertion point of the supra-acetabular screw with about 30° medial and cranial inclination angles, and the semi-length screw is safer for placing and has satisfactory biomechanical stability by compared with a full-length screw.


Assuntos
Fixadores Externos , Fixação de Fratura , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Feminino , Análise de Elementos Finitos , Fixação Interna de Fraturas , Humanos , Masculino
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