Prevalence of sacral dysmorphia in a prospective trauma population: Implications for a "safe" surgical corridor for sacro-iliac screw placement

被引：39
作者：
Hasenboehler E.A. [1 ]
Stahel P.F. [1 ]
Williams A. [1 ,2 ]
Smith W.R. [1 ,3 ]
Newman J.T. [1 ]
Symonds D.L. [4 ]
Morgan S.J. [1 ]
机构：
[1] Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado Denver, School of Medicine, Denver, CO 80204
[2] Eastern Colorado Health Care System, Denver Veterans' Affairs Medical Center, Denver
[3] Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA 17825
[4] Department of Radiology, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204
来源：
Patient Safety in Surgery | / 5卷 / 1期
关键词：
Screw Placement; Safe Zone; Sacral Fracture; Iliosacral Screw; Surgical Corridor;
D O I：
10.1186/1754-9493-5-8
中图分类号：
学科分类号：
摘要：
Background: Percutaneous sacro-iliac (SI) screw fixation represents a widely used technique in the management of unstable posterior pelvic ring injuries and sacral fractures. The misplacement of SI-screws under fluoroscopic guidance represents a critical complication for these patients. This study was designed to determine the prevalence of sacral dysmorphia and the radiographic anatomy of surgical S1 and S2 corridors in a representative trauma population.Methods: Prospective observational cohort study on a consecutive series of 344 skeletally mature trauma patients of both genders enrolled between January 1, 2007, to September 30, 2007, at a single academic level 1 trauma center. Inclusion criteria included a pelvic CT scan as part of the initial diagnostic trauma work-up. The prevalence of sacral dysmorphia was determined by plain radiographic pelvic films and CT scan analysis. The anatomy of sacral corridors was analyzed on 3 mm reconstruction sections derived from multislice CT scan, in the axial, coronal, and sagittal plane. "Safe" potential surgical corridors at S1 and S2 were calculated based on these measurements.Results: Radiographic evidence of sacral dysmorphia was detected in 49 patients (14.5%). The prevalence of sacral dysmorphia was not significantly different between male and female patients (12.2% vs. 19.2%; P = 0.069). In contrast, significant gender-related differences were detected with regard to radiographic analysis of surgical corridors for SI-screw placement, with female trauma patients (n = 99) having significantly narrower corridors at S1 and S2 in all evaluated planes (axial, coronal, sagittal), compared to male counterparts (n = 245; P < 0.01). In addition, the mean S2 body height was higher in dysmorphic compared to normal sacra, albeit without statistical significance (P = 0.06), implying S2 as a safe surgical corridor of choice in patients with sacral dysmorphia.Conclusions: These findings emphasize a high prevalence of sacral dysmorphia in a representative trauma population and imply a higher risk of SI-screw misplacement in female patients. Preoperative planning for percutaneous SI-screw fixation for unstable pelvic and sacral fractures must include a detailed CT scan analysis to determine the safety of surgical corridors. © 2011 Hasenboehler et al; licensee BioMed Central Ltd.
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