Abstract：
OBJECTIVE: In patients with neuromuscular scoliosis undergoing posterior spinal fusion, the S2 alar iliac (S2AI) screw trajectory is a safe and effective method of lumbopelvic fixation but can lead to implant prominence. Here we use 3D CT modeling to demonstrate the anatomic feasibility of the S1 alar iliac screw (S1AI) compared to the S2AI trajectory in patients with neuromuscular scoliosis.
METHODS: This retrospective study used CT scans of 14 patients with spinal deformity to create 3D spinal reconstructions and model the insertional anatomy, max length, screw diameter, and potential for implant prominence between 28 S2AI and 28 S1AI screw trajectories.
RESULTS: Patients had a mean age of 14.42 (range 8-21), coronal cobb angle of 85° (range 54-141), and pelvic obliquity of 28° (range 4-51). The maximum length and diameter of both screw trajectories were similar. S1AI screws were, on average, 6.3 ± 5 mm less prominent than S2AI screws relative to the iliac crests. S2AI screws were feasible in all patients, while in two patients, posterior elements of the lumbar spine would interfere with S1AI screw insertion.
CONCLUSIONS: In this cohort of patients with neuromuscular scoliosis, we demonstrate that the S1AI trajectory offers comparable screw length and diameter to an S2AI screw with less implant prominence. An S1AI screw, however, may not be feasible in some patients due to interference from the posterior elements of the lumbar spine.
METHODS: This retrospective study used CT scans of 14 patients with spinal deformity to create 3D spinal reconstructions and model the insertional anatomy, max length, screw diameter, and potential for implant prominence between 28 S2AI and 28 S1AI screw trajectories.
RESULTS: Patients had a mean age of 14.42 (range 8-21), coronal cobb angle of 85° (range 54-141), and pelvic obliquity of 28° (range 4-51). The maximum length and diameter of both screw trajectories were similar. S1AI screws were, on average, 6.3 ± 5 mm less prominent than S2AI screws relative to the iliac crests. S2AI screws were feasible in all patients, while in two patients, posterior elements of the lumbar spine would interfere with S1AI screw insertion.
CONCLUSIONS: In this cohort of patients with neuromuscular scoliosis, we demonstrate that the S1AI trajectory offers comparable screw length and diameter to an S2AI screw with less implant prominence. An S1AI screw, however, may not be feasible in some patients due to interference from the posterior elements of the lumbar spine.
摘要：
目的：在接受后路脊柱融合术的神经肌肉脊柱侧凸患者中，S2alar（S2AI）螺钉轨迹是一种安全有效的腰骨盆固定方法，但可导致植入物突出。在这里，我们使用3DCT建模来证明与神经肌肉脊柱侧凸患者的S2AI轨迹相比，S1鼻翼髂螺钉（S1AI）的解剖可行性。
方法：这项回顾性研究使用14例脊柱畸形患者的CT扫描来创建3D脊柱重建并建模插入解剖结构，最大长度,螺杆直径,以及在28个S2AI和28个S1AI螺钉轨迹之间植入突出的可能性。
结果：患者的平均年龄为14.42岁（范围8-21岁），85°的冠状cobb角（范围54-141），骨盆倾角28°(范围4-51)。两个螺钉轨迹的最大长度和直径相似。S1AI螺钉为,平均而言,6.3±5mm比S2AI螺钉相对于the骨突出。S2AI螺钉在所有患者中都是可行的，而在两名患者中，腰椎的后部元素会干扰S1AI螺钉的插入。
结论：在这个神经肌肉侧凸患者队列中，我们证明,S1AI轨迹提供的螺钉长度和直径与植入物突出度较小的S2AI螺钉相当.一个S1AI螺钉,然而,由于腰椎后部元素的干扰，某些患者可能不可行。
方法：这项回顾性研究使用14例脊柱畸形患者的CT扫描来创建3D脊柱重建并建模插入解剖结构，最大长度,螺杆直径,以及在28个S2AI和28个S1AI螺钉轨迹之间植入突出的可能性。
结果：患者的平均年龄为14.42岁（范围8-21岁），85°的冠状cobb角（范围54-141），骨盆倾角28°(范围4-51)。两个螺钉轨迹的最大长度和直径相似。S1AI螺钉为,平均而言,6.3±5mm比S2AI螺钉相对于the骨突出。S2AI螺钉在所有患者中都是可行的，而在两名患者中，腰椎的后部元素会干扰S1AI螺钉的插入。
结论：在这个神经肌肉侧凸患者队列中，我们证明,S1AI轨迹提供的螺钉长度和直径与植入物突出度较小的S2AI螺钉相当.一个S1AI螺钉,然而,由于腰椎后部元素的干扰，某些患者可能不可行。
