Abstract
BackgroundTo conduct radiologic anatomical study on the relation between S1 sacroiliac screws’ entry points and the route of the pelvic outer superior gluteal artery branches with the aim to provide the anatomical basis and technical reference for the avoidance of damage to the superior gluteal artery during the horizontal sacroiliac screw placement.MethodsSuperior gluteal artery CTA (CT angiography) vascular imaging of 74 healthy adults (37 women and 37 men) was done with 128-slice spiral CT (computed tomography). The CT attendant-measuring software was used to portray the “safe bony entrance area” (hereinafter referred to as “Safe Area”) of the S1 segment in the standard lateral pelvic view of three-dimensional reconstruction. The anatomical relation between S1 sacroiliac screws’ Safe Area and the pelvic outer superior gluteal artery branches was observed and recorded. The number of cases in which artery branches intersected the Safe Area was counted. The cases in which superior gluteal artery branches disjointed from the Safe Area were identified, and the shortest distance between the Safe Area and the superior gluteal artery branch closest to the Safe Area was measured.ResultsThree cases out of the 74 sample cases were excluded from this study as they were found to have no bony space for horizontal screw placement in S1 segment. Among the remaining 71 sample cases, there are 32 cases (45.1%) where the deep superior branch of superior gluteal artery passes through the Safe Area of S1 entrance point. There was no distinguishing feature and rule on how the deep superior branches and the Safe Area overlapped. In the 39 cases in which superior gluteal artery branches disjointed from the Safe Area, the deep superior branches of superior gluteal artery were the branches closest to the Safe Area and the part of the branch closest to the Safe Area was located in front of the widest part of the Safe Area. The shortest distance between the deep superior branch and the Safe Area is 0.86 ± 0.84 cm.ConclusionThere is a high risk of accidental injury of the deep superior branches of superior gluteal artery in the process of S1 sacroiliac screw placement. Even if the entry points are located in the safe bony entrance area, the absolute secure placement cannot be assured. We suggest that great attention should be paid to make thorough preoperative plans.
Highlights
To conduct radiologic anatomical study on the relation between S1 sacroiliac screws’ entry points and the route of the pelvic outer superior gluteal artery branches with the aim to provide the anatomical basis and technical reference for the avoidance of damage to the superior gluteal artery during the horizontal sacroiliac screw placement
Among the remaining 71 sample cases, there are 32 cases (45.1%) where the deep superior branch of superior gluteal artery passes through the Safe Area of S1 entrance point
In the 39 sample cases where the superior gluteal artery and the entrance point do not intersect, the deep superior branch of superior gluteal artery is the artery branch closest to the Safe Area and the part closest to the Safe Area is located in front of the widest part of the Safe Area
Summary
To conduct radiologic anatomical study on the relation between S1 sacroiliac screws’ entry points and the route of the pelvic outer superior gluteal artery branches with the aim to provide the anatomical basis and technical reference for the avoidance of damage to the superior gluteal artery during the horizontal sacroiliac screw placement. Sacroiliac screw placement has almost become the golden rule for treating posterior pelvic ring injuries [1], but there are still certain risks of injury to superior gluteal artery in the process of screw placement, resulting in hemorrhagic shock, pseudoaneurysm, and other serious complications [2, 3]. There are limited reports on iatrogenic injury to superior gluteal artery, as it may trigger large amount of bleeding and is tough to treat within limited short time, it raises the hidden risk of medical disputes and its serious consequence makes it worthy of high attention. In response to the concerns raised above, this article shows a radiological anatomical study regarding the relation between the direction of the superior gluteal artery and its branches in the outer part of the sacrum and the entrance points of S1 sacroiliac screws so as to provide anatomical basis and technical reference for the avoidance of injuries to artery and its relevant serious complications in the process of clinical placement
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