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Conference Paper: Computational simulation of a novel surgical screw guide system to determine the optimal trajectory for S2-alar-iliac screw fixation in minimally invasive pelvic and spine surgery
Title | Computational simulation of a novel surgical screw guide system to determine the optimal trajectory for S2-alar-iliac screw fixation in minimally invasive pelvic and spine surgery |
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Authors | |
Issue Date | 2021 |
Publisher | Hong Kong Orthopaedic Association.. |
Citation | 41st Annual Congress of the Hong Kong Orthopaedic Association (HKOA), Hong Kong, China, 6-7 November 2021 How to Cite? |
Abstract | Introduction: The ideal trajectory for S2-alar-iliac (S2AI) screw insertion remains difficult to determine intraoperatively. Using a novel surgical guide which references the greater sciatic notch and outer pelvic surface, in conjunction with computational simulation, we identified a point through which an S2AI screw may be passed that optimises screw length, while minimising perforation hazards. Methodology: Computed tomography scans of 87 adult hemipelvises were segmented and imported for 3D manipulation. A simulated array of screws was passed from the sacral entry point through nine target points with distances from the greater sciatic notch (Y) and outer pelvic surface (X) varying in 1-cm intervals. At each point, the maximum allowable screw length and incidence of critical perforations of the hip joint and inner pelvic cortex were recorded. Results: Target points (X,Y) = (1,1) (1,2) and (2,1) allowed for the longest screw lengths, with mean 104.5 mm (95% CI=101.1107.9) vs 101.84 mm (95% CI=97.7-106) vs 105.71 mm (95% CI=99.4-112.1). (1,1) has significantly lower risk for complete inner cortex perforation versus (1,2) and (2,1), 1% vs 8% vs 31% (p<0.001) and partial inner cortex perforation, 2% vs 8% vs 28% (p<0.001). However (1,1) has higher risk of hip perforation than (1,2) 18% vs 2% (p<0.001). Conclusion: We determined that target point (1,1) is optimal for S2AI screw insertion. The surgeon should use fluoroscopy to monitor for potential hip perforation. |
Description | Free Paper Session V: Trauma, FP5.24 |
Persistent Identifier | http://hdl.handle.net/10722/316793 |
DC Field | Value | Language |
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dc.contributor.author | Fang, CX | - |
dc.contributor.author | Cheung, L | - |
dc.contributor.author | Fang, EJHH | - |
dc.contributor.author | Kwan, KYH | - |
dc.contributor.author | Lau, F | - |
dc.contributor.author | Leung, MF | - |
dc.contributor.author | Cheung, KMC | - |
dc.contributor.author | Leung, FKL | - |
dc.date.accessioned | 2022-09-16T07:23:29Z | - |
dc.date.available | 2022-09-16T07:23:29Z | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | 41st Annual Congress of the Hong Kong Orthopaedic Association (HKOA), Hong Kong, China, 6-7 November 2021 | - |
dc.identifier.uri | http://hdl.handle.net/10722/316793 | - |
dc.description | Free Paper Session V: Trauma, FP5.24 | - |
dc.description.abstract | Introduction: The ideal trajectory for S2-alar-iliac (S2AI) screw insertion remains difficult to determine intraoperatively. Using a novel surgical guide which references the greater sciatic notch and outer pelvic surface, in conjunction with computational simulation, we identified a point through which an S2AI screw may be passed that optimises screw length, while minimising perforation hazards. Methodology: Computed tomography scans of 87 adult hemipelvises were segmented and imported for 3D manipulation. A simulated array of screws was passed from the sacral entry point through nine target points with distances from the greater sciatic notch (Y) and outer pelvic surface (X) varying in 1-cm intervals. At each point, the maximum allowable screw length and incidence of critical perforations of the hip joint and inner pelvic cortex were recorded. Results: Target points (X,Y) = (1,1) (1,2) and (2,1) allowed for the longest screw lengths, with mean 104.5 mm (95% CI=101.1107.9) vs 101.84 mm (95% CI=97.7-106) vs 105.71 mm (95% CI=99.4-112.1). (1,1) has significantly lower risk for complete inner cortex perforation versus (1,2) and (2,1), 1% vs 8% vs 31% (p<0.001) and partial inner cortex perforation, 2% vs 8% vs 28% (p<0.001). However (1,1) has higher risk of hip perforation than (1,2) 18% vs 2% (p<0.001). Conclusion: We determined that target point (1,1) is optimal for S2AI screw insertion. The surgeon should use fluoroscopy to monitor for potential hip perforation. | - |
dc.language | eng | - |
dc.publisher | Hong Kong Orthopaedic Association.. | - |
dc.title | Computational simulation of a novel surgical screw guide system to determine the optimal trajectory for S2-alar-iliac screw fixation in minimally invasive pelvic and spine surgery | - |
dc.type | Conference_Paper | - |
dc.identifier.email | Fang, CX: cfang@hku.hk | - |
dc.identifier.email | Kwan, KYH: kyhkwan@hku.hk | - |
dc.identifier.email | Leung, MF: manfai@hku.hk | - |
dc.identifier.email | Cheung, KMC: cheungmc@hku.hk | - |
dc.identifier.email | Leung, FKL: klleunga@hkucc.hku.hk | - |
dc.identifier.authority | Fang, CX=rp02016 | - |
dc.identifier.authority | Kwan, KYH=rp02014 | - |
dc.identifier.authority | Cheung, KMC=rp00387 | - |
dc.identifier.authority | Leung, FKL=rp00297 | - |
dc.identifier.hkuros | 336631 | - |
dc.publisher.place | China | - |