Metode notranjega fiksiranja križnice na črevnico – Pregled literature in analiza serije primerov fiksiranja z iliakalnim vijakom
DOI:
https://doi.org/10.6016/ZdravVestn.3222Ključne besede:
deformacija hrbtenice, psevdoartroza, ledveno-križnični prehod, iliakalni vijak, S2-alarni iliakalniPovzetek
Da bi dosegli zatrditev med gibljivo ledveno hrbtenico in negibljivo križnico, so se ob razvoju instrumentacijskih sistemov za notranje fiksiranje prsno-ledvene hrbtenice razvijale kirurške tehnike, ki omogočajo podaljšati take sisteme na kostne elemente medenice. Izraz sakroiliakalno (SI) fiksiranje zajema vse instrumentacijske sisteme in kirurške tehnike za notranjo učvrstitev ledveno-križničnega predela hrbtenice na črevnico. Preprečevanje psevdoartroze kostne fuzije ledveno-križničnega prehoda, ki nastane na meji med dvema različnima strukturama (gibljivo ledveno hrbtenico in statičnim medeničnim obročem), je dandanes eden glavnih izzivov kirurškega zdravljenja deformacij ledvene hrbtenice pri odraslih. Ledveno-križnični prehod je biomehansko os vrtenja, ki v stranski ravnini poteka skozi posteriorni longitudinalni ligament v višini medvretenčne ploščice gibljivega segmenta L5-S1. Velikost ročice fleksijskega navora je odvisna od števila instrumentiranih ravni gibljive prsno-ledvene hrbtenice, za stabilnost sistema pa je potreben nasprotni navor, ki je zaradi kratke ročice odvisen predvsem od pričvrstitvene moči vsadka na kostne elemente medeničnega obroča. Sistemi SI-fiksiranja preprečujejo nastanek psevdoartroze kostne fuzije ledveno-križničnega prehoda, njen pojav pa je ob odsotnosti bioloških vzrokov (npr. okužba) odvisen izključno od trdnosti instrumentacijskega sistema (lomljivost materiala) in kakovosti fiksiranja instrumentarija na medenični obroč (omajanje na stiku med vsadkom in kostjo).
Indikacije za SI-fiksiranje so ledveno-križnična kostna fuzija (zatrditev) več kot treh ledvenih vretenc, razširjene korektivne osteotomije ledvenih vretenc, zlomi križnice s spinopelvično (SP) disociacijo, delna ali popolna sakrektomija, ledveno-križnična kostna fuzija pri osteoporotični kosti, spondilolisteza, ki je večja od II. stopnje po Meyerdingovi klasifikaciji, korekcija kifotične ali skoliotične deformacije ledvene hrbtenice in nagib medenice v čelni ravnini pri živčnomišičnih deformacijah ledvene hrbtenice.
Pregledni članek opisuje biomehaniko SP prehoda, predstavi zgodovino razvoja vsadkov ter kirurških tehnik in prikaže sodobne metode SI-fiksiranja.
Prenosi
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