髋臼四边体骨折安全置钉角度及范围的测量
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摘要
目的在CT图像上测量四边体后缘螺钉植入的角度与范围,防止螺钉植入髋臼内,为四边体骨折手术固定提供帮助。方法随机选择100例用3 mm层厚CT扫描骨盆的患者,在CT图像上选择髋臼横切面中心图像,根据轴心线将髋臼分成前、后两部分,通过髋臼轴心线与四边体的相交点(A点)测量3个指标(A点与髋臼后缘相切的线与四边体内侧面的夹角,反复测量3次,取得平均值;A点到四边体后缘的距离;该层面的四边体的宽度),分析各项指标的变化。结果全组患者(n=100)的四边体置钉角度平均为(44.7±4.9)°;男组(n=64)、女组(n=36)的四边体置钉角度分别为(45.9±5.3)、(42.5±4.6)°,差异无统计学意义(P>0.05)。全组患者四边体宽度平均为(61.0±2.4) mm;男组、女组的四边体宽度分别为(63.9±2.5)、(59.0±2.3) mm,差异无统计学意义(P>0.05)。全组患者的A点到四边体后缘的距离平均为(38.0±1.9) mm;男组、女组的A点到四边体后缘的平均距离分别为(39.0±1.5)、(37.0±2.3) mm,差异无统计学意义(P>0.05)。结论在CT图像上测量四边体后缘螺钉植入的角度与范围,可为四边体的固定范围及固定角度提供理论指导,实现四边体骨折的牢固固定,并避免螺钉植入髋臼,保证手术成功。
Objective To measure angle and range of nailing implantation from posterior edge of the quadrilateral body on CT images,and to prevent screw implantation into the acetabulum so as to provide assistance for surgical fixation of quadrilateral fracture.Methods A total of 100 patients with pelvic 3 mm CT scan were randomly selected.The central image of acetabular transverse section was selected on CT images.The acetabulum was divided into anterior and posterior parts through the axis line of acetabulum,and the intersection point(A point) between the axis line of acetabulum and the quadrilateral body was performed to measure three indexes(the angle between point A and the posterior edge of acetabulum and the side of the quadrilateral body was measured for three times for its average value;distance from point A to the trailing edge of the quadrilateral;width of the quadrilateral at this level.The changes of above indicators was analyzed.Results The average angle of nailing of quadrilateral body was(44.7±4.9)° in all patients group,(45.9±5.3)° in male group,and(42.5±4.6)° in female group,there were no significant difference in male and female groups(P>0.05).The average width of quadrilateral body was(61.0±2.4) mm in all patients group,(63.9±2.5) mm in the male group,and(59.0±2.3) mm in female group,no significant difference was observed in male and female groups(P>0.05).The average distance from point A to the posterior edge of quadrilateral body was(38.0±1.9),(39.0±1.5),(37.0±2.3) mm,respectively,in all patients group,male group and female group,but there were no significant difference in male and female groups(P>0.05).Conclusion The data measured in this study can provide theoretical guidance for the fixation of quadrilateral fractures.It can achieve solid fixation of quadrilateral fractures and avoid screw implantation into acetabulum to ensure the success of the operation.
Objective To measure angle and range of nailing implantation from posterior edge of the quadrilateral body on CT images,and to prevent screw implantation into the acetabulum so as to provide assistance for surgical fixation of quadrilateral fracture.Methods A total of 100 patients with pelvic 3 mm CT scan were randomly selected.The central image of acetabular transverse section was selected on CT images.The acetabulum was divided into anterior and posterior parts through the axis line of acetabulum,and the intersection point(A point) between the axis line of acetabulum and the quadrilateral body was performed to measure three indexes(the angle between point A and the posterior edge of acetabulum and the side of the quadrilateral body was measured for three times for its average value;distance from point A to the trailing edge of the quadrilateral;width of the quadrilateral at this level.The changes of above indicators was analyzed.Results The average angle of nailing of quadrilateral body was(44.7±4.9)° in all patients group,(45.9±5.3)° in male group,and(42.5±4.6)° in female group,there were no significant difference in male and female groups(P>0.05).The average width of quadrilateral body was(61.0±2.4) mm in all patients group,(63.9±2.5) mm in the male group,and(59.0±2.3) mm in female group,no significant difference was observed in male and female groups(P>0.05).The average distance from point A to the posterior edge of quadrilateral body was(38.0±1.9),(39.0±1.5),(37.0±2.3) mm,respectively,in all patients group,male group and female group,but there were no significant difference in male and female groups(P>0.05).Conclusion The data measured in this study can provide theoretical guidance for the fixation of quadrilateral fractures.It can achieve solid fixation of quadrilateral fractures and avoid screw implantation into acetabulum to ensure the success of the operation.
引文
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[9]Rocca G,Spina M,Mazzi M.Anterior Combined Endopelvic(ACE)approach for the treatment of acetabular and pelvic ring fractures:A new proposal[J].Injury,2014,45(Suppl6):S9-S15.
[10]陈开放,段德胜,熊泽康,等.3D打印技术辅助高位髂腹股沟入路治疗复杂髋臼骨折[J].中华骨科杂志,2017,37(13):786-792.
[2]Briffa N,Pearce R,Hill A M,et al.Outcomes of acetabular fracture fixation with ten years'follow-up[J].J Bone Joint Surg Br,2011,93(2):229-236.
[3]张里程,张立海,许猛,等.髋臼后表面解剖形态测量及新型解剖锁定钢板的设计[J].中华创伤骨科杂志,2014,16(4):290-294.
[4]孟乘飞,宋虎,王小阵,等.3D导航下经皮骶髂关节螺钉内固定联合外固定架治疗Tile B/C型骨盆骨折[J].创伤外科杂志,2018,20(1):6-10.
[5]Zhang Y D,Wu R Y,Xie D D,et al.Effect of 3D printing technology on pelvic fractures:a Meta-analysis[J].Zhongguo gu shang,2018,31(5):465-471.
[6]El-Desouky I I,Mohamed M M,Kandil A E.Percutaneous iliosacral screw fixation in vertically unstable pelvic injuries,a refined conventional method[J].Acta Orthop Belg,2016,82(1):52-59.
[7]Sagi H C,Afsari A,Dziadosz D.The anterior intra-pelvic(modified rives-stoppa)approach for fixation of acetabular fractures[J].J Orthop Trauma,2010,24(5):263-270.
[8]杨运平,郭刚,黎润光,等.Stoppa入路的临床解剖学研究及在骨盆前环骨折中的应用[J].中华创伤骨科杂志,2013,15(8):676-679.
[9]Rocca G,Spina M,Mazzi M.Anterior Combined Endopelvic(ACE)approach for the treatment of acetabular and pelvic ring fractures:A new proposal[J].Injury,2014,45(Suppl6):S9-S15.
[10]陈开放,段德胜,熊泽康,等.3D打印技术辅助高位髂腹股沟入路治疗复杂髋臼骨折[J].中华骨科杂志,2017,37(13):786-792.