计算机辅助导航热塑膜定位固定骶髂关节脱位的实验研究
|
摘要
目的:应用计算机辅助热塑膜定位系统进行骨盆骶髂关节螺钉置入研究,评估该系统的准确性和有效性。
方法:一、材料与分组
实验组在热塑膜系统辅助下对尸体骨盆进行骶髂关节螺钉置入,每侧经骶髂关节置入骶1椎体一枚螺钉,共10枚空心钉。
对照组采用传统方法在C型臂透视下对尸体骨盆进行骶髂关节螺钉置入,螺钉数量及位置同实验组。
二、实验用具
成年男性防腐尸体标本10具,年龄25-70岁,均经福尔马林固定,无明显骨盆病变及畸形,自腰3、4椎间至股骨中段截断,共20侧骶髂关节。(河北医科大学解剖教研室提供)热塑膜系统(河北医科大学第三医院放疗科提供)、C型臂透视机、透X线的手术台、瞄准器(自制)、空心钉器械、计时器、测量尺、标记笔。
三、操作步骤:
实验组:尸体骨盆俯卧位置于定位系统的底板上,将热塑膜置于65℃水箱中加热,待热塑膜变软后覆盖于骨盆上,使之尽量贴敷于骨盆表面,热塑膜两侧固定于底板上,待热塑膜温度下降变硬后对此位置进行标记。将三者置于CT检查台上,应用三维激光定位仪在骨盆上确定一个与CT扫描方向一致的平面,在此平面上选择非同一直线上的三个点用铅粒标记,作为影像学的标记平面。行CT扫描,将CT数据传输到计算机,于治疗计划软件上形成三维图像,由同一名有骶髂螺钉置入经验的医师于三维图像上选择最佳进钉方向、进针深度和螺钉最终到达骶骨的位置,由计划系统精确计算进钉路线、螺钉长度和螺钉尖端到进针点的距离,将出钉方向延长在热塑膜上确定虚拟出钉点。通过标记平面对入钉点和虚拟出钉点进行空间定位,然后将得到的数据用三维激光定位仪定位到热塑膜上并标记。将螺钉尖端到入针点长度与瞄准器套筒长度相加的总和用记号笔标记在导针上。为模拟真实手术过程,术前先将骨盆取出后再放回,用热塑膜固定后,用CT在标记铅点平面进行一层扫描,比较是否与术前计划时扫描平面吻合,此过程称为“复位”,应用热塑膜的一次复位成功率>90%。复位成功后,调节定位瞄准器两端刚好在热塑膜上的进钉点与虚拟出钉点位置上,沿瞄准器给出的钉道钻入2.5mm导针,至标记好的深度后用空心钻扩孔,沿导针拧入7.3mm半螺纹松质骨空心钉,取出导针。对骨盆进行目测、CR和CT检查。
对照组:10具尸体,模拟经皮骶髂螺钉固定的手术操作。手术前,以骨盆前后位、出口位、入口位X线片了解骨盆的大体形态。尸体取标准俯卧位于手术台,C形臂X线透视机以骨盆前后位投照确定S1椎体,于合适位置进针点位于髂后下棘前方(24. 6±2. 9)mm ,坐骨大切迹上方(41. 8±3. 4) mm。透视监测下电钻钻孔置入导引针,更换空心钻头顺导引针钻孔后,植入一枚骶髂螺钉,螺钉不超过后正中线。螺钉植入后,C形臂X线透视机以骨盆前后位、出口位、入口位投照了解螺钉植钉位置,确定有无螺钉穿入骶管、骶孔,有无穿破S1椎体及S1椎弓根。
结果:一、实验组
在计算机辅助导航热塑膜定位下,术中不需要透视,置入一枚导针,平均操作时间为29.6秒(15.4-55.7秒)。目测螺钉位置,10枚空心钉均未穿出骨皮质,未累及上椎板、前皮质、骶神经孔和椎管。CR显示骨盆入口位、前后位和出口位图像,所有螺钉置入位置满意。
二、对照组
在透视控制下徒手操作,置入一枚导针的平均透视次数是29.8次(19.0-43.0次),平均透视累时间为21.6秒(12.0-30.0秒),平均操作时间为413.6秒(243.0-589.0秒)。目测螺钉位置,10枚骶髂关节螺钉中,一枚螺钉穿出前方皮质(10%)。
结论:通过本实验研究,计算机辅助热塑膜定位系统优点在于:①为骶髂螺钉置入提供了精准的空间定位和准确的路径导航。②术前做好计划,导针的准确置入在几秒之内完成节省了时间,的节省了手术操作时间。③能使患者和医生避免术中的反复X线暴露。④真正做到微创,可减少出血、保护软组织和降低术后感染率,缩短了手术时间而降低麻醉意外发生率。目前本系统尚不完善,手术需要在CT室进行;消毒隔离与手术室环境配合方面问题还有待进一步实验解决;需要进一步优化系统设计,规范操作流程。
Objective: To assess effects and security of the insertion of sacroiliac screws by computer assisted thermoplastic elastomer film localization system.
Methods:1 Materials and groups Test Group: In a simulated surgical setup 10 cannulated screws were placed into the sacroiliac screws of 10 pelvis under the guidance of the system. Control group: Ten cannulated screws were placed into the sacroiliac screws of 10 pelvis by traditional methods through the C-arm machine perspective.
2 Experimental equipment 10 Adult males corpse specimens. Hot plastic membrane system. C arm perspective. Through the X-ray operating table. Locator. Hollow nails devices. Timer. Measuring . Marker pen.
3 Operation steps:
Test Group: The pelvic is placed prone body position in the bottom of the positioning system and put the thermoplastic elastomer film in 65℃tank, covered in the pelvis after staying the thermoplastic elastomer film soft. We should try to stick to surfaces of pelvis, and fix the thermoplastic elastomer film on the bottom. Marking this position with thermoplastic elastomer film after temperature drop to harden. Then the pelvis are put on CT examination table, and a planar is labeled consistent with a CT scan direction application 3d laser tracking in the pelvis. Three the different line points in the planar are choosed and used the lead point marker. The CT data is transmitted to treatment planning system , 3d image formaing in the treatment plan software. Doctor, which has experience of placing sacroiliac screws, choose the direction of the best nail way ,the injection depth, finally reaching the position of the sacrum and precise calculate the length of the screw in 3d image, then the virtual needle points are marked on the thermoplastic elastomer film. The virtual needle points are located. Then data is located to the thermoplastic elastomer film and marked by 3d laser tracking. To simulate the real operation process firstly, the pelvis are removed and put back again, after the thermoplastic elastomer film fixing. This process is called "reset". The reset rate is 90% by the thermoplastic elastomer film. After successful resetting, the ends of locator consistent the needles points and a virtual points are made on the thermoplastic elastomer film. 2.5 mm guide pin is scored through the robot design nail way,hole is used hollow drill enlarge and the 7.3 mm cancellous bone hollow nails is thread into, the guide needle is taken out. The pelvis is checked through visual, CR and CT, then the screws are removed.
Control Group: Percutaneous sacroiliac screws operation are simulated. Before the operation, we understand the general form of pelvic by A-P position, the pelvic inlet and exit image. Standard prone body is located on the operation bed,vertebral S1 is determined by C arm X-ray machine. The points are select properly which are anterior of spina iliaca posterior inferior (24. 6±2. 9)mm ,and anodic greater sciatic notch (41. 8±3. 4) mm,Guide pin is scored and hole is used hollow drill to enlarge and the 7.3 mm cancellous are bone hollow nails thread into. The pelvis is checked through visual, CR and CT, then the screws are removed.We definite the screws whether or not break through the sacral canal, sacral foramen,S1 and pedicle of vertebral arch of S1.
Results:1、Test Group,
Putting a screw through Computer-assisted Thermoplastic Elastomer Film Localization System, We need average time which is 29.3 seconds(15.4-55.7秒) without fluoroscopy. Through the visual 10 screw hollow nails, all were not break out the bone cortex, frontal cortex, sacral nerve hole and spinal canal. All the screw position are content through the pelvic entrance and exit image of CR display, CT scans show 10 sacroiliac joints in safety zone screw.
2.Control Group In the fluoroscopy of operation under control, the time that a screw was insert is the average fluoroscopy 29.8 times (19.0-43.0 times), average fluoroscopy for tired fetched seconds (12.0 30.0 seconds), average - operating time for 413.6 seconds (243.0-589.0 seconds). One screw of 10 sacroiliac joint screws wear out front cortex(10%)
Conclusion: Through the experimental study we found the advantage of Computer-assisted Thermoplastic Elastomer Film Localization System is :①providing precise and accurate location of the space navigation path sacroiliac joint screws .②inserting a guide needle need a few seconds and saving the time of operation.③it can make patients and physicians to avoid the repeated X-ray exposure.④This method is truly minimally invasive and reduces haemorrhage , protects soft tissue and reduces postoperative infection.
At present, the system is not consummate ,operation needs in CT room; the Problems of disinfection and operating environment is further to solve; System design need to optimize ,operation flow into need to benchmarking.
方法:一、材料与分组
实验组在热塑膜系统辅助下对尸体骨盆进行骶髂关节螺钉置入,每侧经骶髂关节置入骶1椎体一枚螺钉,共10枚空心钉。
对照组采用传统方法在C型臂透视下对尸体骨盆进行骶髂关节螺钉置入,螺钉数量及位置同实验组。
二、实验用具
成年男性防腐尸体标本10具,年龄25-70岁,均经福尔马林固定,无明显骨盆病变及畸形,自腰3、4椎间至股骨中段截断,共20侧骶髂关节。(河北医科大学解剖教研室提供)热塑膜系统(河北医科大学第三医院放疗科提供)、C型臂透视机、透X线的手术台、瞄准器(自制)、空心钉器械、计时器、测量尺、标记笔。
三、操作步骤:
实验组:尸体骨盆俯卧位置于定位系统的底板上,将热塑膜置于65℃水箱中加热,待热塑膜变软后覆盖于骨盆上,使之尽量贴敷于骨盆表面,热塑膜两侧固定于底板上,待热塑膜温度下降变硬后对此位置进行标记。将三者置于CT检查台上,应用三维激光定位仪在骨盆上确定一个与CT扫描方向一致的平面,在此平面上选择非同一直线上的三个点用铅粒标记,作为影像学的标记平面。行CT扫描,将CT数据传输到计算机,于治疗计划软件上形成三维图像,由同一名有骶髂螺钉置入经验的医师于三维图像上选择最佳进钉方向、进针深度和螺钉最终到达骶骨的位置,由计划系统精确计算进钉路线、螺钉长度和螺钉尖端到进针点的距离,将出钉方向延长在热塑膜上确定虚拟出钉点。通过标记平面对入钉点和虚拟出钉点进行空间定位,然后将得到的数据用三维激光定位仪定位到热塑膜上并标记。将螺钉尖端到入针点长度与瞄准器套筒长度相加的总和用记号笔标记在导针上。为模拟真实手术过程,术前先将骨盆取出后再放回,用热塑膜固定后,用CT在标记铅点平面进行一层扫描,比较是否与术前计划时扫描平面吻合,此过程称为“复位”,应用热塑膜的一次复位成功率>90%。复位成功后,调节定位瞄准器两端刚好在热塑膜上的进钉点与虚拟出钉点位置上,沿瞄准器给出的钉道钻入2.5mm导针,至标记好的深度后用空心钻扩孔,沿导针拧入7.3mm半螺纹松质骨空心钉,取出导针。对骨盆进行目测、CR和CT检查。
对照组:10具尸体,模拟经皮骶髂螺钉固定的手术操作。手术前,以骨盆前后位、出口位、入口位X线片了解骨盆的大体形态。尸体取标准俯卧位于手术台,C形臂X线透视机以骨盆前后位投照确定S1椎体,于合适位置进针点位于髂后下棘前方(24. 6±2. 9)mm ,坐骨大切迹上方(41. 8±3. 4) mm。透视监测下电钻钻孔置入导引针,更换空心钻头顺导引针钻孔后,植入一枚骶髂螺钉,螺钉不超过后正中线。螺钉植入后,C形臂X线透视机以骨盆前后位、出口位、入口位投照了解螺钉植钉位置,确定有无螺钉穿入骶管、骶孔,有无穿破S1椎体及S1椎弓根。
结果:一、实验组
在计算机辅助导航热塑膜定位下,术中不需要透视,置入一枚导针,平均操作时间为29.6秒(15.4-55.7秒)。目测螺钉位置,10枚空心钉均未穿出骨皮质,未累及上椎板、前皮质、骶神经孔和椎管。CR显示骨盆入口位、前后位和出口位图像,所有螺钉置入位置满意。
二、对照组
在透视控制下徒手操作,置入一枚导针的平均透视次数是29.8次(19.0-43.0次),平均透视累时间为21.6秒(12.0-30.0秒),平均操作时间为413.6秒(243.0-589.0秒)。目测螺钉位置,10枚骶髂关节螺钉中,一枚螺钉穿出前方皮质(10%)。
结论:通过本实验研究,计算机辅助热塑膜定位系统优点在于:①为骶髂螺钉置入提供了精准的空间定位和准确的路径导航。②术前做好计划,导针的准确置入在几秒之内完成节省了时间,的节省了手术操作时间。③能使患者和医生避免术中的反复X线暴露。④真正做到微创,可减少出血、保护软组织和降低术后感染率,缩短了手术时间而降低麻醉意外发生率。目前本系统尚不完善,手术需要在CT室进行;消毒隔离与手术室环境配合方面问题还有待进一步实验解决;需要进一步优化系统设计,规范操作流程。
Objective: To assess effects and security of the insertion of sacroiliac screws by computer assisted thermoplastic elastomer film localization system.
Methods:1 Materials and groups Test Group: In a simulated surgical setup 10 cannulated screws were placed into the sacroiliac screws of 10 pelvis under the guidance of the system. Control group: Ten cannulated screws were placed into the sacroiliac screws of 10 pelvis by traditional methods through the C-arm machine perspective.
2 Experimental equipment 10 Adult males corpse specimens. Hot plastic membrane system. C arm perspective. Through the X-ray operating table. Locator. Hollow nails devices. Timer. Measuring . Marker pen.
3 Operation steps:
Test Group: The pelvic is placed prone body position in the bottom of the positioning system and put the thermoplastic elastomer film in 65℃tank, covered in the pelvis after staying the thermoplastic elastomer film soft. We should try to stick to surfaces of pelvis, and fix the thermoplastic elastomer film on the bottom. Marking this position with thermoplastic elastomer film after temperature drop to harden. Then the pelvis are put on CT examination table, and a planar is labeled consistent with a CT scan direction application 3d laser tracking in the pelvis. Three the different line points in the planar are choosed and used the lead point marker. The CT data is transmitted to treatment planning system , 3d image formaing in the treatment plan software. Doctor, which has experience of placing sacroiliac screws, choose the direction of the best nail way ,the injection depth, finally reaching the position of the sacrum and precise calculate the length of the screw in 3d image, then the virtual needle points are marked on the thermoplastic elastomer film. The virtual needle points are located. Then data is located to the thermoplastic elastomer film and marked by 3d laser tracking. To simulate the real operation process firstly, the pelvis are removed and put back again, after the thermoplastic elastomer film fixing. This process is called "reset". The reset rate is 90% by the thermoplastic elastomer film. After successful resetting, the ends of locator consistent the needles points and a virtual points are made on the thermoplastic elastomer film. 2.5 mm guide pin is scored through the robot design nail way,hole is used hollow drill enlarge and the 7.3 mm cancellous bone hollow nails is thread into, the guide needle is taken out. The pelvis is checked through visual, CR and CT, then the screws are removed.
Control Group: Percutaneous sacroiliac screws operation are simulated. Before the operation, we understand the general form of pelvic by A-P position, the pelvic inlet and exit image. Standard prone body is located on the operation bed,vertebral S1 is determined by C arm X-ray machine. The points are select properly which are anterior of spina iliaca posterior inferior (24. 6±2. 9)mm ,and anodic greater sciatic notch (41. 8±3. 4) mm,Guide pin is scored and hole is used hollow drill to enlarge and the 7.3 mm cancellous are bone hollow nails thread into. The pelvis is checked through visual, CR and CT, then the screws are removed.We definite the screws whether or not break through the sacral canal, sacral foramen,S1 and pedicle of vertebral arch of S1.
Results:1、Test Group,
Putting a screw through Computer-assisted Thermoplastic Elastomer Film Localization System, We need average time which is 29.3 seconds(15.4-55.7秒) without fluoroscopy. Through the visual 10 screw hollow nails, all were not break out the bone cortex, frontal cortex, sacral nerve hole and spinal canal. All the screw position are content through the pelvic entrance and exit image of CR display, CT scans show 10 sacroiliac joints in safety zone screw.
2.Control Group In the fluoroscopy of operation under control, the time that a screw was insert is the average fluoroscopy 29.8 times (19.0-43.0 times), average fluoroscopy for tired fetched seconds (12.0 30.0 seconds), average - operating time for 413.6 seconds (243.0-589.0 seconds). One screw of 10 sacroiliac joint screws wear out front cortex(10%)
Conclusion: Through the experimental study we found the advantage of Computer-assisted Thermoplastic Elastomer Film Localization System is :①providing precise and accurate location of the space navigation path sacroiliac joint screws .②inserting a guide needle need a few seconds and saving the time of operation.③it can make patients and physicians to avoid the repeated X-ray exposure.④This method is truly minimally invasive and reduces haemorrhage , protects soft tissue and reduces postoperative infection.
At present, the system is not consummate ,operation needs in CT room; the Problems of disinfection and operating environment is further to solve; System design need to optimize ,operation flow into need to benchmarking.
引文
1王亦璁.骨与关节损伤.第l版.北京:人民卫生出版社,2001:817-827
2 Riemer BL, Butlerfield SL, Diamond DL,et al. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. [J] Trauma 1993;35:671-675
3 Evers BM , Cyrer HM , Miller FB. Pelvic fracture hemorrhage. Priorities in management.Arch surg 1989;124(2):422-424
4 Latenser BA,Gentilello LM,Tarver AA,et al. Improved outcome with early fixation of skeletally unstable pelvic fractures. [J]Trauma 1991; 31:28-31
5肖聪勤,钟惟德,蔡岳斌等,骨盆骨折后尿道损伤的腔内与开放治疗疗效比较.中国内镜杂[J].2001;7(2):71-72
6 Letournel E.Pelvic fractures. Injury 1978,10:145-148
7 Matta J,Saucedo T. Internal fixation of pelvic ring fractures.Clin Orthop 1989;242:83-97
8 Routt ML Jr, Kregor PJ, Simonian PT,et al.Early results of percutaneous iliosacral screws placed with the patient in the supine position. [J] Orthop Trauma. 1995;9(3):207-214
9 Yinger K,Scalise J,Olson SA,et al. Biomechanical comparison of posterior pelvic ring fixation.[J] Orthop Trauma2003;17:481-487
10 Routt ML, Simonian PT,Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. [J]Orthop.Trauma1997;11:584-589
11潘志军,洪华兴,黄宗坚.骶髂关节螺钉固定的钉道参数应用解剖学研究中国临床解剖学杂2004;22(2):125-128
12潘进社,张英泽,陈伟.骶髂关节应用解剖及生物力学研究进展.国际骨科学杂志,2007,28(4):237-238
13 Tile M. Pelvic ring fractures: Should they be fixed? [J] Bnoe Joint Sury 1988;70(1):l-12
14 Kellam JF, McMurtry RY, Paley D,et al: The unstable pelvic fracture. Operative treatment.Orthop Clin North Am 1987; 18:25-41
15 Leighton RK, Waddell JP, Bray TJ et al.Biomechanical testing of new and old fixation devices for vertical shear fractures of the pelvices. [J] Orthop Trauma 1991; 5(3):313-317
16 Semba RT, Yasukawa K,Gustilo RB. Critical analysis of results of 53 Malgaigne fractures of the pelvis. [J] Trauma1983; 23(6):535-537
17 ChmelováJ, Sír M, Jecmínek V. CT-guidedpercutancous fixation of pelvic fractures. Case report. Bimoed. 2005; 149(1):177-181
18 Stocks GW, Gabel GT, Noble PC. Anterior and Posterior internal fixation of vertical shear fracture of pelvic. [J] Orthop Res1991; 9(2):237-245
19 Vanderschot P, Meuleman C, Lefevre A, et al. Trans iliac-sacral-iliac bar stabilisation to treat bilateral lesions of the sacro-iliac joint or sacrum: anatomical considerations and clinical experience. [J] Injury, 2001,32(7):587-592
20 Simonian PT, Routt ML Jr. Biomechanics of pelvic fixation.[J]Orthop Trauma,1997,28(3):351-367
21 Comstock CP, van der Meulen MC, Goodman SB. Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures. [J] Orthop Trauma1996;10(8):517-522
22 Tile M. Disruption of the pelvic ring. Fractures the Pelvic and acetabulum Baltimore: Wi11iarns and wilkins.1984.155-165
23 Schildhauer TA,Josten Ch,Muhr G.Triangular osteosynthesis of vertically unstable sacrum fractures :a new concept allowing early weightbearing. [J] Orthop Trauma1998;12:307-314
24 Schildhauer TA, Josten C , Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a newconcept allowing early weight-bearing. [J]Orthop Trauma 2001;9:24-38
25 Schildhauer TA,Ledoux WR,Chapman JR,et al. Triangular Osteosynthesis and Iliosacral screw Fixation of Unstable Sacral Fractuers: A Cadaveric and Biomechanical Evaluation Under Cyclic Loads.[J] Orthop Trauma2003;17:22-31
26 Korovessis P, Stamatakis M, Baikousis A.Posterior stabilization of unstable sacorilia injuries with the Texas Scottish Rite Hopital spinal insturmentation. Orthopedics 2000;23:323一327
27 Cüneyt Sar and ?nder Kilicoglu. S1 pediculoiliac screw fixation in instabilities of the sacroiliac complex: biomechanical study and report of two cases. [J] Orthop Trauma 2003;17:262-270
28 Choi WW, Green BA, Levi AD. Computer-assisted fluoroscopic targeting system of pedicle screw insertion. Neurosurgery 2000;47:872-878
29 Collinge C , Coons D , Tornetta P , et al. Standard multiplanar fluoroscopy versus a fluoroscopically based navigation system for the percutaneous insertion of iliosacral screws: a cadaver model.[J] Orthop Trauma 2005;19:254-258
30任义军,王钢,陈滨等.骶髂关节脱位直视复位空心螺钉固定的基础研究及临床应用.中华创伤骨科杂志,2006,8(6):515-519
31王建,周跃,滕海军等.CT引导下经皮螺钉固定治疗骶髂关节骨折脱位.中华创伤杂志,2007,10(23):724-727
32 Olson SA, Pollak AN. Assessment of pelvic ring stability after injury. Indication for surgical stabilization. [J]. Clin Orthop,1996,329(8):15-27
33 Routt ML Jr, Simonian PT. Closed reduction and percutaneous skeletal fixation of sacral fractures. Clin Orthop,1996,239:121-128
34 Hinsche AF,Giannoudis PV,SmithRM.Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws.Clin Orthop,2002,(395):135-144
35苏永刚,王军强,刘文勇等.双平面骨科机器人系统辅助骶髂关节螺钉置入的实验研究.中华创伤骨科杂志, 2006,8: 45-49
36蒋国梁.现代肿瘤放射治疗学.上海:上海科学技术出版社,2003,37-381
37潘进社,王涛,郑占乐.计算机辅助导航热塑膜定位固定骶髂关节脱位的研究。河北医科大学学报,2008,29(2):275
38潘进社,郑占乐,翟福山.计算机辅助经皮复位固定髋臼横断骨折的可行性研究.河北医科大学学报,2008,29(4)583
1马晓云,韩振奎.骶髂关节的临床解剖学研究.延安大学学报(医学科学版),2006,9,4(3):1-2
2 Tile M:Acute pelvic fractures:I.Causation and classification [J].JAAOS,1996,4:143-151
3郭澄水,陈新良等.骶髂关节骨折脱位的手术治疗.中国矫形外科杂志,2000,1(1):85-86
4胥少汀,葛宝丰,徐印坎.实用骨科学.人民军医出版社,2006,10,第三版:653
5 Tile M.Classification.In:TileM.Fracture of the pelvis and acetabulum [M]. nd ed. Baltimore:Williams and Wilkins,1995.66-101
6贾健,金鸿宾.骨盆损伤的诊断及外科治疗.中华骨科杂志,2000,20(2):121-123
7 Berg EE,Chebuhar C,Bell RM. Pelvic trauma imaging:a blinded comparison of computed tomography and roentgenograms[J].J Trauma,1996,41:994-998
8贾维东,戈朝辉,吕金捍等.螺旋CT三维成像对骨盆及髋臼骨折临床治疗的指导意义[J].宁夏医学杂志,2000,22 (12):713-715
9潘进社,张英泽,张奉琪等.骨盆骨折X线表现及轴向CT相关性研究,中国骨与关节损伤杂志,2006,06:103-105
10 Matta JM , Tornetta P. Internal fixation of unstable pelvicringinjuries[J].ClinOrthop,1996,329:129-140
11 Tile M. Acute pelvic fractures:Ⅱ.Principles of Management.JAAOS,1996,4:152-161
12夏平光,陈庄洪,蔡贤华等.前路钢板螺钉内固定治疗骶髂关节分离损伤,中华创伤骨科杂志. 2005,7(7):694-685
13 Damian R. Griffin,Adam J.Starr,Charles M.Reinert et al.Vertically Unstable Fracture Fixed with Percutaneous Iliosacral Screws: Does Posterior Injury Pattern Predict Fixation Failure? journal of orthopaedic trauma,2006,20(1):399-405
14贾维东,刘沂,吕金捍等. 34例骶髂关节损伤的临床治疗,创伤外科杂志.2003;5(3):167-169
15 Simonian PT,Rout ML JR.Biomechanics of pelvic fixation[J].Orthop Clin North (Am),1997,28(3):351-367
16 Routt ML,Meir MC,Krgeor PK,et al.Percutaneuos iliosacral serwes with the patient supine technique. Operat Tech Orthop 1993;3:35-45
17 Schildhauer TA,Josten C,Muhr G.Triangular osteosynthesis of vertically unstable sacrum fractures:a new concept allowing early weightbearing. J Orthop Trauma 1998;12:307-314
18 Schildhauer TA. Josten C , Muhr G. Triangular osteosynthesis for unstable sacral fractures. Orthop Traumatol 2001;9:24-38
19 Matta JM ,Saucedo T. Internal fixation of pelvic ring fractures. ClinOrthop,1989,242:83-97
20锡林宝勒日,白靖平,芦永等.后路短螺丝钉固定术治疗骶髂关节骨折脱位实验研究与临床,中国矫形外科杂志,2003,2(11):228-230
21 Kuniyoshi Abumi, Michinori Saita .Reduction and Fixation of Sacroiliac Joint Dislocation by the Combined Use of S1 Pedicle Screws and the Galveston Technique.SPINE Volume 25,Number 15,2000:1977-1983
22王轩,包欣南等.髂骨螺钉联合椎弓根钉治疗骶髂关节脱位,中华现代医药杂志,2006,10(8):85-86
22刘蜀彬,常青等.髂骨空心螺钉治疗骶骨纵形骨折,中国矫形外科杂志,2006,2(14):269-270
24 Iannacone WM,Brathwaite CEM. Use of the external fixationframe for acute stabilization of unstable pelvic fractures [J] . Operat Tech Orthop ,1993,3(1):2 -11
25 Slatis P,Eskola A. External fixation of the pelvic girdle as a test for assessing instability of the sacroiliac joint [J]. Ann Med,1989,21:369-372
26潘进社,王涛,郑占乐等.计算机辅助导航热塑膜定位固定骶髂关节脱位的研究.河北医科大学学报,2008,29(2):275
27潘进社,郑占乐,翟福山等.计算机辅助经皮复位固定髋臼横断骨折的可行性研究.河北医科大学学报,2008,29(4)583
2 Riemer BL, Butlerfield SL, Diamond DL,et al. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. [J] Trauma 1993;35:671-675
3 Evers BM , Cyrer HM , Miller FB. Pelvic fracture hemorrhage. Priorities in management.Arch surg 1989;124(2):422-424
4 Latenser BA,Gentilello LM,Tarver AA,et al. Improved outcome with early fixation of skeletally unstable pelvic fractures. [J]Trauma 1991; 31:28-31
5肖聪勤,钟惟德,蔡岳斌等,骨盆骨折后尿道损伤的腔内与开放治疗疗效比较.中国内镜杂[J].2001;7(2):71-72
6 Letournel E.Pelvic fractures. Injury 1978,10:145-148
7 Matta J,Saucedo T. Internal fixation of pelvic ring fractures.Clin Orthop 1989;242:83-97
8 Routt ML Jr, Kregor PJ, Simonian PT,et al.Early results of percutaneous iliosacral screws placed with the patient in the supine position. [J] Orthop Trauma. 1995;9(3):207-214
9 Yinger K,Scalise J,Olson SA,et al. Biomechanical comparison of posterior pelvic ring fixation.[J] Orthop Trauma2003;17:481-487
10 Routt ML, Simonian PT,Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. [J]Orthop.Trauma1997;11:584-589
11潘志军,洪华兴,黄宗坚.骶髂关节螺钉固定的钉道参数应用解剖学研究中国临床解剖学杂2004;22(2):125-128
12潘进社,张英泽,陈伟.骶髂关节应用解剖及生物力学研究进展.国际骨科学杂志,2007,28(4):237-238
13 Tile M. Pelvic ring fractures: Should they be fixed? [J] Bnoe Joint Sury 1988;70(1):l-12
14 Kellam JF, McMurtry RY, Paley D,et al: The unstable pelvic fracture. Operative treatment.Orthop Clin North Am 1987; 18:25-41
15 Leighton RK, Waddell JP, Bray TJ et al.Biomechanical testing of new and old fixation devices for vertical shear fractures of the pelvices. [J] Orthop Trauma 1991; 5(3):313-317
16 Semba RT, Yasukawa K,Gustilo RB. Critical analysis of results of 53 Malgaigne fractures of the pelvis. [J] Trauma1983; 23(6):535-537
17 ChmelováJ, Sír M, Jecmínek V. CT-guidedpercutancous fixation of pelvic fractures. Case report. Bimoed. 2005; 149(1):177-181
18 Stocks GW, Gabel GT, Noble PC. Anterior and Posterior internal fixation of vertical shear fracture of pelvic. [J] Orthop Res1991; 9(2):237-245
19 Vanderschot P, Meuleman C, Lefevre A, et al. Trans iliac-sacral-iliac bar stabilisation to treat bilateral lesions of the sacro-iliac joint or sacrum: anatomical considerations and clinical experience. [J] Injury, 2001,32(7):587-592
20 Simonian PT, Routt ML Jr. Biomechanics of pelvic fixation.[J]Orthop Trauma,1997,28(3):351-367
21 Comstock CP, van der Meulen MC, Goodman SB. Biomechanical comparison of posterior internal fixation techniques for unstable pelvic fractures. [J] Orthop Trauma1996;10(8):517-522
22 Tile M. Disruption of the pelvic ring. Fractures the Pelvic and acetabulum Baltimore: Wi11iarns and wilkins.1984.155-165
23 Schildhauer TA,Josten Ch,Muhr G.Triangular osteosynthesis of vertically unstable sacrum fractures :a new concept allowing early weightbearing. [J] Orthop Trauma1998;12:307-314
24 Schildhauer TA, Josten C , Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a newconcept allowing early weight-bearing. [J]Orthop Trauma 2001;9:24-38
25 Schildhauer TA,Ledoux WR,Chapman JR,et al. Triangular Osteosynthesis and Iliosacral screw Fixation of Unstable Sacral Fractuers: A Cadaveric and Biomechanical Evaluation Under Cyclic Loads.[J] Orthop Trauma2003;17:22-31
26 Korovessis P, Stamatakis M, Baikousis A.Posterior stabilization of unstable sacorilia injuries with the Texas Scottish Rite Hopital spinal insturmentation. Orthopedics 2000;23:323一327
27 Cüneyt Sar and ?nder Kilicoglu. S1 pediculoiliac screw fixation in instabilities of the sacroiliac complex: biomechanical study and report of two cases. [J] Orthop Trauma 2003;17:262-270
28 Choi WW, Green BA, Levi AD. Computer-assisted fluoroscopic targeting system of pedicle screw insertion. Neurosurgery 2000;47:872-878
29 Collinge C , Coons D , Tornetta P , et al. Standard multiplanar fluoroscopy versus a fluoroscopically based navigation system for the percutaneous insertion of iliosacral screws: a cadaver model.[J] Orthop Trauma 2005;19:254-258
30任义军,王钢,陈滨等.骶髂关节脱位直视复位空心螺钉固定的基础研究及临床应用.中华创伤骨科杂志,2006,8(6):515-519
31王建,周跃,滕海军等.CT引导下经皮螺钉固定治疗骶髂关节骨折脱位.中华创伤杂志,2007,10(23):724-727
32 Olson SA, Pollak AN. Assessment of pelvic ring stability after injury. Indication for surgical stabilization. [J]. Clin Orthop,1996,329(8):15-27
33 Routt ML Jr, Simonian PT. Closed reduction and percutaneous skeletal fixation of sacral fractures. Clin Orthop,1996,239:121-128
34 Hinsche AF,Giannoudis PV,SmithRM.Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws.Clin Orthop,2002,(395):135-144
35苏永刚,王军强,刘文勇等.双平面骨科机器人系统辅助骶髂关节螺钉置入的实验研究.中华创伤骨科杂志, 2006,8: 45-49
36蒋国梁.现代肿瘤放射治疗学.上海:上海科学技术出版社,2003,37-381
37潘进社,王涛,郑占乐.计算机辅助导航热塑膜定位固定骶髂关节脱位的研究。河北医科大学学报,2008,29(2):275
38潘进社,郑占乐,翟福山.计算机辅助经皮复位固定髋臼横断骨折的可行性研究.河北医科大学学报,2008,29(4)583
1马晓云,韩振奎.骶髂关节的临床解剖学研究.延安大学学报(医学科学版),2006,9,4(3):1-2
2 Tile M:Acute pelvic fractures:I.Causation and classification [J].JAAOS,1996,4:143-151
3郭澄水,陈新良等.骶髂关节骨折脱位的手术治疗.中国矫形外科杂志,2000,1(1):85-86
4胥少汀,葛宝丰,徐印坎.实用骨科学.人民军医出版社,2006,10,第三版:653
5 Tile M.Classification.In:TileM.Fracture of the pelvis and acetabulum [M]. nd ed. Baltimore:Williams and Wilkins,1995.66-101
6贾健,金鸿宾.骨盆损伤的诊断及外科治疗.中华骨科杂志,2000,20(2):121-123
7 Berg EE,Chebuhar C,Bell RM. Pelvic trauma imaging:a blinded comparison of computed tomography and roentgenograms[J].J Trauma,1996,41:994-998
8贾维东,戈朝辉,吕金捍等.螺旋CT三维成像对骨盆及髋臼骨折临床治疗的指导意义[J].宁夏医学杂志,2000,22 (12):713-715
9潘进社,张英泽,张奉琪等.骨盆骨折X线表现及轴向CT相关性研究,中国骨与关节损伤杂志,2006,06:103-105
10 Matta JM , Tornetta P. Internal fixation of unstable pelvicringinjuries[J].ClinOrthop,1996,329:129-140
11 Tile M. Acute pelvic fractures:Ⅱ.Principles of Management.JAAOS,1996,4:152-161
12夏平光,陈庄洪,蔡贤华等.前路钢板螺钉内固定治疗骶髂关节分离损伤,中华创伤骨科杂志. 2005,7(7):694-685
13 Damian R. Griffin,Adam J.Starr,Charles M.Reinert et al.Vertically Unstable Fracture Fixed with Percutaneous Iliosacral Screws: Does Posterior Injury Pattern Predict Fixation Failure? journal of orthopaedic trauma,2006,20(1):399-405
14贾维东,刘沂,吕金捍等. 34例骶髂关节损伤的临床治疗,创伤外科杂志.2003;5(3):167-169
15 Simonian PT,Rout ML JR.Biomechanics of pelvic fixation[J].Orthop Clin North (Am),1997,28(3):351-367
16 Routt ML,Meir MC,Krgeor PK,et al.Percutaneuos iliosacral serwes with the patient supine technique. Operat Tech Orthop 1993;3:35-45
17 Schildhauer TA,Josten C,Muhr G.Triangular osteosynthesis of vertically unstable sacrum fractures:a new concept allowing early weightbearing. J Orthop Trauma 1998;12:307-314
18 Schildhauer TA. Josten C , Muhr G. Triangular osteosynthesis for unstable sacral fractures. Orthop Traumatol 2001;9:24-38
19 Matta JM ,Saucedo T. Internal fixation of pelvic ring fractures. ClinOrthop,1989,242:83-97
20锡林宝勒日,白靖平,芦永等.后路短螺丝钉固定术治疗骶髂关节骨折脱位实验研究与临床,中国矫形外科杂志,2003,2(11):228-230
21 Kuniyoshi Abumi, Michinori Saita .Reduction and Fixation of Sacroiliac Joint Dislocation by the Combined Use of S1 Pedicle Screws and the Galveston Technique.SPINE Volume 25,Number 15,2000:1977-1983
22王轩,包欣南等.髂骨螺钉联合椎弓根钉治疗骶髂关节脱位,中华现代医药杂志,2006,10(8):85-86
22刘蜀彬,常青等.髂骨空心螺钉治疗骶骨纵形骨折,中国矫形外科杂志,2006,2(14):269-270
24 Iannacone WM,Brathwaite CEM. Use of the external fixationframe for acute stabilization of unstable pelvic fractures [J] . Operat Tech Orthop ,1993,3(1):2 -11
25 Slatis P,Eskola A. External fixation of the pelvic girdle as a test for assessing instability of the sacroiliac joint [J]. Ann Med,1989,21:369-372
26潘进社,王涛,郑占乐等.计算机辅助导航热塑膜定位固定骶髂关节脱位的研究.河北医科大学学报,2008,29(2):275
27潘进社,郑占乐,翟福山等.计算机辅助经皮复位固定髋臼横断骨折的可行性研究.河北医科大学学报,2008,29(4)583