拉力螺钉内固定骶髂关节的影像学与三维重建研究
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摘要
目的为经髂后下棘与髂结节连线置入拉力螺钉内固定骶髂关节术式提供解剖学基础。方法用60例正常成人骨盆CT数据(男、女各30例)导入mimcs15.01进行三维重建,从骶骨耳状面长轴与S1、S2、S3椎弓根中轴的交点置入螺钉。测量各螺钉与冠状面夹角α及水平面的夹角β。结果 (1)3根螺钉在髂骨翼外侧的穿出点在髂后下棘与髂结节的连线上(2)α、β角分别为男:α1(13.6±3.7)°、α2(4.3±1.8)°、α3(10.0±4.4)°;β1(19.1±5.3)°、β2(9.5±4.1)°、β3(4.0±1.5)°。女:α1(12.4±3.4)°、α2(4.5±2.1)°、α3(10.7±4.0)°;β1(17.5±4.6)°、β2(10.0±4.1)°、β3(3.7±1.5)°。结论经髂后下棘与髂结节连线上确定的进针点置入拉力螺钉内固定骶髂关节安全简便。
Objective To provide anatomic basis for lag screw internal fixation of the sacroiliac joint through the line from the posterior inferior iliac spine to the tubercle of iliac crest. Methods CT scanning data from 60 adults pelvis(30 males and 30 females)were collected clinically and then imported into Mimics15.01 for 3D image reconstruction. Place screws from the intersection of the long axis of sacral articular surface and the pedicle axis of S1, S2, S3.The angle between the screws and coronal plane(α) and horizontal plane(β) were measured. Results(1) Three points that the screws penetrated through the outside of iliac wing fell on the line from the posterior inferior iliac spine to the tubercle of iliac crest.(2)The angle αand β were measured as follows: Male:α1(13.6±3.7)°,α2(4.3±1.8)°,α3(10.0±4.4)°;β1(19.1±5.3)°,β2(9.5±4.1)°, β3(4.0±1.5)°. Female: α1(12.4±3.4)°, α2(4.5±2.1)°, α3(10.7±4.0)°; β1(17.5±4.6)°, β2(10.0±4.1)°,β3(3.7±1.5)°. Conclusions It is safe and convenient for placing lag screws through the entry point in the line from the posterior inferior iliac spine to the iliac tubercle for internal fixation of the sacroiliac joint.
Objective To provide anatomic basis for lag screw internal fixation of the sacroiliac joint through the line from the posterior inferior iliac spine to the tubercle of iliac crest. Methods CT scanning data from 60 adults pelvis(30 males and 30 females)were collected clinically and then imported into Mimics15.01 for 3D image reconstruction. Place screws from the intersection of the long axis of sacral articular surface and the pedicle axis of S1, S2, S3.The angle between the screws and coronal plane(α) and horizontal plane(β) were measured. Results(1) Three points that the screws penetrated through the outside of iliac wing fell on the line from the posterior inferior iliac spine to the tubercle of iliac crest.(2)The angle αand β were measured as follows: Male:α1(13.6±3.7)°,α2(4.3±1.8)°,α3(10.0±4.4)°;β1(19.1±5.3)°,β2(9.5±4.1)°, β3(4.0±1.5)°. Female: α1(12.4±3.4)°, α2(4.5±2.1)°, α3(10.7±4.0)°; β1(17.5±4.6)°, β2(10.0±4.1)°,β3(3.7±1.5)°. Conclusions It is safe and convenient for placing lag screws through the entry point in the line from the posterior inferior iliac spine to the iliac tubercle for internal fixation of the sacroiliac joint.
引文
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[8]游景扬,王钢,黎润光,等.骶髂关节经皮拉力螺钉固定钉道参数的解剖学测量[J].中华创伤骨科杂志,2010,12(4):351-354.
[9]潘志军,洪华兴,黄宗坚,等.骶髂关节螺钉固定的钉道参数应用解剖学研究[J].中国临床解剖学杂志,2004,22(2):125-128.
[2]Matta J,Saucedo T.Intemal fixation of Pelvic fractures.[J]Clin orthop,1989,242:83-97.
[3]Charles GT,David W,Marc F.Minimally invasive versus open sacroiliac joint fusion.Are they similarly safe and effective[J]?Clin Orthop Relat Res,2014,472(6):1831-1838.
[4]柳伟,杜心如,杨立辉,等.合并腰骶移行椎时应用骶髂螺钉的临床解剖测量[J].中国临床解剖学杂志,2011,29(5):520-523.
[5]阮默,徐达传,沈新民,等.经皮骶髂螺钉内固定术的应用解剖学研究[J].中国临床解剖学杂志,2006,24(5):479-484.
[6]苏以林,闵敏,李志权,等.经骶髂关节置入S1椎弓根螺钉的数字解剖学研究[J].中华创伤骨科杂志,2012,14(5):410-414.
[7]谭培勇,项舟,张加劲,等.第2骶椎骶髂螺钉最佳进钉通道的分析[J].中国临床解剖学杂志,2013,31(2):140-143.
[8]游景扬,王钢,黎润光,等.骶髂关节经皮拉力螺钉固定钉道参数的解剖学测量[J].中华创伤骨科杂志,2010,12(4):351-354.
[9]潘志军,洪华兴,黄宗坚,等.骶髂关节螺钉固定的钉道参数应用解剖学研究[J].中国临床解剖学杂志,2004,22(2):125-128.