数字化虚拟骶骨置钉的解剖学测量
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摘要
背景:骶骨由于处在脊柱与骨盆的交界区,其骨折极易漏诊。骶骨骨折的漏诊和治疗不当会造成进一步的神经损伤和后期的腰骶部畸形,其矫形手术困难,且疗效亦不如新鲜骨折。因此,早期诊断治疗骶骨骨折十分重要。目的:利用数字化虚拟技术进行骶骨部分置钉点的数字解剖研究,为临床治疗及内固定的进一步研究提供参考。方法:选取60例成人骨盆CT扫描数据,男女比为1∶1,利用Mimics 16.0软件进行三维模型重建,选择拟进行测量的点,然后分别在水平面、矢状面进行相关数据的测量。结果与结论:(1)L5关节突下缘与S1骶后孔上缘连线的中点允许置钉;(2)每侧上一骶后孔下缘与下一骶后孔上缘连线的中点,即众多学者描述的椎弓根置钉点同样允许置钉;(3)其余测量指标差异均无显著性意义(P>0.05);(4)结果表明,利用数字化模拟技术对骶骨各置钉点进行数据测量,所得出的各置钉点允许置钉的深度及角度可作为临床治疗骶骨骨折的参考依据。
BACKGROUND: The surgeons are prone to leak a sacral fracture because of its junction with the spine and pelvis. Misdiagnosis and improper treatment of sacral fracture can cause further nerve injury and later lumbar sacral deformity, and its orthopedic operation is difficult and the curative effect is not as good as fresh fracture. Thereafter, early diagnosis and treatment of sacral fracture are very important. OBJECTIVE: To carry out digital anatomic study of sacral part placement points using digital virtual technology, so as to provide guidance for clinical treatment. METHODS: Sixty cases of adult pelvis CT scan(the ratio of men and women was 1:1) were selected randomly. The three-dimensional model was reconstructed by Mimics 16.0 software, and the measured points were selected. Then the related data were measured on the horizontal and sagittal planes, separately. RESULTS AND CONCLUSION:(1) The midpoint of the interconnections between the lower edge of the L5 and the upper margin of the posterior sacral hole of the S1 was allowed.(2) The midpoint of the line between the lower margin of the sacral hole and the upper margin of the lower sacral posterior orifice, namely the pedicle point of the longitudinal multi scholar, allowed the nail to be placed equally.(3) The differences in the other measurements were insignificant(P > 0.05).(4) To conclude, the digital simulation technique is used to measure the nail point of the sacrum, and the depth and angle of the nailed points of each point can be used as a reference for the treatment of sacral fracture.
BACKGROUND: The surgeons are prone to leak a sacral fracture because of its junction with the spine and pelvis. Misdiagnosis and improper treatment of sacral fracture can cause further nerve injury and later lumbar sacral deformity, and its orthopedic operation is difficult and the curative effect is not as good as fresh fracture. Thereafter, early diagnosis and treatment of sacral fracture are very important. OBJECTIVE: To carry out digital anatomic study of sacral part placement points using digital virtual technology, so as to provide guidance for clinical treatment. METHODS: Sixty cases of adult pelvis CT scan(the ratio of men and women was 1:1) were selected randomly. The three-dimensional model was reconstructed by Mimics 16.0 software, and the measured points were selected. Then the related data were measured on the horizontal and sagittal planes, separately. RESULTS AND CONCLUSION:(1) The midpoint of the interconnections between the lower edge of the L5 and the upper margin of the posterior sacral hole of the S1 was allowed.(2) The midpoint of the line between the lower margin of the sacral hole and the upper margin of the lower sacral posterior orifice, namely the pedicle point of the longitudinal multi scholar, allowed the nail to be placed equally.(3) The differences in the other measurements were insignificant(P > 0.05).(4) To conclude, the digital simulation technique is used to measure the nail point of the sacrum, and the depth and angle of the nailed points of each point can be used as a reference for the treatment of sacral fracture.
引文
[1]李孟军,印祖静,俞建国,等.骶骨椎弓根的解剖学特征与内固定应用研究[J].临床医学工程,2010,17(9):5-7.
[2]Morse BJ,Ebraheim NA,Jackson WT.Preoperative CTdetermination of angles for sacral screw placement.Spine.1994;19(5):604-607.
[3]王玉红,杜心如,徐小青,等.骶骨骨折的解剖学观察及临床意义[J].中国临床解剖学杂志,2007,25(2):148-151.
[4]王奇,黄其杉,王向阳,等.骶骨后路钉板固定的解剖学研究[J].中华骨科杂志,2010,30(3):277-281.
[5]张楠威,于滨生.经S2骶髂螺钉技术在脊柱骨盆稳定性重建中应用的研究进展[J].中国修复重建外科杂志,2018,32(6):764-768.
[6]刘毅,刘国辉,夏天,等.3D打印导板技术在骶髂关节螺钉置入中的应用[J].中华骨科杂志,2018,38(2):86-92.
[7]熊元,陈明,郑琼,等.直视复位结合经皮骶髂关节螺钉固定治疗难复性骶髂关节脱位[J].中华创伤骨科杂志,2018,20(3):193-198.
[8]李松,陈忠辉,陈曦,等.髂骶螺钉固定模式的解剖学研究[J].中华骨科杂志,2018,38(4):236-242.
[9]Thakkar SC,Thakkar RS,Sirisreetreerux N,et al.2D versus3D fluoroscopy-based navigation in posterior pelvic fixation:review of the literature on current technology.Int J Comp Assist Radiol Surg.2017;12(1):69-76.
[10]Sagi HC.Technical aspects and recommended treatment algorithms in triangular osteosynthesis and spinopelvic fixation for vertical shear transforaminal sacral fractures.JOrthop Trauma.2009;23(5):354.
[11]Toogood P,Mcdonald E,Pekmezci M.A biomechanical comparison of ipsilateral and contralateral pedicle screw placement for modified triangular osteosynthesis in unstable pelvic fractures.J Orthop Trauma.2013;27(9):515-520.
[12]Bellabarba C,Schildhauer TA,Vaccaro AR,et al.Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability.Spine.2006;31(31):S80-88;discussion S104.
[13]丁真奇,刘晖,周亮,等.重建钢板内固定治疗不稳定性骶骨骨折[J].临床骨科杂志,2004,7(1):30-32.
[14]陈红卫,潘骏,赵钢生,等.经皮重建钢板内固定治疗不稳定骶骨骨折[J].中华创伤杂志,2007,23(12):905-907.
[15]谷诚,杨晓东,夏广,等.经腹直肌外侧切口治疗骨盆、骶骨骨折合并腰骶丛损伤的临床疗效[J].中华骨科杂志,2016,36(9):521-527.
[16]尹识渊,罗雪峰,沈明荃,等.经皮骶髂螺钉与重建钢板内固定修复TileC型骶骨骨折的比较[J].中国组织工程研究,2014,18(31):4998-5003.
[17]黄其杉,王奇,王向阳,等.第三骶骨置钉的解剖学研究及临床应用[J].温州医科大学学报,2010,40(3):243-246.
[18]陈康乐,蚩真杉,尹利和,等.第二骶骨置钉的解剖学研究及固定的可行性与安全性[J].中国现代医生,2012,50(4):81-83.
[19]Herman A,Keener E,Dubose C,et al.Zone 2 sacral fractures managed with partially-threaded screws result in low risk of neurologic injury.Injury.2016;47(7):1569-1573.
[20]Denis F,Davis S,Comfort T.Sacral fractures:an important problem.Retrospective analysis of 236 cases.Clin Orthop Relat Res.1988;227(227):67-81.
[21]Duwelius PJ,VanAllen M,Bray TJ,et al.Computed tomography-guided fixation of unstable posterior pelvic ring disruptions.J Orthop Trauma.1992;6:420-426.
[22]Matta JM,Saucedo T.Internal fixation of pelvic ring fractures.Clin Orthop.1989;242:83-97.
[23]Mears DC,Capito CP,Deleeuw H.Posterior Pelvic Disruptions Managed by the Use of the Double Cobra Plate.In Bassett III F(ed).Instructional Course Lectures.Vol 37.St Louis,CV Mosby,1988:143-150.
[24]Pohlemann T,Gansslen A,Tscherne H.The problem of the sacral fractures.Clinical analysis of 377 cases.Orthopade.1992;21:400-412.
[25]Semba RT,Yasukawa K,Gustilo RB.Critical analysis of the results of 53 Malgaigne fractures of the pelvis.J Trauma.1983;23:535-537.
[26]蔡鸿敏,刘又文,李红军,等.S2骶髂螺钉的置入技术[J].中国骨伤,2015,28(10):910-914.
[27]赵勇,张树栋,孙涛,等.三种骶髂螺钉固定方式治疗单侧Tile C型骶骨骨折的稳定性比较[J].中华急诊医学杂志,2013,22(5):530-533.
[28]李辉,易成腊,白祥军,等.微创腰椎骨盆三角固定技术在不稳定型骶骨骨折治疗中的应用[J].创伤外科杂志,2015,17(6):518-521.
[29]Elzohairy MM,Salama AM.Open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable posterior pelvic ring disruptions.Orthop Traumatol Surg Res.2017;103(2):223-227.
[30]李孟军,戴国强,占新华,等.骶骨椎弓根及侧块的应用解剖研究[J].中国脊柱脊髓杂志,2010,20(10):864-867.
[31]陈鸥,陈康乐,王奇,等.第三、四骶骨螺钉应用的解剖学研究[J].浙江创伤外科,2012,17(1):22-25.
[32]邓亦奇,许中豹,罗利芳,等.骶骨椎弓根螺钉治疗骶骨骨折的数字解剖学研究[J].中华创伤杂志,2015,31(9):845-849.
[2]Morse BJ,Ebraheim NA,Jackson WT.Preoperative CTdetermination of angles for sacral screw placement.Spine.1994;19(5):604-607.
[3]王玉红,杜心如,徐小青,等.骶骨骨折的解剖学观察及临床意义[J].中国临床解剖学杂志,2007,25(2):148-151.
[4]王奇,黄其杉,王向阳,等.骶骨后路钉板固定的解剖学研究[J].中华骨科杂志,2010,30(3):277-281.
[5]张楠威,于滨生.经S2骶髂螺钉技术在脊柱骨盆稳定性重建中应用的研究进展[J].中国修复重建外科杂志,2018,32(6):764-768.
[6]刘毅,刘国辉,夏天,等.3D打印导板技术在骶髂关节螺钉置入中的应用[J].中华骨科杂志,2018,38(2):86-92.
[7]熊元,陈明,郑琼,等.直视复位结合经皮骶髂关节螺钉固定治疗难复性骶髂关节脱位[J].中华创伤骨科杂志,2018,20(3):193-198.
[8]李松,陈忠辉,陈曦,等.髂骶螺钉固定模式的解剖学研究[J].中华骨科杂志,2018,38(4):236-242.
[9]Thakkar SC,Thakkar RS,Sirisreetreerux N,et al.2D versus3D fluoroscopy-based navigation in posterior pelvic fixation:review of the literature on current technology.Int J Comp Assist Radiol Surg.2017;12(1):69-76.
[10]Sagi HC.Technical aspects and recommended treatment algorithms in triangular osteosynthesis and spinopelvic fixation for vertical shear transforaminal sacral fractures.JOrthop Trauma.2009;23(5):354.
[11]Toogood P,Mcdonald E,Pekmezci M.A biomechanical comparison of ipsilateral and contralateral pedicle screw placement for modified triangular osteosynthesis in unstable pelvic fractures.J Orthop Trauma.2013;27(9):515-520.
[12]Bellabarba C,Schildhauer TA,Vaccaro AR,et al.Complications associated with surgical stabilization of high-grade sacral fracture dislocations with spino-pelvic instability.Spine.2006;31(31):S80-88;discussion S104.
[13]丁真奇,刘晖,周亮,等.重建钢板内固定治疗不稳定性骶骨骨折[J].临床骨科杂志,2004,7(1):30-32.
[14]陈红卫,潘骏,赵钢生,等.经皮重建钢板内固定治疗不稳定骶骨骨折[J].中华创伤杂志,2007,23(12):905-907.
[15]谷诚,杨晓东,夏广,等.经腹直肌外侧切口治疗骨盆、骶骨骨折合并腰骶丛损伤的临床疗效[J].中华骨科杂志,2016,36(9):521-527.
[16]尹识渊,罗雪峰,沈明荃,等.经皮骶髂螺钉与重建钢板内固定修复TileC型骶骨骨折的比较[J].中国组织工程研究,2014,18(31):4998-5003.
[17]黄其杉,王奇,王向阳,等.第三骶骨置钉的解剖学研究及临床应用[J].温州医科大学学报,2010,40(3):243-246.
[18]陈康乐,蚩真杉,尹利和,等.第二骶骨置钉的解剖学研究及固定的可行性与安全性[J].中国现代医生,2012,50(4):81-83.
[19]Herman A,Keener E,Dubose C,et al.Zone 2 sacral fractures managed with partially-threaded screws result in low risk of neurologic injury.Injury.2016;47(7):1569-1573.
[20]Denis F,Davis S,Comfort T.Sacral fractures:an important problem.Retrospective analysis of 236 cases.Clin Orthop Relat Res.1988;227(227):67-81.
[21]Duwelius PJ,VanAllen M,Bray TJ,et al.Computed tomography-guided fixation of unstable posterior pelvic ring disruptions.J Orthop Trauma.1992;6:420-426.
[22]Matta JM,Saucedo T.Internal fixation of pelvic ring fractures.Clin Orthop.1989;242:83-97.
[23]Mears DC,Capito CP,Deleeuw H.Posterior Pelvic Disruptions Managed by the Use of the Double Cobra Plate.In Bassett III F(ed).Instructional Course Lectures.Vol 37.St Louis,CV Mosby,1988:143-150.
[24]Pohlemann T,Gansslen A,Tscherne H.The problem of the sacral fractures.Clinical analysis of 377 cases.Orthopade.1992;21:400-412.
[25]Semba RT,Yasukawa K,Gustilo RB.Critical analysis of the results of 53 Malgaigne fractures of the pelvis.J Trauma.1983;23:535-537.
[26]蔡鸿敏,刘又文,李红军,等.S2骶髂螺钉的置入技术[J].中国骨伤,2015,28(10):910-914.
[27]赵勇,张树栋,孙涛,等.三种骶髂螺钉固定方式治疗单侧Tile C型骶骨骨折的稳定性比较[J].中华急诊医学杂志,2013,22(5):530-533.
[28]李辉,易成腊,白祥军,等.微创腰椎骨盆三角固定技术在不稳定型骶骨骨折治疗中的应用[J].创伤外科杂志,2015,17(6):518-521.
[29]Elzohairy MM,Salama AM.Open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable posterior pelvic ring disruptions.Orthop Traumatol Surg Res.2017;103(2):223-227.
[30]李孟军,戴国强,占新华,等.骶骨椎弓根及侧块的应用解剖研究[J].中国脊柱脊髓杂志,2010,20(10):864-867.
[31]陈鸥,陈康乐,王奇,等.第三、四骶骨螺钉应用的解剖学研究[J].浙江创伤外科,2012,17(1):22-25.
[32]邓亦奇,许中豹,罗利芳,等.骶骨椎弓根螺钉治疗骶骨骨折的数字解剖学研究[J].中华创伤杂志,2015,31(9):845-849.