CAJ | 학술논문

目的通过CT扫描图像对股骨髓腔进行解剖学测量,模拟分析髓腔与股骨交锁髓内钉的匹配性,探讨髓内钉手术中远端锁钉置入困难的原因.方法对30个干燥股骨标本进行CT横断面扫描,每一个股骨按骨干全长均匀提取20幅图像,分别测量每幅图像中轴点及髓腔壁一周8个点在X、Y轴上的数据.用三维绘图软件画出髓腔、中轴线、髓内钉在三维空间上的形态,重叠后进行比对.绘制髓腔中轴冠状面及矢状面的折线型数据图表,与髓内钉数据结合,模拟髓内钉插入髓腔,观察髓内钉切出髓腔壁情况.结果将股骨髓腔中轴线与髓内钉重叠后进行比对,二者在冠状面上较一致,在矢状面上髓腔弧度较髓内钉大.模拟髓内钉插入髓腔,冠状面上有6根髓内钉于股骨标本的中上段切出髓腔内侧或外侧壁,切出率为20％( 6/30),矢状面上有13根髓内钉从前缘切出,切出率为43％(13/30).结论常规股骨交锁髓内钉与大多数股骨髓腔匹配,但髓腔解剖结构有一定的变异性,部分髓腔成角过大使髓内钉发生形变是引起髓内钉远端锁钉置人困难的主要原因.
목적 통과CT소묘도상대고골수강진행해부학측량,모의분석수강여고골교쇄수내정적필배성,탐토수내정수술중원단쇄정치입곤난적원인.방법 대30개간조고골표본진행CT횡단면소묘,매일개고골안골간전장균균제취20폭도상,분별측량매폭도상중축점급수강벽일주8개점재X、Y축상적수거.용삼유회도연건화출수강、중축선、수내정재삼유공간상적형태,중첩후진행비대.회제수강중축관상면급시상면적절선형수거도표,여수내정수거결합,모의수내정삽입수강,관찰수내정절출수강벽정황.결과 장고골수강중축선여수내정중첩후진행비대,이자재관상면상교일치,재시상면상수강호도교수내정대.모의수내정삽입수강,관상면상유6근수내정우고골표본적중상단절출수강내측혹외측벽,절출솔위20％( 6/30),시상면상유13근수내정종전연절출,절출솔위43％(13/30).결론 상규고골교쇄수내정여대다수고골수강필배,단수강해부결구유일정적변이성,부분수강성각과대사수내정발생형변시인기수내정원단쇄정치인곤난적주요원인.
Objective To investigate the geometric feature of femoral medullary cavity through CT scanning and it's matching with femoral intramedullary nail,and to analysis the reason for difficulties in implanting distal lock pin.Methods Thirty dried femur specimens were measured through CT scanning,and twenty images were taken evenly according to the total length of shaft of femur from each femur.In each image,the data of the central axis point and eight points around medullary cavity wall in X and Y axes were obtained,which were used to reconstruct the three-dimensional models of medullary cavity,central axis,intramedullary nail by computer software.And the models were overlapped for comparison.Then the coronal and sagittal fold line charts for central axis of medullary cavity were drawn.The inserting process of intramedullary nail was simulated to observe whether the nail would punch out of the medullary cavity wall.Results The central axis of femoral medullary cavity and intramedullary nail were overlapped and compared.They matched well in the coronal plane,but the curves of femoral medullary cavity were larger than those of intramedullary nails in sagittal plane.While simulating the inserting process of intramedullary nail,6 nails punched out of the medullary cavity wall in coronal plane (20％,6/30),so did 13 nails in sagittal plane (43％,13/30).Conclusion Intramedullary nails match well with most of the femoral medullary cavities.However,the anatomic structure of the femoral medullary cavity differs individually.Curves of some femoral medullary cavity are large,which can cause deformation of intramedullary nail,and this is the main reason for the failure of distal locking.