中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2009年
1期
15-19
,共5页
李明%徐荣明%校佰平%王国平%郑琦
李明%徐榮明%校佰平%王國平%鄭琦
리명%서영명%교백평%왕국평%정기
髋臼%骨折固定术髓内%解剖学
髖臼%骨摺固定術髓內%解剖學
관구%골절고정술수내%해부학
Acetubulum%Fracture fixation,intrameduUary%Anatomy
目的 探讨髋臼前柱髓内螺钉治疗髋臼前柱骨折的解剖影像学参数,为临床应用提供参考.方法 取30具国人尸体(男18具,女12具)完整骨盆标本.直视下分别置入右侧顺行和左侧逆行双侧髋臼前柱空心拉力螺钉,通过肉眼观测和多排螺旋CT二维重建,测量螺钉的进钉点、角度、钉道长度、螺钉与髋臼和盆腔的关系,确定最佳进钉点和安全角度.结果 髋臼前柱逆行置钉点在耻骨结节处,距耻骨联合中线垂直距离为(17.15±1.82)mm,距耻骨上缘垂直距离为(20.51±2.19)mm;顺行置钉点距坐骨大切迹顶点的水平距离为(33.25±2.35)mm.逆行进钉的安全角度在矢状面头倾(32.1±2.7)°,冠状面外倾角度为(46.5±3.6)°,顺行置钉角度与逆行置钉角度相同,在矢状面和冠状面呈相反方向,左右侧略有不同(P>0.05).螺钉钉道长度为(119.5±2.2)mm,左右侧比较差异无统计学意义(P>0.05).螺钉的最大直径为7.2 mm.结论 髋臼前柱髓内螺钉固定有较高的准确性,可作为髋臼前柱钢板固定的一种有益的补充.
目的 探討髖臼前柱髓內螺釘治療髖臼前柱骨摺的解剖影像學參數,為臨床應用提供參攷.方法 取30具國人尸體(男18具,女12具)完整骨盆標本.直視下分彆置入右側順行和左側逆行雙側髖臼前柱空心拉力螺釘,通過肉眼觀測和多排螺鏇CT二維重建,測量螺釘的進釘點、角度、釘道長度、螺釘與髖臼和盆腔的關繫,確定最佳進釘點和安全角度.結果 髖臼前柱逆行置釘點在恥骨結節處,距恥骨聯閤中線垂直距離為(17.15±1.82)mm,距恥骨上緣垂直距離為(20.51±2.19)mm;順行置釘點距坐骨大切跡頂點的水平距離為(33.25±2.35)mm.逆行進釘的安全角度在矢狀麵頭傾(32.1±2.7)°,冠狀麵外傾角度為(46.5±3.6)°,順行置釘角度與逆行置釘角度相同,在矢狀麵和冠狀麵呈相反方嚮,左右側略有不同(P>0.05).螺釘釘道長度為(119.5±2.2)mm,左右側比較差異無統計學意義(P>0.05).螺釘的最大直徑為7.2 mm.結論 髖臼前柱髓內螺釘固定有較高的準確性,可作為髖臼前柱鋼闆固定的一種有益的補充.
목적 탐토관구전주수내라정치료관구전주골절적해부영상학삼수,위림상응용제공삼고.방법 취30구국인시체(남18구,녀12구)완정골분표본.직시하분별치입우측순행화좌측역행쌍측관구전주공심랍력라정,통과육안관측화다배라선CT이유중건,측량라정적진정점、각도、정도장도、라정여관구화분강적관계,학정최가진정점화안전각도.결과 관구전주역행치정점재치골결절처,거치골연합중선수직거리위(17.15±1.82)mm,거치골상연수직거리위(20.51±2.19)mm;순행치정점거좌골대절적정점적수평거리위(33.25±2.35)mm.역행진정적안전각도재시상면두경(32.1±2.7)°,관상면외경각도위(46.5±3.6)°,순행치정각도여역행치정각도상동,재시상면화관상면정상반방향,좌우측략유불동(P>0.05).라정정도장도위(119.5±2.2)mm,좌우측비교차이무통계학의의(P>0.05).라정적최대직경위7.2 mm.결론 관구전주수내라정고정유교고적준학성,가작위관구전주강판고정적일충유익적보충.
Objective To discuss the anatomical and radiographic parameters of medullary screw fixation of anterior acetabular column so as to provide reference for clinical application. Methods Thirty cadaveric pelvic specimens (including 18 males and 12 females) were involved in the study and fixated re-spectively with 30 retrograde medullary cannular lag screws through pubic tubercle to acetabular posterosu-perior on the left side and with 30 anterograde medullary cannular lag screws through acetabular posterosu-perior to pubic tubercle on the right side. Then, two-dimensional multiplanar CT reconstruction was done to measure the angle and length of the anterograde and retrograde medullary screw trajectory, the relationship of screws with acetabular bone and penis and determine optimal point and angle of screw insertion. Re-suits The entrance of the retrograde medullary screw was located at pubic tubercle, with vertical dimen-sion of ( 17.15±1.82) mm to pubic symphysis and that of (20.51±2.19) mm to superior margin of pu-bis. For the anterograde medullary screw, the distance from the entrance of the screw to greater sciatic notch was (33.25±2.35) mm, with safe insertion angle of (32.1±2.7)°of cephalon tilting at the sagittal plane and (46.5±3.6)°of lateral tilting at the coronal plane. The entrance angle of the anterugrade and retrograde medullary screw trajectory was similar, with only opposite direction and minor difference between the left and the right sides (P>0.05). The length of medullary screw trajectory was (119.5±2.2) mm, with insignificant difference between both sides ( P >0.05). The maximum diameter of the screw was 7.2 mm. Conclusions Medullary screw fixation of anterior acetabular column is clinically feasible but needs rather high accuracy and can be used as an alternative to plate fixation.