中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2010年
14期
1101-1105
,共5页
刘国会%毛玉江%查晔军%王满宜
劉國會%毛玉江%查曄軍%王滿宜
류국회%모옥강%사엽군%왕만의
骨折固定术,内%股骨颈%关节穿出%透视
骨摺固定術,內%股骨頸%關節穿齣%透視
골절고정술,내%고골경%관절천출%투시
Fracture fixation,internal%Femur neck%Joint penetration%Radiograph
目的 探讨在术中透视下空心钉钉头与股骨头边缘的安全距离,避免内固定物穿出股骨头.方法 2007年11月至2008年4月统计30例患者术后正、侧位X线片空心钉在股骨头的实际分布情况.分析股骨头的二维垂直透视影像与三维空间结构的关系,建立立体几何公式,根据统计的分布情况进行计算,确定不同空间位置的空心钉在正位透视上应距离股骨头边缘的数值,以确保空心钉位于股骨头内.结果 空心钉处于股骨头的不同位置,即使正、侧位透视下空心钉头都在股骨头影像内,实际穿出股骨头的风险是不同的.股骨头平均直径为49.8 mm.侧位居中时,只要正位透视空心钉在股骨头影像内,就不会穿出股骨头.侧位为22.5°时,正位在22.5°以内透视下钉头应距股骨头边缘超过2.2 mm;正位>45°时,距离应超过9.6 mm.侧位为45°时,正位在22.5°以内透视下钉头应距股骨头边缘超过8.2 mm;正位>45°时钉头应距股骨头边缘超过17.7 mm.侧位为67.5°时,正位透视下钉头应距股骨头边缘超过23.1 mm.结论 当侧位空心钉中置时,只要正位影像下空心钉在股骨头范围内,空心钉就不会穿出股骨头.正侧位角度(尤其是侧位角度)较大时,正位透视空心钉头要距离股骨头边缘较大.
目的 探討在術中透視下空心釘釘頭與股骨頭邊緣的安全距離,避免內固定物穿齣股骨頭.方法 2007年11月至2008年4月統計30例患者術後正、側位X線片空心釘在股骨頭的實際分佈情況.分析股骨頭的二維垂直透視影像與三維空間結構的關繫,建立立體幾何公式,根據統計的分佈情況進行計算,確定不同空間位置的空心釘在正位透視上應距離股骨頭邊緣的數值,以確保空心釘位于股骨頭內.結果 空心釘處于股骨頭的不同位置,即使正、側位透視下空心釘頭都在股骨頭影像內,實際穿齣股骨頭的風險是不同的.股骨頭平均直徑為49.8 mm.側位居中時,隻要正位透視空心釘在股骨頭影像內,就不會穿齣股骨頭.側位為22.5°時,正位在22.5°以內透視下釘頭應距股骨頭邊緣超過2.2 mm;正位>45°時,距離應超過9.6 mm.側位為45°時,正位在22.5°以內透視下釘頭應距股骨頭邊緣超過8.2 mm;正位>45°時釘頭應距股骨頭邊緣超過17.7 mm.側位為67.5°時,正位透視下釘頭應距股骨頭邊緣超過23.1 mm.結論 噹側位空心釘中置時,隻要正位影像下空心釘在股骨頭範圍內,空心釘就不會穿齣股骨頭.正側位角度(尤其是側位角度)較大時,正位透視空心釘頭要距離股骨頭邊緣較大.
목적 탐토재술중투시하공심정정두여고골두변연적안전거리,피면내고정물천출고골두.방법 2007년11월지2008년4월통계30례환자술후정、측위X선편공심정재고골두적실제분포정황.분석고골두적이유수직투시영상여삼유공간결구적관계,건립입체궤하공식,근거통계적분포정황진행계산,학정불동공간위치적공심정재정위투시상응거리고골두변연적수치,이학보공심정위우고골두내.결과 공심정처우고골두적불동위치,즉사정、측위투시하공심정두도재고골두영상내,실제천출고골두적풍험시불동적.고골두평균직경위49.8 mm.측위거중시,지요정위투시공심정재고골두영상내,취불회천출고골두.측위위22.5°시,정위재22.5°이내투시하정두응거고골두변연초과2.2 mm;정위>45°시,거리응초과9.6 mm.측위위45°시,정위재22.5°이내투시하정두응거고골두변연초과8.2 mm;정위>45°시정두응거고골두변연초과17.7 mm.측위위67.5°시,정위투시하정두응거고골두변연초과23.1 mm.결론 당측위공심정중치시,지요정위영상하공심정재고골두범위내,공심정취불회천출고골두.정측위각도(우기시측위각도)교대시,정위투시공심정두요거리고골두변연교대.
Objectives To investigate the safe distance from the tip of the cannulated screw to the apex of the femoral head, and to avoid cutting out of the cannulated screws from the femoral head. Methods From November 2007 to April 2008, the placement configuration of the cannulated screws in the femoral head on the anteroposterior (AP) and lateral view was investigated. And the relation between the three-dimensional configuration and the two-dimensional perpendicular view of the femoral head to establish a solid geometry formula was analyzed. According to the configuration, the distances from the tips of different cannulated screws to the apex of the femoral head to confirm the screws placement within the femoral head was measured. Results The actual risk of cutting out of the cannulated screws varied according to the different placement of the cannulated screws in the femoral head, even if the screw tips were within the femoral head on the AP and lateral radiograph. The mean diameter of femoral head was 49. 8 mm. If the cannulated screw is in the center of femoral head on the lateral view, the cannulated screw wouldn't cut out as long as it was in the femoral head on the AP view. When the angle was 22. 5° on the lateral view, and under 22.5°on the AP view, the distance from the screw tip to the apex of the femoral head would exceeded 2. 2 mm. If the angle >45°on the AP view, the distance would exceed 9.6 mm. When the angle was 45°on the lateral view, and under 22. 5°on the AP view, the distance would exceed 8. 2 mm. When the angle > 45°on the AP view, the distance would exceed 17.7 mm. When the angle was 67. 5°on the lateral view, the distance would exceed 23. 1 mm on AP view. Conclusions If the cannulated screw is in the center of femoral head on the lateral view, the cannulated screw won't cut out as long as it is in the femoral head on the AP view. The angle is larger on the AP and lateral view (especially on the lateral view), and the distance is longer.
