CAJ | 학술논문

目的设计一种骶髂关节复位固定接骨板,并在骶髂关节脱位模型上验证其辅助复位功能和固定强度的有效性.方法 ①选取80例正常成年人骶髂关节CT平扫影像数据,应用Mimics10.0软件测量骶髂关节的解剖参数(S1椎体斜坡和髂窝的表面曲度),并以此参数采用UGN7.0软件确定接骨板的外形及其辅助复位的螺钉孔形状、数量和位置.②从收集的80例正常成年人骶髂关节CT平扫影像数据中选取15例测量骶髂关节间隙内倾角,确定接骨板近端孔、中间孔和远端孔的内倾角度.然后通过3D打印技术打印出接骨板模型,最后制作出真正的钛金属接骨板.③选取10具成年人骶髂关节尸体标本进行骶髂关节脱位造模和接骨板复位、固定的有效性评估. 结果骶髂关节复位固定接骨板的髂骨侧分别设计了2组复位螺钉孔:①偏中间的一组椭圆孔(A孔)用于复位分离移位,偏两端的一组椭圆孔(B孔)用于复位向近端的移位.同时,在接骨板的中间设计5个螺钉孔,骶骨侧为3个,髂骨侧为2个,均设计为锁定螺钉.骶骨侧螺丝钉锁定孔方向:近端孔向内倾斜27°,中间孔向内倾斜24°,远端孔向内倾斜25°;髂骨侧螺钉设计为垂直方向.在骶髂关节脱位模型上进行的接骨板复位和固定模拟操作结果显示:骶髂关节复位固定接骨板可以纠正垂直5 mm及内外3 mm的移位,并能获得牢固固定. 结论新研发的骶髂关节复位固定接骨板同时考虑了接骨板的解剖形态、辅助复位功能和固定强度.从理论设计及尸体操作验证证实了其对骶髂关节复位与固定的有效性.
목적 설계일충저가관절복위고정접골판,병재저가관절탈위모형상험증기보조복위공능화고정강도적유효성.방법 ①선취80례정상성년인저가관절CT평소영상수거,응용Mimics10.0연건측량저가관절적해부삼수(S1추체사파화가와적표면곡도),병이차삼수채용UGN7.0연건학정접골판적외형급기보조복위적라정공형상、수량화위치.②종수집적80례정상성년인저가관절CT평소영상수거중선취15례측량저가관절간극내경각,학정접골판근단공、중간공화원단공적내경각도.연후통과3D타인기술타인출접골판모형,최후제작출진정적태금속접골판.③선취10구성년인저가관절시체표본진행저가관절탈위조모화접골판복위、고정적유효성평고. 결과 저가관절복위고정접골판적가골측분별설계료2조복위라정공:①편중간적일조타원공(A공)용우복위분리이위,편량단적일조타원공(B공)용우복위향근단적이위.동시,재접골판적중간설계5개라정공,저골측위3개,가골측위2개,균설계위쇄정라정.저골측라사정쇄정공방향:근단공향내경사27°,중간공향내경사24°,원단공향내경사25°;가골측라정설계위수직방향.재저가관절탈위모형상진행적접골판복위화고정모의조작결과현시:저가관절복위고정접골판가이규정수직5 mm급내외3 mm적이위,병능획득뢰고고정. 결론 신연발적저가관절복위고정접골판동시고필료접골판적해부형태、보조복위공능화고정강도.종이론설계급시체조작험증증실료기대저가관절복위여고정적유효성.
Objective To test a self-designed new sacroiliac reduction plate in models of sacroiliac dislocation.Methods First,CT scan data of the sacroiliac joint from 80 normal adults were selected for measurement of the anatomic parameters (the vertebral slope of SI and the intrailiac surface curvature) of the sacroiliac joint using Mimics 10.0.The reduction plate was shaped and the shape,number,and position of the screw holes were determined according to the parameters using UGN7.0.Secondly,the CT scan data of the sacroiliac joint from 15 normal adults were used to measure the intra-sacroiliac introversion angle,on the basis of which the introversion angles of the proximal,middle and distal holes of the reduction plate were determined.The actual titanium reduction plates were manufactured accordingly.Thirdly,we performed simulative surgery using the self-designed reduction plate in 10 adult cadaveric models of the sacroiliac dislocation and evaluated the safety and efficacy of the plate.Results According to the measurements of the posterior pelvic ring in the 80 normal sacroiliac joint,2 types of screw holes were deigned.The elliptical holes (hole A) of the central type were used for reduction of diastasis dislocation,and the elliptical holes of the polarization type (hole B) were used to reduce the proximal displacement.In the reduction plate,5 locking screw holes were designed,3 on the sacral side and 2 on iliac side.The holes on the iliac side were made perpendicular; on the sacral side,the proximal hole had a 27° introversion,the middle one a 24° introversion and the distal one a 25° introversion.The simulated operation showed that the new self-designed reduction plate could achieve rigid fixation,reducing displacements of 5 mm vertically and those of 3 mm laterally and medially.Conclusion Since the new self-designed reduction plate takes the anatomy,reduction and rigidity into consideration in the theoretical design,it proves effective by the cadaveric operation in the reduction and fixation of the sacroiliac joint.