CAJ | 학술논문

目的结合等中心C形臂(Iso-C)三维计算机导航技术,在尸体骨盆标本上模拟双螺钉置入耻骨联合,获得双螺钉置入耻骨联合的进钉角度,置入螺钉后行局部解剖研究及影像学检查,验证螺钉通道的可行性和安全性.方法取成年防腐尸体标本15具,其中男8具,女7具.制作防腐尸体骨盆标本,在Iso-C三维导航辅助引导下,在耻骨联合模拟螺钉置入,得出进钉点及安全通道.在骨盆标本上置入双螺钉,行局部解剖学研究,逐层显露耻骨联合周围神经血管,测量2枚螺钉各进出钉点与同侧精索、股动静脉、股神经、闭孔动静脉及其神经等结构的距离.完全去除周围软组织,只保留骨盆骨性结构,测量螺钉的进钉角度与长度.所有标本在X线及CT下行影像学检查,进一步验证双螺钉治疗耻骨联合分离的可行性.结果第1枚螺钉进钉点为一侧耻骨结节与耻骨上支的移行处,螺钉与水平面夹角男为(7.7±1.9)°,女为(8.1±1.7)°;与冠状面夹角男为(7.8±1.8)°,女为(7.7±2.0)°.第2枚拉力螺钉的进钉点为对侧耻骨结节与耻骨上支移行处,螺钉与水平面角度男为(30.6±4.0)°,女为(30.8±3.4)°;与冠状面角度男为(9.1±3.0)°,女为(9.2±3.3)°.结论应用三维计算机导航技术,获取双螺钉置入耻骨联合安全通道的方法可靠;经皮双螺钉治疗耻骨联合分离是可行的.
목적 결합등중심C형비(Iso-C)삼유계산궤도항기술,재시체골분표본상모의쌍라정치입치골연합,획득쌍라정치입치골연합적진정각도,치입라정후행국부해부연구급영상학검사,험증라정통도적가행성화안전성.방법 취성년방부시체표본15구,기중남8구,녀7구.제작방부시체골분표본,재Iso-C삼유도항보조인도하,재치골연합모의라정치입,득출진정점급안전통도.재골분표본상치입쌍라정,행국부해부학연구,축층현로치골연합주위신경혈관,측량2매라정각진출정점여동측정색、고동정맥、고신경、폐공동정맥급기신경등결구적거리.완전거제주위연조직,지보류골분골성결구,측량라정적진정각도여장도.소유표본재X선급CT하행영상학검사,진일보험증쌍라정치료치골연합분리적가행성.결과 제1매라정진정점위일측치골결절여치골상지적이행처,라정여수평면협각남위(7.7±1.9)°,녀위(8.1±1.7)°;여관상면협각남위(7.8±1.8)°,녀위(7.7±2.0)°.제2매랍력라정적진정점위대측치골결절여치골상지이행처,라정여수평면각도남위(30.6±4.0)°,녀위(30.8±3.4)°;여관상면각도남위(9.1±3.0)°,녀위(9.2±3.3)°.결론 응용삼유계산궤도항기술,획취쌍라정치입치골연합안전통도적방법가고;경피쌍라정치료치골연합분리시가행적.
Objective With the isocentric C-arm (Iso-C) three-dimensional computerized navigation system,cadaveric pelvic specimens were used to imitate double screw fixation of the symphysis pubic.Practicability and safety of the screw trajectory were examined postoperatively by local cadaveric dissections and imaging tests.Methods Pelvic specimens were harvested from 8 male and 7 female adult cadavers.Double screw placement in symphysis pubic was performed using the Iso-C three-dimensional navigation and entry point and safety trajectory was achieved.With the detailed local dissection postoperatively,distances from screw entry and exit points to unilateral structures (spermatic cord,femoral artery and vein,femoral nerve,obturator artery and vein,obtrurator nerve,and so on) were measured respectively.After complete removal of surrounding soft tissues of the specimen with only bony structure kept,the entry angle and length were calculated.Accuracy of double screw fixation of symphysis pubic was further checked using X-ray and CT.Results Entry point of the first screw was at the junction of unilateral pubic tubercle and transitional site of superior pubic ramus.Mean angle of the first screw with the horizontal plane was (7.7 ± 1.9) ° in men and (8.1 ± 1.7) ° in women.Mean angle between the first screw and coronal plane was (7.8 ± 1.8)° in men and (7.7 ±2.0)° in women.Entry point of the second screw was in the same place in the contralateral pubic tubercle.Mean angle between the second screw and horizontal plane was (30.6 ± 4.0) ° in men and (30.8 ± 3.4) ° in women.Mean angle between the second screw and coronal plane was (9.1 ± 3.0)°in men and (9.2 ± 3.3)°in women.Conclusions With the three-dimensional computerized navigation system,the bony channels of double screws implanted in the symphysis pubic are achieved and reliable.Percutaneous double screw fixation is feasible to treat the pubic symphysis diastasis.