CAJ | 학술논문

目的对臀上动脉骨盆外分支的走行与第二骶椎(S2)层面骶髂螺钉进钉点区域的关系进行放射解剖学研究,为临床置钉时避免损伤臀上动脉提供解剖学基础和技术参考.方法以128排CT对74例患者(男、女各37例)的臀上动脉进行CT血管成像(CTA).使用CT自带测量软件确定骨盆标准侧位观上S2节段的“骨性安全进钉区域”(简称“安全区”).观察臀上动脉盆外各分支与“安全区”之间的关系,统计动脉与“安全区”相交的样本数量,对臀上动脉分支未与“安全区”相交的样本进行测量,测量内容为最接近“安全区”的臀上动脉分支与“安全区”的最近距离.结果 74例样本中21例没有S2水平方向置钉的骨性通道,故被排除本研究范围之外.剩余的53例样本中有12例的臀上动脉深上支穿经S2进钉点“安全区”(22.6％),有16例的臀上动脉浅支穿经S2进钉点“安全区”(30.2％),总重叠率高达52.8％;臀上动脉深上支、浅支与“安全区”均无明显的重叠特征和规律;53例样本中有20例的S2进钉点“安全区”位于臀上动脉的深上支与浅支之间(37.7％),有5例的S2进钉点“安全区”位于臀上动脉浅支的后方(9.4％),臀上动脉与进钉点不相交的样本中,臀上动脉走行最接近“安全区”的部分位于“安全区”最宽部分的前方或后方.结论 S2骶髂螺钉置钉过程中误伤臀上动脉深上支和浅支的风险均较高.即便进钉点位于“骨性安全区”,也无法保证置钉的绝对的安全.我们建议临床置钉术前必须制定周密的应对方案.
목적 대둔상동맥골분외분지적주행여제이저추(S2)층면저가라정진정점구역적관계진행방사해부학연구,위림상치정시피면손상둔상동맥제공해부학기출화기술삼고.방법 이128배CT대74례환자(남、녀각37례)적둔상동맥진행CT혈관성상(CTA).사용CT자대측량연건학정골분표준측위관상S2절단적“골성안전진정구역”(간칭“안전구”).관찰둔상동맥분외각분지여“안전구”지간적관계,통계동맥여“안전구”상교적양본수량,대둔상동맥분지미여“안전구”상교적양본진행측량,측량내용위최접근“안전구”적둔상동맥분지여“안전구”적최근거리.결과 74례양본중21례몰유S2수평방향치정적골성통도,고피배제본연구범위지외.잉여적53례양본중유12례적둔상동맥심상지천경S2진정점“안전구”(22.6％),유16례적둔상동맥천지천경S2진정점“안전구”(30.2％),총중첩솔고체52.8％;둔상동맥심상지、천지여“안전구”균무명현적중첩특정화규률;53례양본중유20례적S2진정점“안전구”위우둔상동맥적심상지여천지지간(37.7％),유5례적S2진정점“안전구”위우둔상동맥천지적후방(9.4％),둔상동맥여진정점불상교적양본중,둔상동맥주행최접근“안전구”적부분위우“안전구”최관부분적전방혹후방.결론 S2저가라정치정과정중오상둔상동맥심상지화천지적풍험균교고.즉편진정점위우“골성안전구”,야무법보증치정적절대적안전.아문건의림상치정술전필수제정주밀적응대방안.
Objective To provide the anatomical basis for avoiding damage to the superior gluteal artery in the sacroiliac screw placement horizontally,by means of radiologic anatomy study on the anatomical relationship between S2 sacroiliac screws' entry points and the pelvic outer superior gluteal artery branches.Methods 74 superior gluteal artery CTA vascular imaging of adults (37 women and 37 men) were done with 128-slice spiral CT.The CT attendant measuring software was used to portray the safe entrance bony area (safe area for short) of the S2 segment in the standard lateral pelvic view of three dimensional reconstruction.The anatomical relationship between S2 sacroiliac screws' safe area and the pelvic outer superior gluteal artery branches was observed and recorded.The number of cases in which artery branches intersected the safe area was counted.The cases in which superior gluteal artery branches disjointed from the safe area were chosen and measured.And the measuring point was the shortest distance between the safe area and the superior gluteal artery branch closest to the safe area.Results Among the 74 sample cases,21 cases were found have no bony space for horizontal screw placement,so were excluded from this study.Among the remaining 53 sample cases,there are 12 cases (22.6％)where the deep superior branch of superior gluteal artery passes through the safe area of S2 entrance point,and there are 16 cases (30.2％) where the superficial branch of superior gluteal artery passes through the safe area of S2 entrance point.The total rate of overlap between the safe area and the artery is as high as 52.8％.There is not distinguishing feature and regularity of the overlap between the deep superior and superficial branches and the safe area.Among the 53 sample cases,there are 20 cases (37.7％) where the safe area of S2 entrance point is located between the superficial branch and the deep superior branch of superior gluteal artery.There are 5 cases (9.4％)where the safe area of S2 entrance point is located posterior to the superficial branch of superior gluteal artery.In the sample cases where the superior gluteal artery and the entrance point do not intersect,the part of superior gluteal artery closest to the safe area is located in front or back of the widest part of the safe area.Conclusion There is a higher risk of accidentally injury of the deep superior branch and the superficial branch of superior gluteal artery in the process of S2 sacroiliac screw placement.Even entry points are located in the safe entrance bony area,absolutely secure placement cannot be assured.We suggest that great attention must be paid to make thorough preoperative plans.