髋臼闭孔后缘螺钉通道解剖学参数的研究

发布时间：2018-01-21 06:47

本文关键词： 髋臼骨折闭孔后缘通道三维成像解剖学　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目前就不同类型的髋臼骨折的治疗已有许多相关研究报道,但是目前几乎没有关于如何在闭孔后缘骨性通道中安全置入拉力螺钉的报道,然而根据相关生物力学研究,在该通道中置入一枚拉力螺钉可以显著提高内固定的稳定性。然而该通道十分狭窄,所以有必要对其进行详细的研究。研究目的测量闭孔后缘螺钉通道的进钉参数,根据所得参数在骨性半骨盆标本上进行模拟置钉,探讨合理的置钉方法,为相关置钉瞄准器的设计提供依据。研究方法收集50例正常成人骨盆(男女各25例)的螺旋CT扫描数据,在mimics15.0软件中重建骨盆三维模型,经逆向工程软件Geomagic Studio 12.0处理后得到100个内部为空、仅有外侧皮质的半骨盆模型,将其储存为.stl文件后重新导入mimics15.0软件中。通过“轴位透视法”找到闭孔后缘最大的螺钉通道,置入模拟螺钉后自进钉点O向骨盆界线作垂线交于点A,连接点A与耻骨联合点B。分别测量最大螺钉直径和长度、进钉点的位置、进钉方向与冠状面的夹角α和与矢状面的夹角β,进钉方向与骨面所成外倾角θ和后倾角ψ。对测量数据进行统计学处理后,挑选13具保存完整、肉眼和X线下均未见畸形和骨折的骨性半骨盆标本(男性8具,女性5具),根据测量数据在13具半骨盆标本上进行验证,并统计置钉成功率。研究结果男性的最大螺钉直径平均值为(6.48± 1.07)mm,最大螺钉长度平均值为(98.03±4.08)mm,OA 平均值为(7.93±2.30)mm,AB 平均值为(55.99±4.83)mm,∠α 平均值为(48.93±3.72)°,∠β平均值为(2.42±1.10)°,∠θ平均值为(79.17±9.89)°,∠ψ平均值为(108.72±6.13)°;女性的最大螺钉直径平均值为(5.87±1.34)mm,最大螺钉长度平均值为(87.34±4.76)mm,OA平均值为(3.77±1.37)mm,AB平均值为(63.66±4.74)mm,∠α平均值为(47.03±4.18)°,∠β平均值为(5.34± 1.81)°,∠θ 平均值为(71.81±10.61)°,∠ψ平均值为(98.12±7.43)°。所有的测量参数均存在男女之间的统计学差异(p0.05)。在13具骨性半骨盆标本进行置钉时,8具男性半骨盆标本均于闭孔后缘螺钉通道中安全置入1枚直径3.5mm的克氏针,置钉成功率100%。5具女性半骨盆标本中有1具置钉过程中螺钉穿入关节,4具成功置入1枚直径3.5mm的克氏针,置钉成功率80%。研究结论根据测量所得的闭孔后缘螺钉通道的进钉参数和骨性半骨盆标本上的验证结果,我们认为于该通道置入一枚长度合适、直径3.5mm的拉力螺钉是可行的,同时可根据测量所得的解剖学参数设计相关的进钉导向装置。
[Abstract]:There have been many related studies on the treatment of different types of acetabular fractures, but there are few reports on the safe placement of pull screws in the osseous passage of the posterior margin of the obturator. However, according to biomechanical studies, placement of a pull screw in the channel can significantly improve the stability of the internal fixation. However, the channel is very narrow. Therefore, it is necessary to study it in detail. Methods the helical CT scanning data of the pelvis of 50 normal adults (25 males and 25 males) were collected. Three dimensional model of pelvis was reconstructed in mimics15.0 software. 100 internal models were found to be empty after processing with reverse engineering software Geomagic Studio 12.0. The hemipelvis model with only lateral cortex was stored as .stl file and then re-imported into mimics15.0 software. The largest screw passage was found by "axial perspective". The point A and pubic joint point B were used to measure the maximum screw diameter and length, and the position of the point respectively. The angle 伪 between the direction of the nail and the coronal plane, the angle 尾 with the sagittal plane, the angle 胃 and the posterior inclination between the direction of the nail and the bone plane were obtained. After statistical processing of the measured data, 13 specimens were selected for preservation. No deformities and fractures of the pelvis (8 males and 5 females) were observed in the naked eye and under X-ray. The data were tested on 13 hemipelvis specimens. Results the mean maximum screw diameter and maximum screw length were 6.48 卤1.07mm and 98.03 卤4.08mm respectively. The average value of OA was 7.93 卤2.30mb, the mean value of AB was 55.99 卤4.83mm. the mean value of 伪 was 48.93 卤3.72 掳. The average value of 尾 is 2.42 卤1.10 掳, the average value of angle 胃 is 79.17 卤9.89 掳, and the average value is 108.72 卤6.13 掳. The mean maximum screw diameter and maximum screw length were 5.87 卤1.34 mm and 87.34 卤4.76 mm respectively. The average value of OA was 3.77 卤1.37mb, the mean value of AB was 63.66 卤4.74mm, and the mean value of 伪 was 47.03 卤4.18 掳. The mean value of 尾 is 5.34 卤1.81 掳, and the average value of 胃 is 71.81 卤10.61 掳. The mean value of 蠄 was 98.12 卤7.43 掳. There was a statistical difference between men and women in all the measured parameters (p 0.05). A 3.5mm Kirschner needle was safely placed in the posterior margin screw passage of 8 male hemipelvis specimens. The successful rate of nail insertion was 100.5 female hemi-pelvis specimens. During the process of nail insertion, 4 screws were inserted into the joint and 4 were successfully implanted with a 3.5mm Kirschner needle. The success rate of nail placement is 80%. Conclusion according to the parameters of screw entry and the results of validation on the pelvis specimen, we think it is appropriate to place a piece of nail in this channel. The pull screw with a diameter of 3.5 mm is feasible and can be designed according to the measured anatomical parameters.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687;R322

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