髋臼后柱钢板内固定技术的临床解剖学研究

发布时间：2018-05-31 00:14

本文选题：骨盆 + 髋臼　；参考：《山东大学》2007年硕士论文

【摘要】： 目的：累及后柱或后壁的髋臼骨折多数需要行切开复位内固定术，术中最常用的内固定技术为髋臼后柱钢板技术，在内固定过程中有时会发生螺钉穿入关节内、损伤盆腔内重要血管或神经等并发症，尤其在后柱中部区域放置螺钉时更加危险。目前国内外关于使用髋臼后柱支持钢板技术时，如何既能保证获得坚强内固定，又能防止发生螺钉穿入关节内等严重并发症的定量研究资料极少。我们利用髋骨标本制作后柱系列断面并进行研究，，确定后柱各个区域放置螺钉的最佳角度和长度，以解决后柱中部区域拧入螺钉易穿入关节的难题。方法：取成年男性防腐尸体标本10具，进行标本制备。确定髋臼上、下缘界限和髋臼后柱系列断面，制作髋臼后柱系列断面。在各断面上测量后柱宽、髋臼宽和髋臼后柱宽度百分比，测量各进钉点的螺钉角度和长度，测量数据用SPSS10.0进行统计学分析。结果： 1、髋臼上、下缘界限：髋臼上缘在后柱表面的投影在坐骨大切迹顶点上方10.2±2.7 mm，髋臼下缘在在后柱表面的投影在坐骨棘下缘上方11.5±2.6 mm，髋臼上、下缘在后柱表面的投影之间的距离为54.7±4.8 mm。 2、各断面的后柱宽、髋臼宽和髋臼后柱宽度百分比：A断面的后柱宽X、髋臼宽Y以及髋臼后柱宽度百分比分别为52.2±4.4 mm，0 mm和0％；B断面的后柱宽X、髋臼宽Y以及髋臼后柱宽度百分比分别为40.8±2.2 mm，19.2±1.3 mm和47.1％；C断面的后柱宽X、髋臼宽Y以及髋臼后柱宽度百分比分别为39.3±4.5mm，22.4±1.5 mm和56.9％；D断面的后柱宽X、髋臼宽Y以及髋臼后柱宽度百分比分别为38.1±3.6 mm，17.6±1.1 mm和46.2％；E断面的后柱宽X、髋臼宽Y以及髋臼后柱宽度百分比分别为48.2±5.1 mm，0 mm和0％。将断面A、B、C、D和E的髋臼宽Y的内侧端点用弧线连起来形成髋臼的绝对危险区，含义是在此区域内如果垂直于后柱平面进钉时，螺钉会进入关节内。 3、B、C、D断面各进钉点的螺钉进钉角度和长度：在B断面上，B0点的进钉角度和螺钉长度分别为41°和44 mm；B1点分别为66°和42.2 mm；B2点分别为91°和59.5 mm；B3点分别为107°和64 mm；B4点的最大进钉角度和螺钉长度分别为123°和65.47 mm，最小进钉角度和螺钉长度分别为109°和59 mm。在C断面上，C0点的进钉角度和螺钉长度分别为39°和39 mm；C1点分别为57°和36 mm；C2点分别为74°和36 mm；C3点分别为90°和36 mm；C4点分别为106°和76 mm。在D断面上，D0点的进钉角度和螺钉长度分别为42°和35.5 mm；D1点分别为61°和33 mm；D2点分别为81°和32 mm；D3点分别为100°和31 mm；D4点分别为120°和74 mm。结论：髋臼后柱钢板技术中，在髋臼区的外1／4区、外中1／4区、内中1／4区和在内1／4区，钉后柱角分别为40°～60°、60°～75°、75°～90°、90°～平行于四方区，螺钉长度30mm。
[Abstract]:Objective: most acetabular fractures involving posterior column or posterior wall require open reduction and internal fixation. Complications such as injury to important vessels or nerves in the pelvis, especially when screws are placed in the middle of the posterior column, are more dangerous. At present, there are few quantitative research data on how to obtain strong internal fixation and prevent serious complications such as screw penetrating into the joint when using the technique of acetabular posterior column support plate at home and abroad. In order to solve the problem that the screw in the middle region of the posterior column is easily penetrated into the joint, we make a series of cross-section of the posterior column with hip specimen and determine the optimum angle and length of the screw placed in each region of the posterior column. Methods: 10 adult male embalmed cadavers were prepared. The upper and lower edge of the acetabular and the posterior column of the acetabulum were defined and the series sections of the posterior column of the acetabulum were made. The posterior column width, acetabular width and the percentage of acetabular posterior column width were measured on each cross section. The screw angle and length of each point were measured. The measured data were analyzed statistically by SPSS10.0. Results: 1. The superior edge of the acetabular projection on the surface of the posterior column was 10.2 卤2.7 mm above the top of the great notch of the ischium, and the projection of the lower edge of the acetabulum on the surface of the posterior column was 11.5 卤2.6 mm above the inferior margin of the sciatic spine. The distance between the projection of the lower edge on the surface of the posterior column is 54.7 卤4.8 mm. 2, the back column width of each section, Acetabular width and acetabular posterior column width percentage X, acetabular width Y and acetabular posterior column width percentages were 52.2 卤4.4 mm / 0 mm and 0% for section B, respectively, 40.8 卤2.2% for acetabular width Y and acetabular posterior column width, respectively. The posterior column width (X), acetabular width (Y) and the percentage of acetabular width (Y) on section C were 39.3 卤4.5mm, 22.4 卤1.5 mm and 56.9mm respectively. The percentages of acetabular width Y and acetabular posterior column width were 38.1 卤3.6 mm 17.6 卤1.1 mm and 46.2 mm respectively, and the percentages of posterior column width were 39.3 卤4.5mm and 56.9mm respectively, and the percentages of acetabular width and acetabular posterior column width were 38.1 卤3.6 mm, 17.6 卤1.1 mm and 46.2 mm, respectively. The percentage of acetabular width Y and acetabular posterior column width were 48.2 卤5.1 mm and 0 mm, respectively. The medial end of the acetabular width Y of the cross section of Agna Bu C D and E is connected by arcs to form an absolute dangerous area of the acetabulum, which means that if the screw is perpendicular to the posterior column plane in this area, the screw will enter the joint. (3) the angle and length of screw entry at each point in cross section B: the maximum angle and length of screw at point B 0 are 41 掳and 44 mm / b 1, 66 掳and 42.2 mm B 2, respectively, 91 掳and 59.5 mm B 3 are 107 掳and 64 mm B 4, respectively. The angle and length of screw were 123 掳and 65.47 mm respectively, and the minimum angle and length of screw were 109 掳and 59 mm respectively. On section C, the angle and length of screw at C 0 are 39 掳and 39 mm C 1, 57 掳and 36 mm C 2, 74 掳and 36 mm C 3, 90 掳and 36 mm C 4, 106 掳and 76 mm, respectively. On D section, the angle and length of screw at D 0 were 42 掳and 35.5 mm / d 1, 61 掳and 33 mm D 2, 81 掳and 32 mm D 3, 100 掳and 31 mm D 4, 120 掳and 74 mm, respectively. Conclusion: in acetabular posterior column steel plate technique, the angle of posterior column is 40 掳60 掳60 掳60 掳and 75 掳75 掳75 掳75 掳75 掳75 掳/ 90 掳~ 90 掳~ parallel to the quadrilateral region, and the screw length is 30 mm in the outer 1 / 4 region, the middle 1 / 4 area of the acetabular area, the inner 1 / 4 area and the inner 1 / 4 area.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322;R687.3

【参考文献】