髋臼后柱骨折重建钢板内固定安全性的解剖学研究

发布时间：2018-06-08 16:12

本文选题：髋臼 + 重建钢板　；参考：《吉林大学》2006年硕士论文

【摘要】：目的:主要是通过对髋臼后柱的一些解剖结构进行观察和测量,根据髋臼在后柱上的投影划分螺钉固定的危险区和相对安全区,将这些危险区域提示给临床医生,使其对髋臼后柱的解剖结构有个整体的理解,避免螺钉置入关节和减少术中因为螺钉进入关节而导致的一系列副损伤。实验方法:由同一专业人员在X线下对髋骨标本进行一些指标的测量,包括:髋臼缘到髋臼投影底的垂直距离、髋臼上、下缘位置、髋臼投影底到骨盆内缘垂直距离、过髋臼底切线与髋臼上缘切线的交点45°角到髋臼外缘的距离、过髋臼底切线与髋臼下缘切线的交点45°角到髋臼外缘的距离。实验结果:髋臼上缘在坐骨大切迹顶点下0.56±0.28cm,髋臼下缘在坐骨棘中点的下方0.83±0.34cm,髋臼缘到髋臼投影底的垂直距离1.18±0.17cm,髋臼底切线与髋臼上缘切线的交点45°角到髋臼外缘距离0.99±0.09cm,髋臼底切线与髋臼下缘切线的交点45°角到髋臼外缘的距离 0.86±0.20cm,髋臼投影底到骨盆内缘垂直距离1.91±0.18cm。结论:1.通过对髋臼后柱的解剖结构的观测,能利用坐骨大切迹顶点、坐骨棘中点和坐骨大孔缘将髋臼在后柱的投影分为几部分,包括:髋臼区、危险区(螺钉固定置入的危险区)和相对安全区。2.可以根据5个点描绘出髋臼在后柱上的的半环形投影区即为危险区:髋臼底切线与髋臼上缘切线的交点45°角到髋臼外缘距离0.99±0.09cm,髋臼底切线与髋臼下缘切线的交点45°角到髋臼外缘的距离0.86±0.20cm,髋臼投影底到骨盆内缘垂直距离1.91±0.18cm,髋臼上缘在坐骨大切迹顶点下0.56±0.28cm,髋臼下缘在坐骨棘中点的下方0.83±0.34cm。在这半环形区域以外的我称之为相对安全区。随后对髋臼后柱进行模拟的螺钉固定,在髋臼危险区内以30°～40°的角度进钉、在相对安全区内以小于100°任意角度进钉,内固定物安全准确性为100㳠。3.在对髋臼后柱骨折切开复位内固定的手术中,只要显露出或者触及坐骨大切迹顶点和坐骨棘,不用打开关节腔,根据实验数据就可以描绘出危险区,不需要更多的组织显露,尽可能的减少手术的副损伤。
[Abstract]:Objective: to observe and measure some anatomical structures of the posterior column of the acetabular, divide the dangerous area of screw fixation and the relative safety zone according to the projection of the acetabular on the posterior column, and present these dangerous areas to the clinician. To give it an overall understanding of the anatomical structure of the posterior column of the acetabulum, Avoid screw placement and reduce a series of collateral injuries caused by screws entering the joint during the operation. Including the vertical distance from the acetabular margin to the acetabular projection floor, the position of the acetabular upper and lower edge, the vertical distance from the acetabular projection base to the pelvic inner margin, and the distance between the intersection of the acetabular bottom tangent and the acetabular superior edge tangent to the outer acetabular edge. The distance between the intersection point of the acetabular bottom tangent and the acetabular bottom tangent to the outer edge of the acetabulum. Results: the acetabular upper edge is 0.56 卤0.28 cm below the apex of the great notch of the ischium, the inferior edge of the acetabular is 0.83 卤0.34 cm below the midpoint of the sciatic spine, and the acetabular edge is below the projected base of the acetabular. The vertical distance was 1.18 卤0.17 cm, the distance between the intersection point of acetabular bottom tangent and the superior acetabular edge was 0.99 卤0.09 cm, the distance between 45 掳angle of acetabular bottom tangent and acetabular edge was 0.86 卤0.20 cm, and the vertical distance between acetabular bottom and inner edge of pelvis was 1.91 卤0.18 cm. Conclusion 1. By observing the anatomical structure of the posterior column of the acetabulum, the projection of the acetabulum in the posterior column can be divided into several parts, including the acetabular region, the midpoint of the sciatic spine and the margin of the ischial foramen. Danger area (danger area fixed by screw) and relative safety zone. 2. The semi-circular projection region of acetabular on the posterior column can be described as the dangerous area according to five points: the intersection point between acetabular bottom tangent and acetabular upper edge is 45 掳angle to acetabular outer edge 0.99 卤0.09 cm, and the intersection point between acetabular bottom tangent line and acetabular lower edge tangent line is 0.99 卤0.09 cm. The distance from 45 掳angle to the outer edge of the acetabular is 0.86 卤0.20 cm, the vertical distance from the bottom of the acetabular projection to the inner edge of the pelvis is 1.91 卤0.18 cm, the upper edge of the acetabulum is 0.56 卤0.28 cm below the apex of the great notch of the ischium, and the inferior edge of the acetabulum is 0.83 卤0.34 cm below the middle point of the sciatic spine. Outside this semi-circular area I call it a relative security zone. The posterior post of the acetabulum was then imitated with screw fixation. The internal fixation was made at an angle of 30 掳or 40 掳in the acetabular dangerous area and at any angle less than 100 掳in the relative safety zone. The safety and accuracy of the internal fixator was 100 掳路3. In the operation of open reduction and internal fixation of acetabular posterior column fracture, as long as the apex of the great notch of the ischium and the sciatic spine are exposed or touched, and the articular cavity is not opened, the dangerous area can be delineated according to the experimental data, and no more tissue exposure is needed. Minimize surgical collateral damage.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R322;R687.3

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