骨盆内固定的临床解剖学研究

发布时间：2018-07-25 07:59

【摘要】：目的近年来骨盆创伤的治疗获得了长足的进步,切开复位内固定(Open Reduction and Internal Fixation,ORIF)成为骨盆骨折和髋臼骨折的一种重要治疗手段,在骨盆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严重并发症,因此了解骨盆各个部位的厚度、重要血管和神经距骨壁的距离以及它们在骨盆表面的投影是防止发生血管和神经意外损伤的基础和关键。目前关于整个骨盆厚度的研究未见文献报道,我们在骨盆的内侧面和外侧面分别建立一个坐标系,测量出坐标系中各点的厚度,画出等厚线,在不同的等厚线之间分别用不同的颜色填充,形成几个不同的厚度区域。除髂外血管、闭孔血管神经束、骶髂关节、骶骨侧块和骶2椎弓根外,骨盆内其他的重要结构在骨盆外侧面的体表投影未见文献报道,我们将与骨盆相关的所有重要结构的投影画在骨盆上形成了这些结构的投影图。我们借鉴地理上地形图的概念,将坐标系、等厚线和投影图同时画在骨盆上分别形成了骨盆内侧面和外侧面地形图,形象、直观地表达了骨盆各个部位的厚度、血管和神经的投影位置,便于临床使用和记忆,对于行ORIF治疗骨盆骨折和髋臼骨折时,如何避免损伤重要的血管和神经具有重要的指导意义。骨盆骨折和髋臼骨折的内固定技术主要有骶髂关节拉力螺钉技术、骶髂关节前路钢板技术、髋臼后柱钢板技术、髋臼后柱拉力螺钉技术、髋臼前柱钢板技术和髋臼前柱拉力螺钉技术等技术。对于前四种技术已经有文献描述,这里不再进行重复研究,本课题主要研究前柱钢板技术和前柱拉力螺钉技术。如果在单一的前方入路中使用前柱钢板技术,由于看不到对侧的关节面,可能会发生螺钉穿入关节内的严重并发症。Benedetti对螺钉进钉方向的研究是以前柱前表面的垂线做为参照,可靠性较差,另外数据过多,难以记忆,我们对
[Abstract]:Objective in recent years, great progress has been made in the treatment of pelvic trauma. Open reduction and internal fixation (Open Reduction and Internal FixationORIF) has become an important treatment for pelvic and acetabular fractures. Serious complications such as injury to important vessels or nerves in the pelvis, so the thickness of each part of the pelvis is known, The distance between the important blood vessels and the talus wall and their projection on the pelvic surface are the basis and key to prevent the accidental injury of blood vessels and nerves. At present, there is no literature report on the whole pelvis thickness. We set up a coordinate system on the inner and outer sides of the pelvis, measure the thickness of each point in the coordinate system, draw the equal thickness line. Different thickness lines are filled with different colors to form several different thickness regions. Except for the external iliac vessels, obturator vessels and nerve bundles, sacroiliac joints, sacrum lateral mass and sacral pedicle, there are no reports on the surface projection of other important structures in the pelvis. We project all the important structures associated with the pelvis into the pelvis. Using the concept of geographical topographic map for reference, the coordinate system, equal thickness line and projection map are drawn on the pelvis at the same time to form a topographic map of the inner and outer sides of the pelvis respectively. The images show the thickness of each part of the pelvis intuitively. The projection position of blood vessels and nerves is convenient for clinical use and memory. It has important guiding significance for the treatment of pelvic fractures and acetabular fractures with ORIF, how to avoid the injury of important blood vessels and nerves. The main internal fixation techniques for pelvic and acetabular fractures include sacroiliac joint lag screw technique, sacroiliac joint anterior plate technique, acetabular posterior column screw technique, and internal fixation technique for pelvic and acetabular fractures. Acetabular anterior column steel plate technique and acetabular anterior column lag screw technology and so on. For the first four techniques have been described in the literature, there will not be repeated research here, this subject mainly studied the front column steel plate technology and the front column lag screw technology. If the anterior column plate technique is used in a single anterior approach, because the opposite articular surface is not visible, serious complications of screw penetration into the joint may occur. Benedetti's study of the direction of screw entry is a reference to the vertical line on the front surface of the anterior column. Poor reliability, too much data, hard to remember.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2005
【分类号】：R687;R322

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