骨盆应用解剖学数字化测量与髋臼区域置钉准确性研究

发布时间：2018-01-20 15:30

本文关键词： 骨盆髋臼骨折内固定解剖测量并发症　出处：《上海交通大学》2015年博士论文　论文类型：学位论文

【摘要】：目的:对弓状线上缘、弓状线下缘等常用的骨盆髋臼骨折固定部位的重要解剖学参数进行数字化测量;探讨弓状线上、下缘髋臼区域安全置钉的解剖学路线,保证髋臼区域置钉的准确性及安全性;根据测量结果设计应用于相应部位的骨盆解剖型内固定系统。材料与方法:从2009年12月至2010年11月,在上海市第一人民医院取得正常成人175例完整骨盆CT断层扫描数据,在Mimics软件中对骨盆三维重建,建立清晰完整的三维数字化骨盆模型。分别测量弓状线上、下缘部位的骨质厚度、固定路线弧长、曲率半径等解剖学数据,测量髋臼区域的最薄骨质厚度,测量骨盆入口平面解剖学参数,并与骨盆形态分型相匹配,明确术中重建钢板的主要折弯点。对正常成人100例CT数据,建模后在弓状线上缘区域距离骨盆缘5mm皮质处,沿弓状线上缘固定路线取点绘制骨表面空间曲线。将髋臼区域在空间曲线上投影5等分,从前至后依次为截面1~5。测量不同截面的安全进钉角度、有效进钉角度(α、β)及对应的进钉深度d1、d2;比较男女性间差异。根据测量结果,对上述部位设计解剖学内固定系统,验证内固定与骨盆匹配度。结果:对弓状线上缘固定路线,在耻骨结节、髂耻隆起及靠近骶髂关节处弯曲度最大,曲率半径分别为29.18±15.53mm、43.04±14.42mm、43.61±19.10mm;对弓状线下缘固定路线,在耻骨结节、坐骨大切迹及靠近骶髂关节处弯曲度最大,曲率半径分别为52.33±24.10mm、44.01±12.05mm、43.26±21.01mm。在弓状线上缘,髋臼截面2中的男性和女性角度α分别为22.03±9.49°,28.68±11.81°;髋臼截面3中男性和女性角度α分别为25.66±12.21°,40.40±12.90°;角度β分别为44.02±11.57°,51.97±11.26°。髋臼截面2的α,截面3的α、β在男女性间具有统计学差异(P0.05)。弓状线上缘和弓状线下缘解剖型内固定匹配误差基本都在3 mm以内。结论:骨盆弓状线区域解剖学参数可指导术中钢板折弯,髋臼区域进钉角度可以帮助安全置钉;骨盆解剖型内固定系统能与骨盆较好匹配。
[Abstract]:Objective: to measure the important anatomical parameters of pelvic acetabular fracture in common use, such as the superior edge of the arch line and the lower margin of the arch line, and to measure the important anatomical parameters of the fixed position of the pelvic acetabular fracture. To explore the anatomical route of safe nail placement in the acetabular region of the arch line and the lower edge of the acetabular area to ensure the accuracy and safety of the nail placement in the acetabular region. The internal fixation system of pelvic anatomy was designed according to the measurement results. Materials and methods: from December 2009 to November 2010. A total of 175 normal adults were collected from Shanghai first people's Hospital for CT scanning of the pelvis. The pelvic 3D reconstruction was performed with Mimics software. A clear and complete three-dimensional digital pelvic model was established. The thickness of bone in the arcuate line and the lower margin, the arc length of the fixed line, and the radius of curvature were measured respectively, and the thinnest bone thickness of the acetabular region was measured. The anatomical parameters of the pelvic entrance plane were measured and matched with the pelvic morphological classification. The main bending points of the reconstruction plate were determined. The CT data of 100 normal adults were obtained. After modeling, the space curve of bone surface was drawn along the fixed route of the upper edge of the arch line at the point of 5 mm from the upper edge of the arch line to the pelvic margin. The acetabular area was projected on the space curve 5 equal. The safety angle of different cross sections, effective angle (伪, 尾) and the corresponding depth d _ 1 ~ (-1) d _ 2 were measured from front to back. According to the measurement results, the anatomical internal fixation system was designed to verify the matching degree between the internal fixation and the pelvis. Results: the superior margin of arcuate line was fixed in the pubic tubercle. The curvature of the iliopariac eminence and the sacroiliac joint was the largest, with a curvature radius of 29.18 卤15.53 mm, 43.04 卤14.42 mm and 43.61 卤19.10 mm, respectively. For the lower margin of arcuate line, the curvature of pubic tubercle, great incision of ischium and close to sacroiliac joint was the largest, and the curvature radius was 52.33 卤24.10 mm, respectively. The angle 伪 of male and female in acetabular section 2 was 22.03 卤9.49 掳at the upper edge of arcuate line. 28.68 卤11.81 掳; In acetabular section 3, the angle 伪 of male and female were 25.66 卤12.21 掳and 40.40 卤12.90 掳, respectively. The angle 尾 was 44.02 卤11.57 掳/ 51.97 卤11.26 掳respectively. The 伪 of acetabular cross-section 2 and cross-section 3 were 伪. There was a statistical difference of 尾 between men and women (P0.05). The matching errors of the upper edge of the arcuate line and the inferior edge of the arcuate line were within 3 mm. Conclusion: the anatomical parameters of the pelvic arcuate line can guide the plate bending during the operation. The angle of the acetabular area can help to secure the nail placement. The pelvic anatomical internal fixation system can better match the pelvis.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R322.7;R683.3

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