髋臼后柱顺行拉力螺钉置钉安全区的相关解剖学研究

发布时间：2018-03-09 01:28

  本文选题：髋臼　切入点：后柱　出处：《蚌埠医学院》2015年硕士论文　论文类型：学位论文

【摘要】：背景:对于移位型髋臼骨折应该采用外科治疗。拉力螺钉技术具有良好的骨折块间加压作用,因此可以获得更好的复位,这是被广泛接受及推荐的。同时,仅使用单一的前方入路即可同时固定髋臼前方和后方的骨折,也减小了手术的创伤。然而,在后柱妥善置入顺行拉力螺钉目前仍然面临巨大的挑战。在技术上,由于后柱解剖结构不规则,缺乏具体的定量解剖学信息,拉力螺钉存在切割骨皮质、损伤关节面和髋臼重要血管神经的风险,这也导致了后柱顺行拉力螺钉技术并不常用。目的:本研究旨在运用mimics 10.01软件对骨盆三维模型模拟髋臼后柱顺行拉力螺钉的置入,尝试找出位于髂骨内板上的置钉安全区,进而对其相关解剖学参数进行测量,为临床上开展前入路后柱顺行拉力螺钉技术提供理论依据,并为将来研发的置钉安全区导板提供应用解剖学依据。方法:随机收集扫描范围涵盖骨盆的64排CT原始DICOM数据40例,男女各20例,将获取到的40例DICOM原始数据依次导入MIMICS 10.01软件进行三维建模。人为定义横断位闭孔下缘与坐骨结节相交层面的中心点O作为拉力螺钉的穿出点,并在横断位微分髂骨内板骨皮质及定义拉力螺钉的进钉点。将进钉点和出钉点的位置参数导入Med CAD模块构建虚拟虚拟拉力螺钉。筛选出所有螺纹均位于髋臼后柱骨质内的拉力螺钉,这些即是安全区内的拉力螺钉,其进钉点在髂骨内板骨皮质上所构成的区域即是髋臼后柱拉力螺钉置入的安全区。对每一根拉力螺钉的长度及置入角度进行测量,获得拉力螺钉置入的长度范围和角度范围,并测量进钉点出至髂前上棘、髂前下棘及耳状面前缘的距离,获得置钉安全区的相关解剖学参数。结果:经测量后发现所有符合筛选条件的虚拟髋臼后柱拉力螺钉的进钉点在髂骨内板的骨皮质上围成了一个形似“三角形”的置钉安全区。“三角形”的三个顶点A、B、C至髂前上棘的距离分别为66.7±2.9mm(61.0-72.6mm),79.9±6.0mm(71.3-93.9mm),58.3±4.8mm(50.1-66.9mm);至髂前下棘的距离分别为47.4±2.8mm(42.0-52.6mm),74.7±7.5mm(62.2-87.8mm),63.6±6.5mm(51.2-74.5mm);至耳状面前缘的距离分别为32.8±5.3mm(23.4-42.5mm),28.8±5.6mm(20.1-41.0mm),50.9±5.5mm(41.5-59.5mm)。螺钉OA为安全区内最短螺钉,长度为99.5±4.6mm(87.6-108mm),螺钉OC为最长螺钉,长度为133.6±12.3mm(120.0-148.7mm)。所有置钉安全区内的虚拟螺钉在髋臼后柱内均呈外展前倾状态,外展角度范围为10.4±2.9°(4.4-15.9°),前倾角度范围为12.0±2.6°(7.2-17.4°)。男性和女性在三个顶点的螺钉长度、螺钉OA与冠状面及矢状面的夹角、螺钉OB与矢状面的夹角、螺钉OC与冠状面及矢状面的夹角、点B至髂前上棘、髂前下棘的距离、点C至髂前下棘、耳状面前缘的距离以及螺钉在前后位与侧位的安全角度范围等方面差异均有统计学意义(P0.05),而在螺钉OB与冠状面的夹角、点A至髂前上棘、髂前下棘、耳状面前缘距离、点B至耳状面前缘的距离、点C至髂前上棘的距离等方面差异无统计学意义(P0.05)。结论:通过使用MIMICS 10.01软件模拟髋臼后柱顺行拉力螺钉的置入,我们在髂骨内板上确实发现一个形状近似于“三角形”的置钉安全区,该区域内所有螺钉均位于髋臼后柱骨质内,其出钉点均指向闭孔下缘与坐骨结节相交的层面的中点。然而,由于髋臼后柱解剖结构的复杂,直接将本研究的实验结果应用于临床实际后柱顺行拉力螺钉的置入,对于骨科医生来说仍是一项艰巨的任务,未来研发的置钉安全区导板可能会使手术过程变得简单而安全。
[Abstract]:Background: for displaced acetabular fractures. Surgical treatment should adopt the lag screw technique has good compression effect between fracture reduction, so you can get better, it is widely accepted and recommended. At the same time, using only a single anterior approach to the front and rear of the fixation of acetabular fractures, reduces the surgery trauma. However, in the post column antegrade lag screw properly is still facing a great challenge. Technically, because after the column structures of irregular, lack of quantitative information on specific anatomy, existence of cortical bone screw cutting, the risk of damage to the articular surface of acetabulum and important blood vessels and nerves, which also led to the posterior column antegrade lag screw technique is not commonly used. Objective: the purpose of this study was to implantation using mimics 10.01 software to 3D model of pelvis simulated posterior column antegrade lag screw, trying to find out internal iliac bone Board nailing safety zone, and then carries on the related anatomic parameters for measurement, anterior posterior antegrade lag screw technique provides a theoretical basis for the clinical development, and for the future development of the security zone for the screw plate to provide anatomical basis. Methods: a random collection of scanning range covers the pelvis of 64 row CT original DICOM data in 40 cases, 20 cases of male and female 40 cases, DICOM will gain access to the original data were imported into MIMICS 10.01 software for three-dimensional modeling. Artificially defined transverse obturator and the lower edge of the ischial tuberosity intersection center point O level as the piercing point screw, and the axial differential plate iliac bone cortex and the definition of the lag screw the screw entry point. The point of screw nail and position parameters into Med CAD module to construct virtual virtual screening lag screw. All threads are located in the screw column bone in posterior, which is safe Screw in the region, the region in the iliac screw plate of cortical bone on the safety zone of acetabulum and screw placement. For each screw length and placement angle measurement, length and angle range for screw placement, and measure the entry points out to the anterior superior iliac spine, anterior inferior iliac spine and auricular surface front distance, obtain the related anatomical parameters of screw safety zone. Results: after measuring found all meet the conditions of virtual screening of acetabular posterior column lag screw in the internal iliac bone cortex plate point formed a shape of "triangle" screw "triangle" safe area. The three vertices of A, B, C to the anterior superior iliac spine distance were 66.7 + 2.9mm (61.0-72.6mm), 6.0mm (71.3-93.9mm) 79.9 +, 58.3 + 4.8mm (50.1-66.9mm); to the anterior inferior iliac spine distance were 47.4 + 2.8mm (42.0-52.6mm 74). .7卤7.5mm(62.2-87.8mm),63.6卤6.5mm(51.2-74.5mm);鑷宠，

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