骶骨侧块螺钉置钉安全通道的解剖与应用研究

发布时间：2018-03-24 16:29

本文选题：骶骨骨折　切入点：侧块螺钉　出处：《山东大学》2015年硕士论文

【摘要】：目的：研究骶骨侧块螺钉置钉安全通道的解剖学特征,寻找骶骨各节段侧块最佳置钉位置,为临床应用骶骨侧块螺钉内固定技术提供理论依据与参考。材料及方法：1、随机选择60例正常成人骶尾椎CT资料,年龄25-78岁,其中男性33例,女性27例。利用mimics 15.0对骶骨CT数据进行三维重建骶骨模型,在骶骨模型中分离侧块及可置钉区域,并于各节段侧块层面绘制出骶骨侧块螺钉置钉安全通道,测量S1-S4侧块螺钉置钉安全通道的相关解剖学数据。对测量数据进行统计学处理并分析性别间差异统计学意义2、随机选取6例成人尸体标本,在按照上述测量结果自制模具辅助下进行置钉验证试验,置钉标本观察置钉位置情况。结果：1、S1侧块螺钉最佳进钉点位于骶骨上缘与第1骶孔连线尾侧1/3处、关节突外侧处,可使用直径不超过13mm的螺钉,长度控制在33mm以内,矢状位上进钉方向与S1上终板平行,水平位上内倾24.05±3.25。；S2侧块螺钉最佳进钉点位于第1骶孔与第2骶孔连线中点,可使用直径不超过10mm的螺钉,长度控制在36mm以内,矢状位上进钉方向与S2上终板夹角11.23±2.53。,水平位上内倾35.79±1.20。(男)、37.92±3.75。(女)；S3侧块螺钉最佳进钉点位于第2、3骶孔外侧缘连线中点,可使用直径不超过6.5mm的螺钉,长度控制在30mm以内,矢状位上进钉方向与S3上终板夹角5.23±1.05。,水平位上内倾46.26±2.56。；S4侧块螺钉最佳进钉点位于第3、4骶孔外侧缘连线中点下lmm处,可使用直径不超过6mm的螺钉,长度控制在14mm内矢状位上进钉方向与S4上终板夹角12.15±3.42°,水平位上内倾48.52±4.36°。性别问t检验显示仅骶2侧块置钉方向与正中矢状面夹角男女性别间存在统计学差异。2、按照测量结果尸体标本置钉验证,一枚螺钉于骶2节段进入骶髂关节,一枚螺钉于骶3节段穿出对侧皮质,其余螺钉均在骶骨侧块骨质内,未穿透至骶孔、骶管及耳状面,置钉验证实验准确率95.83%。结论：经骶骨侧块行螺钉固定具有可行性,但需选择合适的进钉方向及深度以保证置钉的安全性、牢固性最大化,骶骨侧块螺钉技术可为骶骨骨折提供科学、可靠的直接固定方式,为临床骶骨骨折固定提供另一种选择。
[Abstract]:Objective: to study the anatomical characteristics of the safe passage of sacral lateral mass screw insertion, and to find out the best location of the lateral mass of sacrum. To provide theoretical basis and reference for clinical application of sacral lateral mass screw fixation, materials and methods 60 normal adults, aged 25 to 78 years, including 33 males, were randomly selected for CT data of sacral and caudal vertebrae. Mimics 15.0 was used to reconstruct the sacral model. The lateral mass and the nailable region were separated from the sacral model, and the safe passage of the sacral lateral mass screw screw placement was drawn at each level of the lateral mass of the sacrum. The anatomical data of the safe passage of S1-S4 lateral mass screw insertion were measured. The data were statistically processed and analyzed statistically. 2. Six adult cadavers were randomly selected. According to the above measurement results, the nail placement verification test was carried out with the aid of self-made mould, and the position of the screw was observed. Results the optimal point of insertion of the screw was located at the superior edge of the sacrum and 1 / 3 of the caudal side of the first sacral foramen, and the lateral side of the articular process, and the lateral side of the articular process. Screws with a diameter not exceeding 13mm can be used, the length of which is controlled within 33mm, the direction of the sagittal upward screw is parallel to that of the S1 upper end plate, and the horizontal upward inclination of the screw is 24.05 卤3.25. The best point of the lateral mass screw is located at the midpoint of the line between the first sacral hole and the second sacral orifice. Screws with a diameter not exceeding 10mm may be used, the length of which is controlled within 36mm, the angle between the direction of the sagittal upward screw and the S 2 upper end plate is 11.23 卤2.53.3.The horizontal position is 35.79 卤1.20 (male = 37.92 卤3.75). Screws not exceeding 6.5mm in diameter can be used, the length is controlled within 30mm, the angle between the direction of sagittal upward screw and S3 upper end plate is 5.23 卤1.05.The lateral mass screw of S4 lateral mass screw with upward inclination 46.26 卤2.56.N in horizontal position is located at the lmm below the midpoint of the lateral edge of 3nd-4 sacral foramen, and the angle between the direction of sagittal screw and the upper end plate of S3 is 5.23 卤1.05. Screws not exceeding 6mm in diameter may be used, The length was controlled at the angle of 12.15 卤3.42 掳and 48.52 卤4.36 掳between the direction of the upper sagittal screw and the upper end plate of S4 in 14mm. The gender test showed that there was a statistical difference between male and female in the direction of the screw insertion and the angle between the median sagittal plane and the direction of the screw in the sacral 2 sides. The results of the measurement were confirmed by nail placement in cadaveric specimens. One screw entered the sacroiliac joint at the second sacral segment, the other screw perforated the contralateral cortex at the third sacral segment. The other screws were in the lateral mass of the sacrum and did not penetrate the sacral foramen, sacral canal and auricular surface. Conclusion: it is feasible to use screw fixation through sacral lateral mass, but it is necessary to select the proper direction and depth of screw insertion to ensure the safety and the maximum fastness of the nail placement. The technique of sacral lateral mass screw can provide scientific and reliable direct fixation for sacral fractures and provide another choice for clinical fixation of sacral fractures.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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