经改良Stoppa入路沿真骨盆缘置钉技巧

发布时间：2018-03-28 13:28

本文选题：改良Stoppa入路　切入点：髋臼　出处：《河北医科大学》2017年硕士论文

【摘要】：背景:骨盆、髋臼解剖结构特殊、复杂,骨折类型多样,使其在手术治疗上存在巨大难度。改良Stoppa入路的出现,简化了既往复杂的骨盆、髋臼骨折手术入路。该入路可以充分的显露四边体及骨盆缘,且相对创伤较小,已被广泛的应用于临床上。但是,由于其不能暴露髋关节面,沿真骨盆内缘置入的钢板螺钉几乎是凭借术者经验盲打置入,且需要反复透视确认,不仅延长了手术时间,而且此过程中螺钉可能侵入髋关节,造成软骨溶解、骨性关节炎甚至股骨头坏死等严重并发症,严重影响患者的预后及生活质量。目的:通过测量经改良Stoppa入路沿真骨盆缘钢板螺钉固定时髋臼周围的置钉危险区域及目前临床常用的直型骨盆重建钢板的孔距,寻找置入钢板时在置钉危险区需空置钢板孔数,为临床中安全快速置入钢板螺钉提供指导。方法:选取不同厂家的直型骨盆重建钢板,测量其孔距及钢板空置不同孔数置钉后钢板的安全长度。选取50例正常成人骨盆正位片,将其髋骨分成左、右侧两组,以耻骨结节为点A,过髋臼下缘作与真骨盆缘垂线交于点B,过髋臼上缘作水平切线交真骨盆缘于点C,以骶髂关节于真骨盆缘上的最高点为点D,计算机辅助测量AB、BC、CD的距离。结合临床操作可行性及避免螺钉穿入髋关节,拟定置钉方向为:髋臼近端以与身体纵轴垂直或远离髋臼方向置钉,远端以垂直骨面或远离髋臼方向置钉。结果:目前临床常用的直型骨盆重建钢板(施乐辉、创生、威高、正天)孔距为12mm,辛迪斯钢板孔距为13mm,空置3孔置钉时钢板的安全长度,施乐辉、创生、威高、正天为43mm,辛迪斯钢板为47mm。耻骨支区ab(右侧:49.32±1.24mm;左侧:49.07±0.95mm)与临近骶髂关节区cd(右侧:45.22±1.37mm;左侧:45.22±1.52mm)为置钉安全区,髋臼区bc(右侧:40.30±0.90mm;左侧40.40±0.78mm)为置钉危险区,左右两侧比较无统计学意义。比较骨盆与不同钢板孔距及置钉后钢板安全长度可知:在真骨盆缘危险区空置3孔后置钉是安全的,且空置相同孔置钉时,辛迪斯钢板更安全;在AB区(耻骨支区)安全进钉区域为4孔钢板长度,辛迪斯钢板建议3孔;在CD区(邻近骶髂关节区)安全进钉区域约为3-4孔钢板长度。结论:经改良Stoppa入路沿真骨盆缘钢板螺钉固定时,根据骨折线的位置不同放置钢板,在髋臼置钉危险区空置3孔置钉是安全的,其在指导术中安全快速置入钢板螺钉时具有重要临床意义。
[Abstract]:Background: pelvic and acetabular anatomical structure is special, complex, and fracture types are various, which makes it difficult to treat surgically. The appearance of modified Stoppa approach simplifies the complicated pelvis in the past. Surgical approach for acetabular fractures. This approach can fully expose the quadrangular body and pelvic margin, and has been widely used in clinical practice due to its relatively minor trauma. However, because of its inability to expose the hip joint, The plate and screw placed along the inner margin of the true pelvis was almost blindly inserted with the experience of the operator, and it needed to be confirmed by repeated fluoroscopy, which not only prolonged the operation time, but also caused the screw to invade the hip joint and cause cartilage dissolution during this process. Serious complications such as osteoarthritis and even necrosis of the femoral head, Objective: to measure the peri-acetabular periacetabular risk area and the pore spacing of the orthograde pelvic reconstruction plate after modified Stoppa approach, which has a severe impact on the prognosis and quality of life of the patients. In order to find out the number of empty plate holes in the dangerous area of nail placement, it is necessary to provide guidance for the safe and rapid placement of plate and screw in clinic. Methods: the straight pelvis reconstruction plate from different manufacturers was selected. The distance between the holes and the safe length of the plate after the plate was placed with different holes were measured. Fifty cases of normal adult pelvis were selected and divided into two groups: left group and right side group. Using pubic nodule as point A, transacetabular edge as perpendicular line with verticality of true pelvis, crossing acetabular edge as horizontal tangent line to cross true pelvis at point C, point D of sacroiliac joint on the edge of true pelvis as point D, computer aided measurement of ABN BCU CD. Distance. Combined with clinical feasibility and prevention of screw penetration into the hip joint, The orientation of pin placement was as follows: the proximal end of the acetabular was placed perpendicular to or away from the acetabular axis, and the distal end was placed in the vertical bone or away from the acetabular direction. Results: the current clinical use of straight pelvic reconstruction plate (Schlehui, Genesis, Vigo, The hole spacing is 12mm, the Hole distance of Sindis steel plate is 13mm, the safety length of steel plate when three holes are empty, Schlehui, creation, Whigao, The right sky was 43mm, the Sindis plate was 47mm.The pubic branch area (right: 49.32 卤1.24mm; left: 49.07 卤0.95mm) and the adjacent sacroiliac joint area (right: 45.22 卤1.37mm; left: 45.22 卤1.52mm) were the safe area of nail placement, and the acetabular area (right side: 40.30 卤0.90mm; left side: 40.40 卤0.78mm) was the risk area. Comparing the distance between pelvis and different plate holes and the safety length of plate after nailing: it is safe to put 3 hole post nail in the danger area of the true pelvis, and it is safer to place the same hole nail in the same hole. In the AB region (pubic branch area), the length of the plate was 4 holes in the safe nail area, and 3 holes in the Sindeus plate. The length of steel plate is about 3-4 holes in the safe region of CD (adjacent to sacroiliac joint). Conclusion: the plate should be placed according to the position of fracture line according to the position of fracture line when fixed with plate and screw along the bony pelvic margin via modified Stoppa approach. It is safe to place 3 holes in the dangerous area of acetabular nail placement, which is of great clinical significance in guiding the safe and rapid placement of steel plate and screw during operation.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

【参考文献】