内髂坐钢板治疗髋臼后柱骨折安全置钉的数字模型研究

发布时间：2018-08-30 08:28

【摘要】：研究背景随着我国经济社会的快速发展,由工业、建筑及交通事故等高能量损伤造成的髋臼骨折患者日益增多。经典的髋臼骨折手术学观点认为,手术入路的选择由骨折的类型决定。髋臼前柱骨折需选择前方髂腹股沟入路进行固定,髋臼后柱骨折需选择后方K-L入路进行固定。Hirvensalo和Cole最早使用改良Stoppa入路对髋臼骨折进行手术治疗,结果显示疗效令人满意。此后,越来越多的骨科医师开始运用此技术。改良Stoppa入路较传统髋臼前方入路或后方入路而言优势明显,具有创伤小、操作安全、并发症少等优点,它能暴露从耻骨联合到骶髂关节前方之间的整个真骨盆,将钢板直接支撑于方形区表面,获得更好的稳定性。本课题组在对髋臼后柱及方形区解剖关系的进一步理解后,认为坐骨大切迹前方骨质为髋臼后柱在骨盆内侧面的投影,因此在投影区内也能实现对髋臼后柱的固定,且经临床验证疗效确切。而在骨盆内侧面固定髋臼后柱(髂骨-坐骨柱)的钢板则被命名为内髂坐钢板。这种技术颠覆了传统的后柱骨折治疗理念,为髋臼骨折的治疗提供了一种新思路。在临床上,内髂坐钢板螺钉的安全置入难度较大,骨科医师往往根据手术经验以及对髋臼和方形区解剖关系的理解进行置钉,一旦螺钉误入关节,可造成关节软骨损伤、创伤性关节炎等严重的并发症。目前改良Stoppa入路下内髂坐钢板的安全置钉研究较少,本研究将采用计算机三维重建技术,建立骨盆数字模型,测量骸臼后柱内髂坐钢板放置的安全区及螺钉置入的安全角度,为内髂坐钢板在骨盆内表面的安全置钉提供解剖学依据。研究目的1.内髂坐钢板治疗髋臼后柱骨折的可行性分析。综合利用Mimics和Geomagic软件,对髋臼后柱内髂坐钢板放置的安全区进行定义,并测量其绝对大小和相对大小。2.内髂坐钢板治疗髋臼后柱骨折的安全性分析。在安全区内,分别于不同位置测量内髂坐钢板螺钉置入的通用安全角度,为临床医师的安全置钉提供参考。材料和方法收集52例成年国人(男27例,女25例)正常骨盆的CT扫描数据,重建出骨盆3D模型。对髋臼进行抽壳和增厚5mm处理,测量内髂坐钢板安全区的宽度d;测量闭孔管顶点到大切迹的垂直距离w并计算d/w的比值r。过髋臼中心、垂直于方形区和大切迹对装配后的髋骨进行截骨得到截面。根据安全区的大小,男性在大切迹前方1.0、1.5、2.0和2.5 cm处取4点,于截面上分别测量方形区与增厚的髋臼外缘切线所成的角度∠a、∠b、∠c和∠d;女性在大切迹前方1.0、1.5和2.0 cm处取3点,测量∠a、∠b和∠c。比较男、女性之间上述参数的差异。结果男性和女性放置内髂坐钢板安全区的宽度(d)平均分别为(28.56±2.44)、(24.36±2.47)mm,r分别约为3/5(0.61)、1/2(0.54)。男性置钉的安全角度∠a、∠b、∠c 和 ∠d 平均分别为 88.04° ±3.18°、77.81° ±3.85°、68.01° ±4.11° 和 56.81° ±4.81°;女性∠a、∠b 和∠c 平均分别为 91.29° ±4.52°、76.23° ±3.82°和62.79° ±3.51°。男、女性之间d、r、∠a和∠c比较差异均有统计学意义(P0.05)。结论髋臼后柱内侧面有足够的空间放置内髂坐钢板,在安全区内以一定的置钉角度完全可以避免螺钉误入髋关节。
[Abstract]:Background With the rapid development of economy and society in China, more and more acetabular fractures are caused by high-energy injuries such as industrial, architectural and traffic accidents. Hirvensalo and Cole first used modified Stoppa approach to treat acetabular fractures with satisfactory results. Since then, more and more orthopaedics have begun to use this technique. It can expose the whole true pelvis from the pubic symphysis to the anterior sacroiliac joint, and directly support the plate on the surface of the square area to obtain better stability. For the projection of the posterior column of the acetabulum on the medial side of the pelvis, the fixation of the posterior column of the acetabulum can also be achieved within the projection area, and has been clinically proven to be effective. In clinic, it is difficult to insert the internal iliac plate screw safely. Orthopedics doctors usually insert the screw according to the operation experience and the understanding of the anatomical relationship between acetabulum and square area. Once the screw is misplaced into the joint, it can cause serious complications such as articular cartilage injury, traumatic arthritis and so on. There are few studies on the safety of internal iliac plate screw placement under toppa approach. In this study, a digital pelvic model will be established by using computer three-dimensional reconstruction technology. The safe area and the safe angle of screw placement in the posterior column of the acetabulum will be measured to provide anatomical basis for the safety of internal iliac plate screw placement on the internal surface of the pelvis. OBJECTIVE 1. Feasibility analysis of internal iliac plate in the treatment of acetabular posterior column fractures.The safety zone of internal iliac plate placement in acetabular posterior column was defined by using Mimics and Geomagic software,and its absolute size and relative size were measured.2.Safety analysis of internal iliac plate in the treatment of acetabular posterior column fractures. Materials and Methods CT scan data of 52 adult Chinese (27 males and 25 females) normal pelvis were collected to reconstruct the 3D model of pelvis. The vertical distance W from the apex to the large notch and the ratio r of d/w were calculated. The cross section was obtained by osteotomy through the acetabular center, perpendicular to the square area and the large notch. The angles_a, b, C and_d were measured at 1.0, 1.5 and 2.0 cm in front of the large incision, and the differences of the above parameters between men and women were compared. The average safety angles of nails_a, b, C and_d were 88.04 [3.18], 77.81 [3.85], 68.01 [4.11], and 56.81 [4.81]], respectively. The mean safety angles of nails a, B and C in women were 91.29 [4.52], 76.23 [3.82] and 62.79 [3.51], respectively (P 0.05). The posterior column of the acetabulum has enough space for the internal iliac plate to be placed inside the posterior column of the acetabulum.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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