经椎弓根定位骶髂螺钉导向器的应用研究及转化
发布时间：2018-08-30 14:12
【摘要】：目的:本课题通过对S1椎体及骶髂通道放射解剖学研究,在前期研究的基础上进一步验证经椎弓根定位引导骶髂螺钉植入的安全性;应用导向器模拟手术在尸体标本上置钉和应用于临床实际病例,为该发明专利应用于临床及大面积推广提供理论基础和实验依据。方法:1、对正常成人50例(男女各25例)骨盆CT片进行测量,测量指标:(1)S1椎体横径;(2)S1椎体矢径;(3)S1椎体前缘高度;(4)S1椎体后缘高度;(5)S1侧块中轴线与后正中线的夹角;(6)进针点与S1椎体中心距离;(7)进针点与椎体对侧前皮质距离;(8)进针点与骶髂通道最窄处中心点距离;(9)冠状面骶髂通道最窄处高度;(10)水平面骶髂通道最窄处宽度。2、应用骶髂螺钉导向器在尸体标本上(5具成人新鲜尸体标本,10例骶髂关节)模拟手术进行置钉。3、使用导向器在临床手术中辅助置钉两例。结果:1、(1)S1椎体横径:男性57.4±4.7mm,女性52.9±5.4mm;(2)S1椎体矢径:男性35.1±2.4mm,女性33.3±3.7mm;(3)S1椎体前缘高度:男性35.3±2.2mm,女性31.8±2.3mm;(4)S1椎体后缘高度:男性25.4±1.6mm,女性23.4±2.0mm;(5)S1侧块中轴线与后正中线的夹角:男性:73.1±6.3°,女性68.4±7.5°;(6)进针点与S1椎体中心距离:男性75.5±6.2mm,女性70.2±6.9mm;(7)进针点与椎体对侧前皮质距离:男性:93.1±4.6mm,女性90.1±4.3mm;(8)进针点与骶髂通道最窄处中心点距离:男性52.3±1.4mm,女性51.8±1.3mm;(9)冠状面骶髂通道最窄处高度:男性21.7±3.0mm,女性20.6±3.6mm;(10)水平面骶髂通道最窄处宽度:男性24.3±2.7mm,女性23.3±3.6mm。性别比较(1)(2)(3)(4)(5)(6)(7)指标有统计学意义(P0.05),(8)(9)(10)指标无统计学意义(P0.05);左右侧比较(5)(6)(7)(8)(9)(10)无统计学意义(P0.05)。2、应用导向器在5具成人新鲜尸体标本上对10例骶髂关节成功植入10枚螺钉,所有螺钉位置良好,无置钉失败或螺钉位置不当。3、经术中、术后透视证实两例手术螺钉均准确植入骶髂安全通道,位置良好,无明显并发症发生。结论:经椎弓根定位骶髂螺钉导向器引导螺钉植入准确安全、简单方便、透视少、能明显缩短手术时间,经过短期培训即可掌握骶髂螺钉内固定技术,大大缩短了骨科医师的学习曲线,值得临床推广应用。该导向器初步应用于临床,尚未发现明显缺陷,目前应用经验不足,有待于在后期使用中进一步积累、改进。
[Abstract]:Objective: to further verify the safety of sacroiliac screw placement guided by pedicle of vertebra S1 and sacroiliac channel on the basis of previous studies. The guide device is used to simulate the operation on the cadaveric specimen and to be used in clinical practice, which provides the theoretical basis and experimental basis for the patent application in clinical and extensive application. Methods CT films of pelvis were measured in 50 normal adults (25 male and 25 male). Measurements: (1) transverse diameter of S1 vertebral body; (2) sagittal diameter of S1 vertebral body; (3) height of anterior edge of S1 vertebral body; (4) height of posterior edge of S1 vertebral body; (5) angle between axis of lateral mass of S1 and posterior median line; (6) distance between needle point and center of S1 vertebrae; (7) distance between entry point and contralateral anterior cortex of vertebral body; (8) distance between entry point and contralateral anterior cortex of vertebral body; The distance between the point of needle and the center of the narrowest point of sacroiliac passage; (9) the height of the narrowest point of sacroiliac passage on coronal plane; (10) the narrowest width of sacroiliac passage in horizontal plane. The iliac joint was operated with analogue operation. 3. 2 cases were treated with guide device. Results: 1, (1) the transverse diameter of S1 vertebral body: male 57.4 卤4.7 mm, female 52.9 卤5.4 mm; (2) S1 vertebral body sagittal diameter: male 35.1 卤2.4 mm, female 33.3 卤3.7 mm; (3) S1 anterior height: male 35.3 卤2.2 mm, female 31.8 卤2.3 mm; (4) S1 posterior edge height: male 25.4 卤1.6 mm, female 23.4 卤2.0 mm; (5) S1 lateral mass axis angle to posterior median line: male 73.1 卤6.3 掳, female: male 73.1 卤6.3 掳 68.4 卤7.5 掳; (6) distance between insertion point and S1 vertebral center: male 75.5 卤6.2 mm, female 70.2 卤6.9 mm; (7) distance between needle point and contralateral anterior cortex of vertebral body: male: 93.1 卤4.6 mm, female: 90.1 卤4.3 mm; (8) distance between needle point and the narrowest point of sacroiliac passage: male 52.3 卤1.4mm, female 51.8 卤1.3mm; (9) coronal sacroiliac channel Narrow height: male 21.7 卤3.0mm, female 20.6 卤3.6mm; (10) horizontal plane sacroiliac channel narrowest width: male 24.3 卤2.7mm, female 23.3 卤3.6mm. Gender comparison (1) (2) (3) (4) (5) (6) (7) had statistical significance (P0.05), (8) (9) (10) had no statistical significance (P0.05), left and right (5) (6) (7) (8) (9) (10) had no statistical significance (P0.05). All the screws were in good position, none of them failed to place the screws or the screw was not in the proper position. After operation and postoperative fluoroscopy, the sacroiliac safe passage was accurately implanted in two cases. There were no obvious complications in the two cases. Conclusion: transpedicular placement of sacroiliac screw guide screws is accurate, safe, simple and convenient, less fluoroscopy, and can significantly shorten the operation time. After short-term training, sacroiliac screw internal fixation technology can be mastered. The learning curve of orthopedic physicians is greatly shortened, and it is worth popularizing and applying in clinic. The application of the guide device in clinical practice has not found obvious defects, but the current application experience is insufficient, which needs to be further accumulated and improved in the later use.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
本文编号：2213312
[Abstract]:Objective: to further verify the safety of sacroiliac screw placement guided by pedicle of vertebra S1 and sacroiliac channel on the basis of previous studies. The guide device is used to simulate the operation on the cadaveric specimen and to be used in clinical practice, which provides the theoretical basis and experimental basis for the patent application in clinical and extensive application. Methods CT films of pelvis were measured in 50 normal adults (25 male and 25 male). Measurements: (1) transverse diameter of S1 vertebral body; (2) sagittal diameter of S1 vertebral body; (3) height of anterior edge of S1 vertebral body; (4) height of posterior edge of S1 vertebral body; (5) angle between axis of lateral mass of S1 and posterior median line; (6) distance between needle point and center of S1 vertebrae; (7) distance between entry point and contralateral anterior cortex of vertebral body; (8) distance between entry point and contralateral anterior cortex of vertebral body; The distance between the point of needle and the center of the narrowest point of sacroiliac passage; (9) the height of the narrowest point of sacroiliac passage on coronal plane; (10) the narrowest width of sacroiliac passage in horizontal plane. The iliac joint was operated with analogue operation. 3. 2 cases were treated with guide device. Results: 1, (1) the transverse diameter of S1 vertebral body: male 57.4 卤4.7 mm, female 52.9 卤5.4 mm; (2) S1 vertebral body sagittal diameter: male 35.1 卤2.4 mm, female 33.3 卤3.7 mm; (3) S1 anterior height: male 35.3 卤2.2 mm, female 31.8 卤2.3 mm; (4) S1 posterior edge height: male 25.4 卤1.6 mm, female 23.4 卤2.0 mm; (5) S1 lateral mass axis angle to posterior median line: male 73.1 卤6.3 掳, female: male 73.1 卤6.3 掳 68.4 卤7.5 掳; (6) distance between insertion point and S1 vertebral center: male 75.5 卤6.2 mm, female 70.2 卤6.9 mm; (7) distance between needle point and contralateral anterior cortex of vertebral body: male: 93.1 卤4.6 mm, female: 90.1 卤4.3 mm; (8) distance between needle point and the narrowest point of sacroiliac passage: male 52.3 卤1.4mm, female 51.8 卤1.3mm; (9) coronal sacroiliac channel Narrow height: male 21.7 卤3.0mm, female 20.6 卤3.6mm; (10) horizontal plane sacroiliac channel narrowest width: male 24.3 卤2.7mm, female 23.3 卤3.6mm. Gender comparison (1) (2) (3) (4) (5) (6) (7) had statistical significance (P0.05), (8) (9) (10) had no statistical significance (P0.05), left and right (5) (6) (7) (8) (9) (10) had no statistical significance (P0.05). All the screws were in good position, none of them failed to place the screws or the screw was not in the proper position. After operation and postoperative fluoroscopy, the sacroiliac safe passage was accurately implanted in two cases. There were no obvious complications in the two cases. Conclusion: transpedicular placement of sacroiliac screw guide screws is accurate, safe, simple and convenient, less fluoroscopy, and can significantly shorten the operation time. After short-term training, sacroiliac screw internal fixation technology can be mastered. The learning curve of orthopedic physicians is greatly shortened, and it is worth popularizing and applying in clinic. The application of the guide device in clinical practice has not found obvious defects, but the current application experience is insufficient, which needs to be further accumulated and improved in the later use.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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