成人腰椎骨盆固定髂骨螺钉通道的影像解剖学研究
发布时间：2018-12-11 21:11
【摘要】：目的：对成人腰椎骨盆融合固定髂骨螺钉置钉位置及钉道参数进行CT测量,探讨腰椎骨盆固定髂骨螺钉的理想置钉位置及置钉的可行性与安全性。 方法：随机抽取骨盆正常的40例腰椎病变患者,年龄23-65岁,平均47岁,其中男20例,女20例。对其骨盆行螺旋CT薄层扫描和三维重建,经过骶1、骶2椎板后平面进行切割,以髂骨切面远端作为髂骨螺钉入点A,对该点进行解剖定位分析。以A为起点,指向分别为坐骨大切迹上方、髂前下棘、髂前上棘做切面,对每条路径中钉道的长度及直径进行数据分析。 结果：在骶1、骶2椎板后平面上进行切割,髂骨翼切割平面的远端与第2骶后孔上缘连线基本位于同一水平,以该点作为髂骨螺钉入点A,设计3条置钉路径,分别指向坐骨大切迹上方(AB路径)、髂前下棘(AC路径)、髂前上棘(AD路径),三个不同方向均可植入直径超过7mm的髂骨钉。正态性检验显示钉道各参数均符合正态分布。各参数同性别左右无统计学差异。三条路径中髓腔曲度依次增大,由“工”形向“S“形过度,置入髂骨钉的难度逐渐增大,钉长可在以下范围内选择(男:AD路径70.0±1.2mm,AB路径114.6±1.6mm,AC路径123.4±2.Omm;女：AD路径69.2±0.9mm,AB路径102.3±1.4mm,AC路径116.0±1.7mmP0.05)。统计结果显示女性螺钉钉道尾向偏角与男性比较无统计学差异(P0.05),外向偏角与男性相比无统计学差异(P0.05)。外向偏角可在以下范围内选择(男25.1±3.0°；女25.2±2.2P0.05)。在该区间内,入点偏内,外向偏角增大时,通过髓腔狭窄区、增加置钉长度相对容易。 结论：在骶1、骶2椎板后平面上,位于髂后下棘上方、第2骶后孔的上缘连线水平可实施髂骨钉植入,以增加骶后区固定节段的长度,指向坐骨大切迹上方、髂前下棘及髂前上棘三个不同方向,在(男25.1±3.0°；女25.2±2.2°P0.05)度外向偏角区间内可置入直径超过7mm,长度(男：AD路径70.0±1.2mm,AB路径114.6±1.6mm,AC路径123.4±2.0mm；女：AD路径69.2±0.9mm,AB路径102.3±1.4mm,AC路径116.0±1.7mm P0.05)的髂骨钉。是一种理想的腰椎骨盆固定髂骨钉置入方式。
[Abstract]:Objective: to study the feasibility and safety of iliac screw placement and screw placement for lumbar pelvic fusion fixation in adults by CT measurement of the location and nail path parameters of iliac screw fixation. Methods: a total of 40 patients with normal pelvis were randomly selected, ranging from 23 to 65 years old (mean 47 years), including 20 males and 20 females. Spiral CT thin slice scanning and 3D reconstruction were performed on the pelvis. The posterior plane of the sacral and sacral laminae was cut. The distal iliac section was used as the entry point of the iliac screw, and the anatomical location of the point was analyzed. Taking A as the starting point, the length and diameter of the nail passage in each path were analyzed, respectively, at the top of the great notch of the ischium, the anterior inferior iliac spine and the anterior superior iliac spine. Results: the distal end of the incision plane of the iliac pterygoid was located at the same level as the superior margin of the second posterior sacral foramen in the posterior plane of the sacral 1 and 2 vertebrae. This point was used as the insertion point A of the iliac screw, and three ways of nailing were designed. At the top of the great notch of the ischium (AB pathway), the anterior inferior iliac spine (AC pathway), and the superior iliac spine (AD pathway), the iliac nail with diameter larger than 7mm could be implanted in three different directions. Normal test showed that all the parameters of the nail track were in accordance with the normal distribution. There was no statistical difference between each parameter and sex. The curvature of medullary cavity increased in turn from "workpiece" to "S", and the difficulty of placement of iliac nail gradually increased. The length of nail could be chosen in the following range (male: AD path 70.0 卤1.2 mm AB path 114.6 卤1.6 mm), The AC pathway was 123.4 卤2.Omm; Female: AD pathway 69.2 卤0.9mm / AB 102.3 卤1.4mm AC path 116.0 卤1.7mmP0.05). The statistical results showed that there was no statistical difference between female and male (P0.05), and there was no statistical difference between outward angle and male (P0.05). The outward deviation angle can be selected in the following range (male 25.1 卤3.0 掳; female 25.2 卤2.2P0.05). In this region, it is easy to increase the length of nail through the narrow area of the medullary cavity when the entry point is inward and the outward deviation angle is increased. Conclusion: iliac nail implantation can be carried out at the level of the superior margin of the second posterior sacral foramen on the posterior laminar plane of sacral 1 and sacral 2, which is located above the posterior iliac spine, so as to increase the length of the fixed segment of the posterior sacral region and point to the superior incisor of the ischium. The anterior inferior iliac spine and the anterior superior iliac spine were in three different directions (male 25.1 卤3.0 掳). Female 25.2 卤2.2 掳P 0.05) the diameter and length of the outward deviation angle were more than 7 mm and 123.4 卤2.0 mm respectively (male: AD path 70.0 卤1.2 mm) AB path 114.6 卤1.6 mm AC path 123.4 卤2.0 mm; Female: iliac nail with AD pathway 69.2 卤0.9mm AB pathway 102.3 卤1.4mm AC pathway 116.0 卤1.7mm P0.05). It is an ideal way to place iliac nail in lumbar pelvis fixation.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.8
本文编号：2373228
[Abstract]:Objective: to study the feasibility and safety of iliac screw placement and screw placement for lumbar pelvic fusion fixation in adults by CT measurement of the location and nail path parameters of iliac screw fixation. Methods: a total of 40 patients with normal pelvis were randomly selected, ranging from 23 to 65 years old (mean 47 years), including 20 males and 20 females. Spiral CT thin slice scanning and 3D reconstruction were performed on the pelvis. The posterior plane of the sacral and sacral laminae was cut. The distal iliac section was used as the entry point of the iliac screw, and the anatomical location of the point was analyzed. Taking A as the starting point, the length and diameter of the nail passage in each path were analyzed, respectively, at the top of the great notch of the ischium, the anterior inferior iliac spine and the anterior superior iliac spine. Results: the distal end of the incision plane of the iliac pterygoid was located at the same level as the superior margin of the second posterior sacral foramen in the posterior plane of the sacral 1 and 2 vertebrae. This point was used as the insertion point A of the iliac screw, and three ways of nailing were designed. At the top of the great notch of the ischium (AB pathway), the anterior inferior iliac spine (AC pathway), and the superior iliac spine (AD pathway), the iliac nail with diameter larger than 7mm could be implanted in three different directions. Normal test showed that all the parameters of the nail track were in accordance with the normal distribution. There was no statistical difference between each parameter and sex. The curvature of medullary cavity increased in turn from "workpiece" to "S", and the difficulty of placement of iliac nail gradually increased. The length of nail could be chosen in the following range (male: AD path 70.0 卤1.2 mm AB path 114.6 卤1.6 mm), The AC pathway was 123.4 卤2.Omm; Female: AD pathway 69.2 卤0.9mm / AB 102.3 卤1.4mm AC path 116.0 卤1.7mmP0.05). The statistical results showed that there was no statistical difference between female and male (P0.05), and there was no statistical difference between outward angle and male (P0.05). The outward deviation angle can be selected in the following range (male 25.1 卤3.0 掳; female 25.2 卤2.2P0.05). In this region, it is easy to increase the length of nail through the narrow area of the medullary cavity when the entry point is inward and the outward deviation angle is increased. Conclusion: iliac nail implantation can be carried out at the level of the superior margin of the second posterior sacral foramen on the posterior laminar plane of sacral 1 and sacral 2, which is located above the posterior iliac spine, so as to increase the length of the fixed segment of the posterior sacral region and point to the superior incisor of the ischium. The anterior inferior iliac spine and the anterior superior iliac spine were in three different directions (male 25.1 卤3.0 掳). Female 25.2 卤2.2 掳P 0.05) the diameter and length of the outward deviation angle were more than 7 mm and 123.4 卤2.0 mm respectively (male: AD path 70.0 卤1.2 mm) AB path 114.6 卤1.6 mm AC path 123.4 卤2.0 mm; Female: iliac nail with AD pathway 69.2 卤0.9mm AB pathway 102.3 卤1.4mm AC pathway 116.0 卤1.7mm P0.05). It is an ideal way to place iliac nail in lumbar pelvis fixation.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.8
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