髋臼四边区上界置钉安全区域的影像解剖学研究

史黎晗,高仕长,周华,余璐鑫,张安维

中国临床解剖学杂志 ›› 2016, Vol. 34 ›› Issue (2) : 138-144.

中国临床解剖学杂志 ›› 2016, Vol. 34 ›› Issue (2) : 138-144. DOI: 10.13418/j.issn.1001-165x.2016.02.005
断层影像解剖

髋臼四边区上界置钉安全区域的影像解剖学研究

  • 史黎晗, 高仕长, 周华, 余璐鑫, 张安维
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Image anatomic study of safe zone for screw insertion at upper boundary of acetabular quadrilateral plate

  • SHI Li-han, GAO Shi-chang, ZHOU Hua, YU Lu-xin, ZHANG An-wei
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摘要

目的 通过对髋臼四边区三维重建模型进行解剖参数测量和从上方置入虚拟螺钉,明确四边区骨折螺钉固定的安全区域。  方法    用Mimics软件对50例(100侧)骨盆CT数据进行三维重建,切割出髋臼四边区三维模型,测量四边区解剖参数,确定置钉危险区域,并在四边区上界模拟置钉,计算其安全角度。    结果 P1螺钉最大后倾角男性为(7.63±5.47)°,女性为 (6.18±5.16)°,P5螺钉最大前倾角男性为(7.50±6.09)°,女性为(7.30±6.54)°,两者男女间差异均无统计学意义。P2、P4螺钉内外倾安全范围男性分别为(7.60±2.93)°、(16.88±5.61)°,女性分别为(7.96±2.98)°、(15.82±5.94)°,男女间差异均无统计学意义。男、女性分别有13侧及28侧P3螺钉安全范围很小,只能以固定角度置入,固定角度均值男性为(-0.22±2.87)°,女性为(-5.62±4.48)°,其差异有统计学意义。剩余59侧(男37侧,女22侧)P3螺钉安全范围男性为(5.39±2.60)°,女性为(4.06±2.58)°,其差异无统计学意义。   结论 P3为四边区上界最危险进钉点,距离起点约27 mm,若术前Mimics软件测量显示四边区骨质最薄处厚度男性小于4.47 mm,女性小于3.56 mm,则拧入长度小于14 mm或12 mm的短钉或空置。

Abstract

Objective To identify the safe zone for screws to fix fractures of acetabular quadrilateral plateby anatomical parameter measurement and virtual screws insertion at upper boundary of three-dimensional reconstruction quadrilateral plate model. Methods 50 pelves(100 sides) including 25 females and 25 males were reconstructed in three-dimensional form and cut by Mimics software. The quadrilateral plate anatomical parameters were measured and the dangerous zone of screw insertion was determined;then the virtual screws were placed in the quadrilateral plate through different entry points at upper boundary,and the safe ranges of the screws were calculated. Results The maximum backward incline angles of screw P1 were (7.63±5.47)° in male and(6.18±5.16)° in female, and the maximum forward incline angles of screw P5 were(7.50±6.09)° in male and(7.30±6.54)° in female, both of them had no significant difference between genders. The inward and outward incline safe ranges of screw P2 and P4 were(7.60±2.93)° and (16.88±5.61)° in male and(7.96±2.98)° and(15.82±5.94)° in female, respectively. There were 13 sides in male and 28 sides in female whose safe range of screw P3 was extremely narrow that they have to be inserted at given angles, which were(-0.22±2.87)°in male and (-5.62±4.48)°in female, and the difference between male and female had statistical significance. The safe ranges of screw P3 of the remaining 59 sides were (5.39±2.60)° in male and(4.06±2.58)°  in female, with no significant difference between genders. Conclusions Point P3 is the most dangerous zone of the upper boundary of the quadrilateral plate, which is about 27 mm from point P3 to point P1. If the thickness of the thinnest portion of quadrilateral plate is less than 4.47 mm in male or 3.56 mm in female by Mimics measurement, then no screw or short screw with length shorter than 14 mm in male or 12 mm in female is recommended to be inserted at point P3.

关键词

四边区 / 安全区域 / 应用解剖

Key words

Quadrilateral plate / Safe zone / Applied anatomy 

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导出引用
史黎晗,高仕长,周华,余璐鑫,张安维. 髋臼四边区上界置钉安全区域的影像解剖学研究[J]. 中国临床解剖学杂志. 2016, 34(2): 138-144 https://doi.org/10.13418/j.issn.1001-165x.2016.02.005
Image anatomic study of safe zone for screw insertion at upper boundary of acetabular quadrilateral plate[J]. Chinese Journal of Clinical Anatomy. 2016, 34(2): 138-144 https://doi.org/10.13418/j.issn.1001-165x.2016.02.005

参考文献

[1] Chang JK, Gill SS, Zura RD , et al. Comparative strength of three methods of fixation of transverse acetabular fractures [J]. Clin Orthop Relat Res, 2001, (392): 433-441
[2]  Farid YR. Cerclage Wire–plate composite for fixation of quadrilateral plate fractures of the acetabulum: a checkrein and pulley technique[J]. Orthop Trauma, 2010, 24(5):323-328.
[3]  彭烨, 张立海, 唐佩福. 髋臼方形区骨折的治疗及研究进展[J]. 中国骨伤, 2015, 28(5): 672-675.
[4]  黄进成, 刘曦明, 蔡贤华,等. 累及方形区的髋臼骨折有限元建模及固定方法比较[J]. 中华创伤杂志, 2014, 30(5): 449-454.
[5]  杨宁浙,毕大卫,马海涛,等.涉及髋臼四边体骨折内固定技术研究现状[J].浙江临床医学, 2012,14(4): 499-501.
[6]  Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction: preliminary report. [J].J Bone Joint Surg Am, 1964, 46:1615–1638.
[7]  (美)Tile M, Helfet D, Kellam J, 等著. 骨盆与髋臼骨折[M].第3版. 邱贵兴译. 北京:人民卫生出版社,2008:.22.
[8]  高波华, 王钢, 卢超,等. 基于CT三维重建的髋臼方形区骨折线的初步研究[J]. 中华创伤骨科杂志, 2014, 16(4): 305-310.
[9]  苏万汉. 应用3D技术研究Stoppa入路下四方区螺钉植入的安全区[D]. 广州:南方医科大学, 2014. 14-16.
[10]Shiramizu K, Naito M, Yatsunami M. Quantitative anatomic characterization of the pelvic brim to facilitate internal fixation through an anterior approach[J]. J Orthop Surg, 2003, 11(2): 137-140.
[11]毕春, 纪晓希, 汪方,等. 弓状线上方髋臼区域准确置钉的三维重建及数字化测量研究[J]. 中华创伤骨科杂志, 2014, 16(5): 371-376.
[12] Xian-quan W, Jin-fang C, Xue-cheng C, et al. A quantitative anatomic study of plate-screw fixation of the acetabular anterior column through an anterior approach[J]. Arch Orthop Trauma Surg, 2010, 130(2): 257-262.
[13]McGibbon CA ,Dupuy DE, Palmer WE, et al. Cartilage and subchondral bone thickness distribution with MR imaging[J]. Acad Radiol, 1998,5(1): 20-25.
[14]蔡贤华, 刘曦明, 汪国栋, 等. 前路钛板结合方形区螺钉内固定治疗涉及方形区的髋臼骨折[J]. 中华创伤骨科杂志, 2013,15(2): 102-106.

基金

重庆市科委(cstc2012gg-yyjs0205);重庆市渝中区科委 (20110311)


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