正常人骨盆骶棘韧带的解剖学及MRI成像研究
Anatomy and MRI study of the sacrospinous ligaments of normal pelvis
目的 明确骶棘韧带MRI最佳扫描平面角度并探讨其临床意义。 方法 （1）正常成人新鲜尸体骨盆标本8具，观察骶棘韧带起止点及其形态特点；（2）利用36例正常人骨盆CT数据，测量骶棘韧带在矢状面上的投影与冠状面的角度；（3）对10名志愿者进行3D MRI扫描，记录骶棘韧带角度并与CT数据对比；比较斜冠状面与常规3个面的显像效果。 结果 （1）骶棘韧带起于骶尾部连接至坐骨棘。（2）骶棘韧带在矢状面上的投影与冠状面的角度CT数据测量结果为（61.32±8.71）°, 在双侧及性别上无统计学差异（P>0.05）；（3）MRI测量结果为（57.53±2.12）°。CT数据与MRI数据比较无统计学差异（P>0.05）；斜冠状面的成像优于常规扫描（P <0.05）。 结论 骶棘韧带MRI扫描在（60.0±5.0）°斜冠状面上显像较好，是常规扫描的重要补充。
Objective To obtain the angle of between the axis of the sacrospinous ligament and the human coronal plane in the human sagittal plane. Methods Eight fresh cadaveric specimen were disserted to find the insertion and the course of sacrospinous ligaments. 3D models were reconstructed from the pelvic CT scan data of 36 normal pelvis, the angle between the axis of the sacrospinous ligament and the human coronal plane in the human sagittal plane were calculated based on 3D coordinate of spatial points. 20 sacrospinous ligaments of 10 volunteers were conducted in the 3D MRI series and observed in the MPR(Multiple Planar Reconstruction) image. The MRI image findings of sacrospinous ligaments were compared among different views. Results The sacrospinous ligament passed from the sacrum to the ischial spine. A board range of insertion on the sacrococcygeal region were observed. We found in the CT data measurements that there was no significant differences between the left and the right sides in both genders (P>0.05). The differences between male and female were of no statistical significance (P>0.05). The mean angle of the 72 sides was (61.32±8.71)°. The mean angle measured on MRI data was （57.53±9.50）°. There was no statistical significant differences between the CT and MRI measurement results (P>0.05). We compared the MR imaging at the position of (60±5)° oblique coronal plane and the 3 normal planes and found that the ligaments can better be observed in oblique coronal plane (P<0.05). Conclusions The sacrospinous ligaments were well shown in (60.0±5)° oblique coronal plane.
Pelvic / Sacroiliac joints / Sacrospinous ligaments / 3D Magnetic resonance imaging
[1] Grotz MR, Allami MK, Harwood P, et al. Open pelvic fractures: epidemiology, current concepts of management and outcome[J]. Injury, 2005,36(1):1-13.
[2] Guthrie HC, Owens RW, Bircher MD. Fractures of the pelvis[J]. J Bone Joint Surg Br, 2010, 92(11):1481-1488.
[3] 潘进社, 康红军, 张英泽, 等. 骨盆韧带损伤对骶髂关节稳定性影响的生物力学研究[J]. 中华创伤骨科杂志, 2008,10(1):68-71.
[4] Steinke H, Hammer N, Slowik V, et al. Novel insights into the sacroiliac joint ligaments[J]. Spine (Phila Pa 1976), 2010,35(3):257-263.
[5] Tile M, Helfet D, Kellam J. 骨盆与髓臼骨折[M]. 邱贵兴,主译.第3版.北京:人民卫生出版社, 2006:11-19.
[6] Edeiken-Monroe BS, Browner BD, Jackson H. The role of standard roentgenograms in the evaluation of instability of pelvic ring disruption[J]. Clin Orthop Relat Res,1989, (240):63-76.
[7] Gansslen A, Pohlemann T, Paul C, et al. Epidemiology of pelvic ring injuries[J]. Injury, 1996, 27(Suppl 1):A13-A20.
[8] Garcia DSL, de Miguel CJ, Aguilera DHL, et al. MR imaging-based assessment of the female pelvic floor[J]. Radiographics, 2014,34(5):1417-1439.
[9] Gary JL, Mulligan M, Banagan K, et al. Magnetic resonance imaging for the evaluation of ligamentous injury in the pelvis: a prospective case-controlled study[J]. J Orthop Trauma, 2014,28(1):41-47.
[10]Le Blanche AF, Mabi C, Bigot JM, et al. The sacroiliac joint: anatomical study in the coronal plane and MR correlation[J]. Surg Radiol Anat, 1996, 18(3):215-220.
[11]徐松, 罗明英, 邓鹏程, 等. 骶结节韧带和骶棘韧带的解剖定位研究[J]. 解剖学研究, 2010, 32(5):351-353.
[12]Hammer N, Steinke H, Slowik V, et al. The sacrotuberous and the sacrospinous ligament--a virtual reconstruction[J]. Ann Anat, 2009,191(4):417-425.
[13]易正湘, 仲炜, 刘建滨, 等. 磁共振Dixon法在膝关节骨损伤中的应用价值[J]. 中国医师杂志, 2004, 6(4):544-545.
[14]邓军, 梁碧玲, 陈健宇, 等. 前交叉韧带损伤的3D MRI诊断价值[J]. 中国医学影像技术, 2008, 24(6):814-817.
国家自然科学基金（81272008）
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