髋臼上区域置钉安全范围的影像学研究

谭山,高仕长,张安维,陈剑飞

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (3) : 259-263.

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (3) : 259-263. DOI: 10.13418/j.issn.1001-165x.2018.03.005
断层影像解剖

髋臼上区域置钉安全范围的影像学研究

  • 谭山, 高仕长, 张安维, 陈剑飞
作者信息 +

A primary imaging study on quantitative measurement of the supra-acetabular screw safe fixation zone

  • TAN Shan, GAO Shi-chang, ZHANG An-wei, CHEN Jian-fei
Author information +
文章历史 +

摘要

目的 探究髋臼上区域螺钉的进钉位置、角度以及安全范围。  方法 收集男女骨盆CT数据各50例,利用Mimics软件重建髋臼上置钉区域三维模型(髂前下棘至髂后上棘方向)。同一横断面上,通道狭窄处中点连线方向确定为螺钉方向,沿该方向每2.5 mm为一层,逐层测量安全范围相关指标。在1/2高度层面放置中心钉,测量中心钉进钉点与髂前下棘的位置关系及螺钉方向,在水平面和矢状面上移动钉尖,测量安全倾角范围。  结果 髋臼上骨通道存在前、后两狭窄点,不同层面其宽度不同,从下至上,前狭窄由窄变宽再变窄,后狭窄逐层增宽。螺钉通道中间层较宽,上下层较窄;中心通道宽度90%的男、女性分别大于7 mm和6 mm;进钉约50 mm至前狭窄,70 mm至坐骨大切迹顶上方,100 mm至后狭窄,全程长约130 mm;螺钉为内倾、头倾方向,与矢状面和横断面的夹角均约为30°;97%的进钉点位于髂前下棘中心外侧,其中外下方占71%。  结论 髋臼上螺钉的进钉点主要位于髂前下棘外方,内倾、头倾方向,与矢状面和横断面的夹角均约为30°。

Abstract

Objective To investigate the entry point location and orientation of the supra-acetabular screw as well as its safe corridor size.     Methods    100 (male 50, female 50) CT data of pelvis were collected from our hospital. The three-dimensional model of supra-acetabular corridor (oriented from the anterior inferior iliac spine (AIIS) to posterior superior iliac spine (PSIS) was reconstructed by Mimics software. On the horizontal scan, the screw was placed along the two midpoints of the anterior and posterior narrowing in the corridor, and the relevant parameters of safe corridor were measured from inferior to superior at an interval layer thickness of 2.5 mm. On the middle layer, the orientations of the central virtual screws were measured and the position relation between the entry point and the center apex of AIIS was determined. The safe fixation zone was measured by moving the tip of the screw on the horizontal and sagittal planes.   Results There were two narrowing in the supra-acetabular corridor. From inferior to superior, the width of the anterior narrowing had the characteristic of narrow-wide-narrow and the posterior narrowing became wider and wider. The width for safe fixation corridor from inferior to superior had the feature of narrow-wide-narrow. The width of the corridor on the middle layer was (10.61±2.10) mm for male and (8.44±2.03) mm for female (t=7.413,P<0.001). On the middle layer, the distances from the entry point to anterior narrowing, greater sciatic notch and posterior narrowing were about 50 mm, 70 mm and 100 mm, respectively. The whole length of the corridor was about 130 mm. The inward inclination angle was (29.50±4.05) degrees for male and (28.00±3.78) degrees for female (t=2.709, P=0.007), and the virtual screw had a safe rang about 5 degrees. The cranial inclination angle was (29.40±5.38) degrees for male and (28.57±6.01) degrees for female (t=1.025, P=0.306), and the safe rang was about 10 degrees. 97% of the entry points were located on the lateral area of the AIIS, and 71% in the lateral-inferior quadrant.   Conclusion    The entry point of the supra-acetabular screw are located on the lateral area of the AIIS. The inward and cranial inclination angles are both about 30 degrees.

关键词

髋臼上固定 /  骨盆骨折 /  髂前下棘 /  影像学

Key words

Supra-acetabular fixation;    / Pelvic fracture;    / Anterior inferior iliac spine;    / Imaging study

引用本文

导出引用
谭山,高仕长,张安维,陈剑飞. 髋臼上区域置钉安全范围的影像学研究[J]. 中国临床解剖学杂志. 2018, 36(3): 259-263 https://doi.org/10.13418/j.issn.1001-165x.2018.03.005
TAN Shan, GAO Shi-chang, ZHANG An-wei, CHEN Jian-fei. A primary imaging study on quantitative measurement of the supra-acetabular screw safe fixation zone[J]. Chinese Journal of Clinical Anatomy. 2018, 36(3): 259-263 https://doi.org/10.13418/j.issn.1001-165x.2018.03.005

参考文献

[1]  Tscherne H, Pohlemann T, Gnsslen A, et al. Crush injuries of the pelvis[J]. Eur J Surg, 2000, 166(4): 276-282.
[2]  Galois L, Pfeffer F, Mainard D, et al. The value of external fixation for unstable pelvic ring injuries[J]. Acta Orthop Belg, 2003, 69(4): 321-327.
[3] Calafi LA, Routt ML. Anterior pelvic external fixation: is there an optimal placement for the supra-acetabular pin[J]. Am J Orthop (Belle Mead NJ), 2013, 42(12): E125-E127.
[4]  Haidukewych GJ, Kumar S, Prpa B. Placement of half-pins for supra-acetabular external fixation: an anatomic study[J]. Clin Orthop Relat Res, 2003, 411(6): 269-273.
[5] Gardner MJ, Kendoff D, Ostermeier S, et al. Sacroiliac joint compression using an anterior pelvic compressor: a mechanical study in synthetic bone[J]. J Orthop Trauma, 2007, 21(7): 435-441.
[6] Vigdorchik JM, Esquivel AO, Jin X, et al. Biomechanical stability of a supra-acetabular pedicle screw internal fixation device (INFIX) vs external fixation and plates for vertically unstable pelvic fractures[J]. J Orthop Surg Res, 2012, 7(9): 31-35.
[7] Gardner MJ, Nork SE. Stabilization of unstable pelvic fractures with supraacetabular compression external fixation[J]. J Orthop Trauma, 2007, 21(4): 269-273.
[8] Berry JL, Stahurski T, Asher MA. Morphometry of the supra sciatic notch intrailiac implant anchor passage[J]. Spine (Phila Pa 1976), 2001, 26(7): E143-E148.
[9] Schildhauer TA, McCulloch P, Chapman JR, et al. Anatomic and radiographic considerations for placement of transiliac screws in lumbopelvic fixations[J]. J Spinal Disord Tech, 2002, 15(3): 199-205.
[10]Mitchell PM, Corrigan CM, Patel NA, et al. 13-Year experience in external fixation of the pelvis: complications, reduction and removal[J]. Eur J Trauma Emerg Surg, 2016, 42(1): 91-96.
[11]汪方, 唐昊, 王秋根, 等. 髋臼上方置钉骨盆外固定的应用解剖[J]. 解剖学杂志, 2010, 33(3): 377-380.
[12]Mischkowski RA, Selbach I, Neugebauer J, et al. Lateral femoral cutaneous nerve and iliac crest bone grafts--anatomical and clinical considerations[J]. Int J Oral Maxillofac Surg, 2006, 35(4): 366-372.
[13]Bjurlin MA, Davis KE, Allin EF, et al. Anatomic variations in the lateral femoral cutaneous nerve with respect to pediatric hip surgery[J]. Am J Orthop (Belle Mead NJ), 2007, 36(3): 143-146.
[14]Osterhoff G, Aichner EV, Scherer J, et al. Anterior subcutaneous internal fixation of the pelvis - what rod-to-bone distance is anatomically optimal [J]. Injury, 2017, 48(10): 2162-2168.

基金

重庆市科委资助项目(cstc2012ggyyjs0205)


Accesses

Citation

Detail

段落导航
相关文章

/