目的 数字化测量髋臼后柱壁安全置钉相关参数，为临床治疗后壁或/和后柱骨折置钉提供参考。 方法 经软件Mimics20.0重建100例正常成人髋骨三维模型。将髋臼后壁分为累及臼顶的高位后壁区与未累及臼顶的低位后壁区，切割髋臼高位后壁区得到断面M、D、E和N，切割低位髋臼后壁区形成断面F、G、H、I和J。在断面上测量进钉角度和进钉长度。 结果 在断面M、D、E和N上距臼缘5.0 mm的进钉点，男女螺钉最大安全进钉角度分别不应超过80°、70°、60°与50°，男女进钉长度分别不应超过40.0与35.0 mm。在断面F、G、H、I和J上，男女距臼缘5.0、10.0、20.0与30.0 mm的进钉角度应分别小于50°、60°、80°和90°。断面F至J中，男性进钉点螺钉长度应分别小于40.0、35.0、30.0、30.0与40.0 mm；女性应分别小于35.0、30.0、25.0、25.0与35.0 mm。 结果 在髋臼后柱壁不同进钉位点，应采取不同的进钉角度与长度以防螺钉误入髋关节腔。
Abstract
Objective To digitally measure the relevant anatomical parameters of safe screw placement for posterior column wall of the acetabulum, so as to provide data reference for the clinical treatment of screw placement for posterior wall and/or posterior column fractures. Methods 3D hip-bone models of 100 normal adults were reconstructed by Mimics 20.0. The acetabular posterior wall was divided into high posterior wall area involving the acetabular roof and the low posterior wall area without involving the acetabular roof. Sections M, D, E and N were obtained by cutting the high posterior wall area of the acetabulum, and sections F, G, H, I and J were obtained by cutting the low posterior wall area of the acetabulum. The following parameters were measured on each section: the angle and the length of the screw. Results In the entry points 5.0 mm away from the acetabular edge on sections M, D, E and N, the maximum safe entry angles of screws for men and women should not exceed 80°, 70°, 60° and 50°, respectively, and the entry lengths for men and women should not exceed 40.0mm and 35.0mm, respectively. On sections F, G, H, I and J, the screw angles of 5.0 mm, 10.0 mm, 20.0 mm and 30.0 mm away from the acetabular edge should be less than 50°, 60°, 80° and 90°, respectively. On sections F to J, the screw lengths of male should be less than 40.0 mm, 35.0 mm, 30.0 mm, 30.0 mm and 40.0 mm, respectively, the screw lengths of female should be under 35.0 mm, 30.0 mm, 25.0 mm, 25.0 mm and 35.0 mm respectively. Conclusions Different insertion angles and lengths should be adopted at different insertion points in the posterior column wall of the acetabulum to avoid the screw entering into the hip cavity.
关键词
/
髋臼 /
/
/
后柱 /
/
/
后壁 /
/
/
数字化 /
/
/
解剖测量
Key words
Acetabulum /
/
/
Posterior column /
/
/
Posterior wall /
/
/
Digitization /
/
/
Anatomical measurement
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Mauffrey C, Hao J, Cuellar DO 3rd, et al. The epidemiology and injury patterns of acetabular fractures: are the USA and China comparable[J]? Clin Orthop Relat Res, 2014, 472(11): 3332-3337. DOI: 10.1007/s11999-014-3462-8.
[2] 潘昌武, 刘曦明, 蔡贤华, 等. AO微型联合重建接骨板内固定治疗髋臼后壁骨折[J]. 中华骨科杂志, 2013, 33(11): 1097-1103. DOI: 10.3760/cma.j.issn.0253-2352.2013.11.005.
[3] Lee C, Johnson EE. Use of spring plates in fixation of comminuted posterior wall acetabular fractures[J]. J Orthop Trauma, 2018, 32(Suppl 1): S55-S59. DOI: 10.1097/BOT.0000000000001089.
[4] Ebraheim NA, Waldrop J, Yeasting RA, et al. Danger zone of the acetabulum[J]. J Orthop Trauma, 1992, 6(2): 146-151. DOI: 10.1097/00005131-199206000-00003.
[5] Harnroongroj T, Riansuwan K, Sudjai N, et al. Posterior acetabular arc angle of unstable posterior hip fracture-dislocation[J]. Int Orthop, 2013, 37(12): 2443-2449. DOI: 10.1007/s00264-013-2090-3.
[6] 王先泉, 张进禄, 周东生. 髋臼后柱支持钢板的临床解剖学研究[J]. 中国骨与关节损伤杂志, 2005, (1): 9-11. DOI: 10.3969/j.issn.1672-9935.2005.01.004.
[7] 周程鹏, 高仕长, 刘杰, 等. 髋臼后壁钢板螺钉固定安全区域的应用解剖学研究[J]. 中国临床解剖学杂志, 2013, 31(1): 13-18. DOI: 10.13418/j.issn.1001-165x.2013.01.020.
[8] Wu X, Chen W, Zhang Q, et al. The study of plate-screw fixation in the posterior wall of acetabulum using computed tomography images[J]. J Trauma, 2010, 69(2): 423-431. DOI: 10.1097/TA.0b013e3181ca05f6.
[9] 凌超. 成人髋臼后壁骨折解剖型钢板研发的解剖学研究[D]. 安徽医科大学, 2013.
[10] 陈嘉楠, 郑益钒, 连俊红, 等. 累及臼顶的髋臼后壁骨折治疗进展[J]. 国际骨科学杂志,2021, 42(5): 271-274, 300. DOI: 10.3969/j.issn. 1673-7083.2021.05.003.
[11] 王先泉, 蔡锦芳, 曹学成, 等. 髋臼后柱钢板内固定技术的解剖学研究[J]. 中华外科杂志, 2009,(15): 1182-1184. DOI: 10.3760/cma.j.issn. 0529-5815.2009.15.018.
[12] 王愉思, 何畔, 王家让, 等. 髋臼后柱安全置钉的临床解剖学研究[J]. 中国骨与关节损伤杂志,2009, 24(7): 584-586. CNKI:SUN:GGJS. 0.2009-07-005.
基金
卫勤保障能力创新与生成专项（20WQ034）
PDF(2411 KB)
京ICP备08002354号-3
