术前应用螺旋CT个体化测量在骶髂关节置钉中的意义
刘新园, 黄继锋, 刘 忠, 赵卫东, 田龙海, 段连鸿
中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (2) : 179-183.
术前应用螺旋CT个体化测量在骶髂关节置钉中的意义
The significance of individual measuring by preoperatively application of helical computed tomography in the placement of screw on the sacroiliac joint
目的 探讨切开复位骶髂螺钉内固定术前应用螺旋CT个体化测量健侧螺钉钉道参数，指导术中置钉的可行性。 方法 ⑴对10例冰冻正常成人骨盆标本进行螺旋CT扫描与多平面重组，在不同重组图像中依次测量左右侧S1螺钉的进针方向、进针点与髂后上、下棘的距离、钉道的长度与安全角度等参数；⑵将10例骨盆标本左右侧骶髂关节制成垂直不稳定贩折模型，然后左右侧骶髂关节分别根据对侧的CT测量结果进行个体化置钉验证。 结果 ⑴进针方向与冠状面、水平面的夹角分别为（25.95± 1.39）°与（19.61±2.97）°，进针点与髂后上、下棘的距离分别为(37.17±2.90)mm与(38.23±1.69)mm，冠、轴状面上的安全角度分别为(19.87±1.61)°与(23.84±2.08) °；⑵左侧骶髂关节所置10枚螺钉均安全、准确地到达S1椎体预定位置；右侧骶髂关节所置螺钉除1枚偏离突出骨质外，其余9枚均安全到达S1椎体预定位置。 结论 切开复位骶髂螺钉内固定术前应用螺旋CT个体化测量健侧螺钉钉道参数，指导术中置钉的方法是可靠的。
Objective To explore the feasibility of individual measuring the parameters of the screwing trajectory of the screw on the uninjured side by application of helical computed tomography before open reduction and internal fixation using sacroiliac screw to guide the placement of screw on the injured side. Methods (1) Ten frozen pelvic specimens of normal Chinese adults were scanned and multiplanarly reconstructed by helical computed tomography in order to measure the entrance direction of the S1 screw, the distance from the entry point to the posterior superior iliac spine and the posterior inferior iliac spine, the length, and safe angle of the screwing trajectory as well. (2) The left and right sacroiliac joints of eight pelvic specimens were made into vertical unstable model. Then, the left sacroiliac joints were individually validated by the iliosacral screws according to the measurement result of the screw trajectory scanned by CT on the right sacroiliac joints, and the right sacroiliac joints by the measurement results of the screw trajectory on the left side. Results (1)The direction of screw was （25.95±1.39）° to the coronal plane, and （19.61±2.97）° to the horizontal plane. The distance from the entry point was (37.17±2.90) mm to posterior superior iliac spine, and (38.23±1.69) mm to the posterior inferior iliac spine. The safe angle of the screw trajectory was（19.87±1.61）° to the coronal plane, and (23.84±2.08)° to the axial plane. (2)All of the ten inserted iliosacral screws of the left sacroiliac joints inserted were entirely within the pedicle; In the right side, except one deviated out of the bone, other nine cases were entirely within the pedicle. Conclusions The method through individual measuring the parameters of the screwing trajectory of the screw on the uninjured side by application of helical computed tomography before open reduction and internal fixation using sacroiliac screw to guide the placement of screw on the injured side has been proved a reliable method.
Sacroiliac joint / Sacroiliac screw / Screwing trajectory / Helical computed tomography
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