髋臼后壁钢板螺钉固定安全区域的应用解剖学研究

中国临床解剖学杂志 ›› 2013, Vol. 31 ›› Issue (1): 13-18.

髋臼后壁钢板螺钉固定安全区域的应用解剖学研究

周程鹏¹，　高仕长¹，　刘杰¹，　倪卫东¹，　蒋电明¹，　孙善权²，　李咏梅³

1. 重庆医科大学附属第一医院骨科, 重庆 400016；　2.重庆医科大学基础医学院解剖教研室，重庆 400016；
3. 重庆医科大学附属第一医院放射科, 重庆 400016

收稿日期:2012-09-12 发布日期:2013-01-29
通讯作者: 高仕长，副教授，副主任医师，硕士生导师，Tel：13594057589, E-mail:778925053@qq.com v E-mail:wegrubby@163. com
作者简介:周程鹏（1987-），男，四川成都人，在读硕士，主要从事骨科临床解剖学方面的研究，Tel：（023）65659595，E-mail：wegrubby@163. com
基金资助:
重庆市科委（cstc2012gg-yyjs0205）;重庆市渝中区科委（20110311）

Applied anatomic study of surgical safe zone for placement plates and screws in treatment of fracture of the posterior wall of acetabulum

ZHOU Cheng-peng¹, GAO Shi-chang¹, LIU Jie¹, NI Wei-dong¹, JIANG Dian-ming¹, SUN Shan-quan², LI Yong-mei³

1.Department of Orthopaedics，the First Affiliated Hospital of Chongqing Medical University，Chongqing 400016，China; 2.Department of Anatomy, Chongqing Medical University，Chongqing 400016，China; 3.Department of Radiology, the First Affiliated Hospital of Chongqing Medical University，Chongqing 400016，China

Received:2012-09-12 Published:2013-01-29

摘要/Abstract

摘要：

目的　测量髋臼后壁三维重建模型参数和行虚拟钢板螺钉固定，明确髋臼后壁钢板放置的安全位置及螺钉置入角度。方法用Mimics软件对25例（50侧）骨盆薄层CT行三维重建，切割出髋臼后壁三维模型，测量相关参数。用SolidWorks2010软件设计髋臼后壁虚拟钢板，导入Mimics软件，得出髋臼后壁虚拟钢板放置位置和螺钉安全角度。然后在15具（30侧）尸体髋臼后壁标本上进行钢板螺钉固定。结果髋臼纵径为55 mm，横径为52 mm。髋臼后壁最宽处位于上缘，为51 mm，最窄处位于髋臼后壁中下部，为38 mm。螺钉能够拧入Zimmer重建钢板钉孔所允许最小角度范围为50~66°。Mimics模拟置钉后，将钢板放置在距尸体标本髋臼后壁外缘6 mm处行钢板螺钉固定，螺钉未进入髋臼。结论重建钢板放置在距髋臼后壁外缘6 mm以远时，螺钉可以安全置入，且钢板距外缘越远，螺钉的安全范围越大。

关键词: 髋臼后壁, 安全置钉, 应用解剖

Abstract:

Objective　To investigate the safe position of the plates and safe angles of the screws through measurement of the parameter of the acetabulum and virtual plate-screw placement in the three-dimensional posterior wall of the acetabulum.　Methods　The thin slice CT data of 50 pelvics and 15 normal cadavers were used in this study. Three-dimensional reconstruction of pelvics were achieved by Mimics 10.0; then the virtual 3-dimensional acetabulum was resliced ,and the transverse, longitudinal diameter of the acetabulum and the width of the posterior wall of the acetabulum were measured, respectively. The virtual plate was designed by the software of Solidworks2010 and was introduced into the software of Mimics 10.0. The position of the plates and the angle of the screws were measured and the safe zones of the plate and the safe angles of the screws were deduced. Based on the above-mentioned data, the plates were fixed on the 30 posterior walls of the acetabulum 6mm away from the posterior edge of the acetabulum. Results The longitudinal and transverse diameter of the acetabulum were 55 mm and 52 mm, respectively. The widest width of posterior wall was 51 mm, which was at the superior edge; The narrowest was 38 mm，which was at the edge of middle-lower part of the posterior wall. When the screws could be drived into the hole of the plates, the smallest angle between the reconstructive plate and the screws were from 50° to 66°. The screws were not inserted into the acetabulum ,when plate-screw fixation were palced in the posterior wall of the acetabulum in cadavers 6mm away from the lateral edge of acetabulum. Conclusions When the plate is at least 6mm away from the posterior edge of the acetabulum, the screws could safely avoid entering the hip joint. As the distance of the plate away from the lateral edge of the acetabulum grows, the safe range of for screw placement increases.

Key words: Posterior wall of the acetabulum, Surgical safe zone for plates and screws, Applied anatomy

中图分类号:

R323.45

周程鹏, 高仕长, 刘杰, 倪卫东, 蒋电明, 孙善权, 李咏梅. 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.

ZHOU Cheng-Feng, GAO Shi-Chang, LIU Jie, NI Wei-Dong, JIANG Dian-Meng, SUN Shan-Quan, LI Yong-Mei. Applied anatomic study of surgical safe zone for placement plates and screws in treatment of fracture of the posterior wall of acetabulum[J]. Chinese Journal Of Clinical Anatomy, 2013, 31(1): 13-18.

[1]	陈仁, 杨胜波. 咬肌的解剖与临床应用研究进展[J]. 中国临床解剖学杂志, 2024, 42(1): 115-117.
[2]	吴文斌, 胡雨田, 代琳曦, 吕旺轩, 吕丰均, 尹袁杰, 杨红梦, 畅君达, 李文奇, 郭义威. 椎神经节麻醉的应用解剖学研究[J]. 中国临床解剖学杂志, 2023, 41(6): 640-646.
[3]	白继岳, 徐永清. 周围神经选择性部分切断术治疗脑性瘫痪的解剖学研究进展[J]. 中国临床解剖学杂志, 2023, 41(6): 754-756.
[4]	何晓清, 杨曦, 石岩, 徐月仙, 方翔, 范新宇, 吴亚玲, 徐永清. 腓肠外侧浅动脉穿支皮瓣术中解剖学观察及临床意义[J]. 中国临床解剖学杂志, 2023, 41(2): 132-136.
[5]	陈帅, 易陈鹏, 王杰, 宫大伟, 焦峰, 黄华扬, 郑小飞, 王海彬. 胫侧副韧带与内侧半月板的关系解剖研究及临床意义[J]. 中国临床解剖学杂志, 2022, 40(5): 519-522.
[6]	朱明昇, 王增涛, 陈京国, 郝丽文, 陈超, 侯致典. 第1掌心动脉掌骨颈尺侧穿支的解剖研究及临床意义[J]. 中国临床解剖学杂志, 2022, 40(3): 249-254.
[7]	周家宇, 周国燕, 杨胜波. 成人前臂前群肌的神经入肌点定位及意义[J]. 中国临床解剖学杂志, 2022, 40(2): 126-131.
[8]	王少和, 范红斌, 史关祺, 陈杨澍, 高娣, 金哲悟, 王真, 杜斌, 胡一波, 吴柯. 近节指骨滑车损伤对近指间关节侧方稳定性影响的应用解剖学研究[J]. 中国临床解剖学杂志, 2021, 39(6): 635-637.
[9]	刘兴利, 杜自宏, 张湘敏, 尹俊琨, 付杜娟, 李治, 吕梁. 基于血管显像仪的右上肢肘窝区浅静脉应用解剖研究[J]. 中国临床解剖学杂志, 2021, 39(3): 269-275.
[10]	赵文韬, 赵民. 手指伸肌腱Ⅰ区肌腱末节指骨止点与毗邻组织的应用解剖学研究[J]. 中国临床解剖学杂志, 2021, 39(2): 126-129.
[11]	孙诗竹, 　于胜波, 　隋鸿锦. P45断层塑化技术在应用解剖学研究中的应用[J]. 中国临床解剖学杂志, 2021, 39(2): 240-243.
[12]	田维东, 彭龙锋, 祝绍磊, 王孝文. 小脑动脉与三叉神经根毗邻关系的应用解剖[J]. 中国临床解剖学杂志, 2020, 38(6): 625-628.
[13]	陈韦东, 钱蕾, 瞿东滨, 贺善礼, 李泽宇, 谭炜浩, 钟锦涛, 杨航, 欧阳钧, 郑明辉. 胸椎旁神经阻滞术穿刺深度的解剖学研究[J]. 中国临床解剖学杂志, 2020, 38(5): 545-548.
[14]	姜铧财, 龙雳, 李森. 高位髂腹股沟入路治疗Tile C型骨盆骨折的应用解剖及临床疗效[J]. 中国临床解剖学杂志, 2020, 38(4): 471-475.
[15]	曹禹文, 刘由军, 袁佳, 江凯燕, 徐聪. 后路经皮内窥镜下颈椎椎间盘切除术的解剖学研究及临床意义[J]. 中国临床解剖学杂志, 2020, 38(3): 246-249.