目的 通过数字化分析、测量青少年骶骨安全骨性螺钉钉道并观察钉道增龄变化的规律。 方法 收集160名10~17岁健康青少年志愿者骨盆CT扫描数据，三维重建测量S1、S2横向骶髂螺钉最优置钉通道的轴向狭窄处的宽度，测量S1、S2最优钉道经“骶骨经髂骨”（trans-sacral trans-iliac，TSTI）螺钉通道长度，测量S1、S2 TSTI通道投影长短轴长度并观察通道随年龄增长的变化规律。 结果 S1骶髂螺钉安全通道宽度，男性：左（8.96±2.02）mm，右（9.03±2.24）mm；女性：左（8.26±1.96）mm，右（8.37±2.11）mm。S1处TSTI螺钉长度，男性（141.25±5.92）mm，女性（134.37±5.68）mm。S2骶髂螺钉安全通道宽度，男性：左（6.49±1.98）mm，右（6.38±1.88）mm；女性：左（6.21±1.76）mm，右（6.14±1.55）mm。S2处TSTI螺钉长度，男性（126.28±4.94）mm，女性（122.31±5.13）mm。 结论 青少年在S1、S2均存在影像学上安全的骨性髂骶螺钉通道，随着年龄的增长，通道投影长短轴比例逐渐加大，高度的增长速度快于宽度的增长速度。
关键词：
青少年; ; ; 骶骨; ; ; 螺钉通道; ; ; 数字化
Objective To explore the rule of the aging change of the screw pathway through digital analysis, measurement of the safety sacral screw pathway of adolescents. Methods The pelvic CT scan data of 160 healthy adolescent volunteers aged 10~17 years old were collected in this research. The width of the axial "narrow point" of the optimal transverse sacroiliac screw placement channel of the S1, S2 was measured bilaterally by three-dimensional reconstruction. The length of the screw pathway through the "trans-sacral trans-iliac" (TSTI) at the superior screw pathway, and the width of the long and short axis of the TSTI pathway projection of the S1 and S2 were measured at the same time, and the changes of the pathway with age were observed. Results S1 sacroiliac screw safety pathway width was left (8.96±2.02) mm, right (9.03±2.24) mm in male; left (8.26±1.96) mm, right (8.37±2.11) mm in female. Sacral length of S1 TSTI screw was (141.25±5.92) mm in male, (134.37±5.68) mm in female. S2 sacroiliac screw safety pathway width was ( left (6.49±1.98) mm, right (6.38±1.88) mm in male; left (6.21±1.76) mm, right (6.14±1.55) mm in female. Sacral length of S2 TSTI screws was (126.28±4.94) mm in male, (122.31±5.13) mm in female. Conclusions There are radiologically safe bony iliosacral screw pathways in both S1 and S2 in adolescents. With the increasing of age, the ratio of the width of the long and short axis of the TSTI pathway projection of the S1 and S2 gradually increases, and the growth rate of height is faster than that of width.
[1] Gardner MJ, Morshed S, Nork SE, et al. Quantification of the upper and second sacral segment safe zones in normal and dysmorphic sacra[J]. J Orthop Trauma, 2010, 24(10): 622-629. DOI: 10.1097/BOT.0b013e3181cf0404.
[2] Holden CP, Holman J, Herman MJ. Pediatric pelvic fractures[J]. J Am Acad Orthop Surg, 2007, 15(3): 172-177. DOI: 10.5435/00124635-200703000-00007.
[3] 张元智, 李鉴轶, 张立峰, 等. 水平方向经皮第二骶椎骶髂关节螺钉固定治疗骶骨纵形骨折的评价[J]. 中华创伤骨科杂志, 2014, 19(3): 234-239. DOI: 10.3760/cma.j.issn.1671-7600.2017.03.009.
[4] Smith W, Shurnas P, Morgan S, et al. Clinical outcomes of unstable pelvic fractures in skeletally immature patients[J]. J Bone Joint Surg Am, 2005, 87(11): 2423-2431. DOI: 10.2106/JBJS.C.01244v.
[5] Carlson DA, Scheid DK, Maar DC, et al. Safe placement of S1 and S2 iliosacral screws: the “vestibule” concept[J]. J Orthop Trauma, 2000, 14(4): 264-269. DOI: 10.1097/00005131-200005000-00007.
[6] Mendel T, Noser H, Wohlrab D, et al. The lateral sacral triangle-a decision support for secure transverse sacroiliac screw insertion[J]. Injury, 2011, 42(10): 1164-1170. DOI: 10.1016/j.injury.2010.03.016.
[7] Routt Jr ML, Simonian PT, Agnew SG, et al. Radiographic recognition of the sacral alar slope for optimal placement of iliosacral screws: a cadaveric and clinical study[J]. J Orthop Trauma, 1996, 10(3): 171-177. DOI: 10.1097/00005131-199604000-00005.
[8] Mehlman CT, DiPasquale TG. Radiation exposure to the orthopaedic surgical team during fluoroscopy: ‘‘how far away is far enough?’’[J]. J Orthop Trauma, 1997, 11(6): 392-398. DOI: 10.1097/00005131-199708000-00002.
[9] Gardner MJ, Routt ML Jr. Transiliac-transsacral screws for posterior pelvic stabilization[J]. J Orthop Trauma, 2011, 25(6): 378-384. DOI: 10.1097/BOT.0b013e3181e47fad.
[10] Routt ML Jr, Nork SE, Mills WJ. Percutaneous fixation of pelvic ring disruptions[J]. Clin Orthop Relat Res, 2000, 375: 15-29. DOI: 10.1097/00003086-200006000-00004.
[11]Miller AN, Routt MLC Jr. Variations in sacral morphology and implications for iliosacral screw fixation[J]. J Am Acad Orthop Surg, 2012, 20(1): 8-16. DOI: 10.5435/JAAOS-20-01-008.
[12] Burn M, Gary JL, Holzman M, et al. Do safe radiographic sacral screw pathways exist in a pediatric patient population and do they change with age[J]? J Orthop Trauma 2016, 30(1): 41-47. DOI: 10.1097/BOT.0000000000000421.
[13] Oransky M, Arduini M, Tortora M, et al. Surgical treatment of unstable pelvic fracture in children: long term results[J]. Injury, 2010, 41(11): 1140-1144. DOI: 10.1016/j.injury.2010.08.002.
[14] Heeg M, Klasen HJ. Long-term outcome of sacroiliac disruptions in children[J]. J Pediatr Orthop, 1997, 17(3): 337-341. DOI: 10.1097/01241398-199705000-00013.
[15]初向全, 董永伟, 徐波, 等. 国人骶髂贯穿螺钉置钉通道的数字解剖学研究[J]. 中华创伤杂志, 2018, 34(1): 51-56. DOI: 10.3760/cma.j.issn.1001-8050.2018.01.012.
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