经S_2椎弓根骶髂关节螺钉固定CT和解剖学研究  

Anatomical and computer tomographical study of the parameters of lag screw fixation of the sacroiliac joint through S_2 pedicle

作　　者：洪华兴[1] 潘志军[1] 陈欣[1] 徐刚[1] 

机构地区：[1]浙江大学医学院附属第二医院骨科,浙江杭州310009

出　　处：《中国骨伤》2004年第9期527-530,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的 :为经S2 椎弓根水平骶髂关节螺钉固定提供解剖学依据。方法 :对 2 2个骨盆标本进行解剖学研究 ,测量经S2 椎弓根骶髂关节螺钉固定的进针点、进针方向、钉道直径、进针点至S2 椎体中心和椎弓根中心距离、S2 椎弓根横断面形状。结果 :螺钉进针点在髂后下棘前方 2 8 7mm (15 0～34 5mm) ,坐骨切迹上方 15 3mm(10 0～ 2 2 0mm) ;进针方向垂直于正中矢状面且与髂骨翼外侧面夹角为 6 2 4°(5 5°～ 72°) ;钉道直径为 11 5mm (8 5～ 14 0mm) ;进针点至S2 椎体中心距离 6 4 7mm(5 5 3～ 77 6mm) ;进针点至S2 椎弓根中心距离为 5 3 1mm(45 3～ 6 4 8mm) ;S2 椎弓根横截面呈三角形。结论 :经S2 椎弓根水平骶髂关节螺钉固定的进针点应位于髂后下棘前方 30mm ,坐骨切迹上方15mm ;进针方向垂直于正中矢状面且与髂骨翼外侧面夹角为 6 0°;S2 椎弓根钉道直径较小 ,经S2 椎弓根水平骶髂关节螺钉固定应选择直径较小的短螺钉。Objective:To provide the anatomic basis for sacroiliac screw fixation through S-2 pedicle.Methods:Twenty-two pelvis specimens of native adults were studied.Spiral CT was used to scan 22 pelvis specimens.The axis of S-2 pedicle and the direction of sacroiliac screw were studied on axial CT scans.Then,anthropometric measurement were performed on 22 cadaveric pelvis to determine the optimal entry point for sacroiliac screw on the outer table of ilium,the direction of sacroiliac screw,the diameter of the sacroiliac screw path,the distance from entry point to the center of S-2 vertebral body,the distance from entry point to the center of S-2 pedicle,and the shape of the S-2 pedicle transverse section.Results:The average entry point for screw fixation on the outer table of ilium located 28.7 mm(15.0～34.5 mm) anterior to posterior inferior iliac spine and 15.3 mm(10.0～22.0 mm) superior to the sciatic notch.The direction of screw was perpendicular to midsagittal plane.The angle between the direction of screw and the outer table of ilium was 62.4°(55°～72°).The diameter of the sacroiliac screw path,the distance from entry point to the center of S-2 vertebral body and the distance from the entry point to the center of S-2 pedicle were 11.5 mm(8.5～14.0 mm),64.7 mm(55.3～77.6 mm) and 53.1 mm(45.3～64.8 mm) respectively.The shape of S-2 pedicle transverse section was triangle.Conclusion:The entry point locates 30 mm anterior to posterior inferior iliac spine and 15 mm superior to the sciatic notch.The direction of sacroiliac screw perpendicular to midsagittal plane.The angle between the direction of screw and the outer talble of ilium is 60°.The diameter of sacroiliac screw path through S-2 pedicle smaller than that of sacroiliac screw path through S-1 pedicle.Sacroiliac screw fixation for sacroiliac joint through S-2 pedicle should use the smaller diameter and shorter screw.

关 键 词：椎弓根 螺钉固定 骶髂关节 进针点 钉道 进针方向 解剖学研究 水平 目的 依据 

分 类 号：R681[医药卫生—骨科学] R687[医药卫生—外科学]