骶髂关节脱位直视复位空心螺钉固定的基础研究及临床应用  

A biomechanical study of sacroiliac dislocation treated with euthyphoria reduction and percutaneous canulated screw fixation

作　　者：任义军[1] 王钢[1] 陈滨[1] 秦煜[1] 梅良斌[1] 王瑞金[1] 赵卫东[2] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州510515 [2]南方医科大学生物力学实验室,广州510515

出　　处：《中华创伤骨科杂志》2006年第6期515-519,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的研究总结直视复位、经皮空心螺钉固定骶髂关节脱位的解剖学基础、生物力学稳定性以及初步的临床疗效。方法采用12具(24侧)福尔马林固定的尸体标本,测量骶骨翼上缘L_4、L_5神经根前支和闭孔神经至骶髂关节的距离。采用6具新鲜尸体骨盆标本建立骶髂关节脱位模型,比较本固定法与传统后路经皮骶髂关节螺钉和前路钢板固定的稳定性。同期采用本固定法手术治疗17例Tile C型骨折患者,随访疗效。结果①L_4、L_5神经根及闭孔神经分别距离骶髂关节(20．24±1．12)mm、(23．80±1．43)mm、(16．26±2．07)mm；②本固定方式与后路经皮骶髂关节螺钉的稳定性无显著性差异,但优于前路钢板固定；③临床治疗17例患者,平均随访2．2年,根据Matta功能评定标准,功能恢复均为优良。结论该固定系统具有良好的生物力学稳定性,同时可避免神经损伤、临床效果好、操作简便,便于基层医院开展。Objective To study the anatomy basis and biomechanical stability of euthyphoria reduction and percutaneous cannulated screw fixation for sacroiliac dislocation, and to evaluate the primary clinical efficacy of this method. Methods The distances from the anterior branches of the nerve roots at L4, and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were measured on 12 adult cadavers （24 sides） fixed and preserved by formalin. Models of sacroiliac dislocation were made on six pelvic specimens of fresh cadavers. A comparison of stability was made on the six models between the fixation studied here and the traditional fixations by posterior percutaneous sacroiliac screws and by anterior sacroiliac joint plates. At the same time, 17 patients with type C Tile fracture were treated with our method. The clinical efficacy was analyzed for the 17 patients. Results The distances from the anterior branches of the nerve roots at L4, and L5 and obturator nerve on the superior border of sacral ala to the sacroiliac joint were 20. 24 ± 1.20 mm, 23.80 ± 1.43 mm, and 16.26 ±2.07 mm respectively. There was no statistically significant difference in stability between our method and the traditional fixation by posterior percutaneous sacroiliac screws, though ours seemed better. Follow-ups for the 17 cases averaged 2. 2 years, revealing fine functional recovery in all according to Matta scoring. Conclusions Euthyphoria reduction and percutaneous cannulated screw fixation can lead to sufficient biomechanical stability for the sacroiliac joint and effectively avoid nervous injuries. In addition, our method is simple and clinically effective. It is recommendable for small and middle-sized hospitals.

关 键 词：骶髂关节 直视复位 空心螺钉 生物力学 解剖 

分 类 号：R687.1[医药卫生—骨科学]