CT辅助导航经皮骶髂螺钉内固定路径  

An approach of percutaneous sacroiliac screw fixation guided by CT

作　　者：陈练[1] 王晨 杨亚安[1] 吴开云[1] 

机构地区：[1]苏州大学医学部解剖学教研室,江苏苏州215123

出　　处：《中国临床解剖学杂志》2009年第1期52-55,共4页Chinese Journal of Clinical Anatomy

基　　金：苏州大学创新团队项目资助(90134602);苏州市重点实验室项目资助(SZS0602)

摘　　要：目的:探讨CT辅助导航经皮骶髂螺钉内固定术的定位和路径。方法:60个成年健康志愿者行S1～3多层螺旋CT扫描,由计算机重构图像后测量通过椎弓根狭窄处中心点与正中矢状面之间的角度、椎弓根高度和宽度等参数,根据这些数据确定体表进钉点、进钉角度和螺钉长度。结果:S1进针点距离后正中线(91.03±10.62)mm,同侧髂嵴后部(41.16±8.80)mm,位于通过髂后上棘连线的骶骨层面头侧(11.29±5.87)mm,进钉方向与水平面夹角(30.76±5.34)°,矢状面(48.76±9.43)°,最佳长度(84.59±5.29)mm。S2体表进针点距离后正中线(127.82±15.63)mm,同侧髂嵴后部(59.34±9.03)mm,位于通过髂后上棘连线的骶骨层面尾侧(15.35±5.50)mm,进钉方向与水平面夹角(30.76±5.34)°,矢状面(61.15±8.38)°,最佳长度(64.04±6.65)mm。仰卧位和俯卧位骶骨倾斜度差别无统计学意义(P>0.05)。结论:(1)经多层螺旋CT扫描图像分析确立的体表进钉点、进钉角度和螺钉长度可直接引导经皮骶髂螺钉内固定术;(2)分析确立的由CT扫描导航经皮骶髂螺钉内固定手术定位和路径为临床骶髂关节修复手术提供了一种快速、准确、安全的方法。Objective： To investigate the surgical location and approach for percutaneous sacroiliac screw fixation with multi-slice spiral CT. Methods： Bilateral sacroiliac joints of sixty healthy adult volunteers were scanned by multi-slice spiral CT. The angles between middle point of S1, S2 pedicle axis and median sagittal plane, as well as the width and height of S1, S2 pedicles, were measured on the CT films reconstruted on computer. The inserting point, ideal angle and the length of the screw within the S1, S2 pedicles were statistically analyzed and determined basing on the data presented. Results： The S1 inserting point was about （91.03±10.62） mm away from the median line, （41.16±8.80）mm from the homolateral posterior part of iliac crest in sacral transverse section, and （1 1.29 ±5.87）mm from the cranial sacral transverse section which passed through posterosuperior iliac spine. The angle between the screw and the horizontal plane of S 1 was （30.76±5.34） °, and the sagittal plane （48.76±9.43） °. The ideal length of the screw for Sl was （84.59±5.29） mm. The S2 inserting point was （127.82±15.63）mm away from the median line, （59.34±9.03） mm from the homolateral posterior part of iliac crest in sacral transverse section, and （15.35 ±5.50）mm from the caudal sacral transverse section. The angle between the screw and the horizontal plane of S2 was （30.76±5.34） °,and the sagittal plane （61.15±8.38） °. The ideal length of screw for S2 was （64.04±6.65）mm. There were no statistically significant differences of sacral slant angle between dorsal and prone positions （P〉0.05）. Conclusions： The data gained from this study reveal the approach that can quickly, accurately and harmlessly guide percutaneous sacroiliac screw fixation in both dorsal and prone position for clinical application.

关 键 词：骶髂关节 骨盆骨折 修复手术 多层螺旋CT 体表定位 螺钉固定 

分 类 号：R323.4[医药卫生—人体解剖和组织胚胎学] R814.42[医药卫生—基础医学]