骶髂关节前路双钢板固定骶骨侧不同螺钉数量的解剖安全性研究  

Anatomic security of applying different numbers of screws at the sacrum sides in the anterior double plate fixation of the sacroiliac joint

作　　者：刘佳[1] 高仕长[1] 倪卫东[1] 蒋电明[1] 周程鹏[1] 

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《重庆医科大学学报》2012年第11期1001-1004,共4页Journal of Chongqing Medical University

基　　金：重庆市渝中区科委资助项目(编号:20110311)

摘　　要：目的:通过对骶髂关节行前路双钢板固定,在骶骨侧拧入不同数量的螺钉,明确在兼顾固定稳定的同时,骶髂关节前路双钢板骶骨侧螺钉固定几枚较安全。方法:(1)15具成人尸体骨盆,行普通CT平扫,保存薄层CT扫描数据,将数据带入Ma-terialies公司的交互式医学影像控制系统10.0(Materialise’s interactive medical image control system 10.0,MIMICS 10.0),模拟在骶髂关节前方行重建钢板固定,在骶骨侧置入2枚螺钉,明确其可行性;(2)15例标本左侧骶髂关节为A组,骶骨侧植入2枚螺钉,右侧为B组,骶骨侧置入1枚螺钉,测量钢板内侧缘到腰4、5神经根前支的距离,然后行前后位、入口位、出口位X线片扫描,观测螺钉与骶髂关节的关系。结果:(1)MIMICS模拟显示骶骨侧植入2枚螺钉是可行的;(2)左侧上、下钢板到腰5神经前支的距离分别为(3.0±1.4)mm和(1.5±1.0)mm,左侧上、下钢板可在腰4神经前支深面安全穿过;右侧上钢板与腰4、5神经前支距离分别为(5.0±1.1)mm和(10.3±1.3)mm,而下钢板分别为(2.7±0.5)mm和(5.0±1.1)mm。(3)骨盆摄片提示左侧上钢板无螺钉进入骶髂关节,下钢板有4枚骶骨侧螺钉进入骶髂关节;右侧上下钢板骶骨侧螺钉均未进入骶髂关节。结论:考虑到骶髂关节固定的稳定性,前路双钢板骶骨侧上钢板置入2枚螺钉,下钢板置入1枚螺钉在临床上是可行的。Objective：To compare the anatomic security of applying different numbers of screws at the sacrum sides in the anterior double plates fixation of the sacroiliac joint and to clarify which is safer when the stability of the fixation is considered.Methods：（1） Totally 15 normal cadavers pelvis were scanned by CT.Thin-section CT scan data were saved and analyzed by the software Materialise’s interactive medical image control system（MIMICS 10.0）.The virtual operations of the anterior double plates approach for fixation of the sacroiliac joint were performed in the same software.（2）The left sides of the sacroiliac joint were named as group A,in which two screws were placed into the sacrum sides.The right sides of the sacroiliac joint were named as group B,in which one screw was placed into the sacrum sides.The distances from the medial edge of the plates to the lateral sides of the anterior branches of lumbar nerves 4,5 were measured.The relationship of the screws and the sacroiliac joint was checked by radiograph.Results：（1）In the virtual operations,the sacrum sides can accommodate two screws safely.（2）In group A,the distances from the medial edge of the upper and lower plates to the lateral sides of the anterior branches of lumbar nerve 5 were（3.0±1.4）mm and（1.5±1.0）mm respectively.The upper and lower plates can be placed below the anterior branches of lumbar nerve 4 safely.In group B,the distances from the medial edge of the upper plates to the lateral sides of the anterior branches of lumbar nerves 4,5 were（5.0±1.1） mm and（10.3±1.3）mm respectively and those from the medial edge of the lower plates were（2.7±0.5）mm and（5.1±0.9）mm respectively.（3）In X-ray examination,no screw of the left upper plates was found in the sacroiliac joint in group A and 4 screws of the left lower plates were observed.On the other hand,no screw of the right plates（lower and upper）in the group B was found in the sacroiliac joint.Conclusions：Two screws implanted into the sacru

关 键 词：骶髂关节 前方入路 螺钉 

分 类 号：R683.3[医药卫生—骨科学]