经椎弓根定位骶髂螺钉导向器的研制及可行性研究  

Feasibility analysis of sacroiliac screw guide through pedicle orientation

作　　者：王治[1] 杨铁毅[1] 雷磊[1] 郑士伟[1] 刘树义[1] 叶维光 

机构地区：[1]上海市浦东新区公利医院骨科,200135

出　　处：《中国骨与关节损伤杂志》2014年第3期263-265,共3页Chinese Journal of Bone and Joint Injury

基　　金：上海市浦东新区科技发展基金创新基金资助项目(PKJ2010-Y18)

摘　　要：目的探索经椎弓根定位引导骶髂螺钉置入的可行性,设计导向器并初步验证其安全性。方法通过对100例(男女各50例)正常成人S1椎弓根与骶髂关节间特殊解剖关系的CT影像学测量,以明确经椎弓根定位引导螺钉置入的安全角度范围。据此制作导向器,并在5具模拟骨盆(10例骶髂关节)上进行初步安全性验证。结果水平、冠状面上骶髂通道最窄处宽度及最窄处横截面积完全允许骶髂螺钉的置入;当定位针定位于S1椎体中心时,在水平面、冠状面上男性分别有(16.93±6.14)°、(27.11±7.18)°的安全范围,女性为(17.60±2.74)°、(28.28±6.12)°的安全范围,且男、女组间比较差异无统计学意义(P>0.05);经导向器置入10枚螺钉位置良好,无置钉不当或置钉失败。结论经椎弓根定位引导螺钉置入安全、可行。对于传统置钉方式不适合的骶骨侧块下倾角较大者,或是骶髂通道过于狭窄者,若在空间上允许骶髂螺钉的置入,均可应用导向器置钉。Objective To explore feasibility of sacroiliac screw placement through the pedicle spotting, provide experimental evidence and safety for the application of screw placement by the pedicle position. Methods One hundred normal adult pelvises were measured for special anatomical relationship between S, pedicle and lateral mass by CT imaging to decide the security angle range for pedicle positioning guide screw placement. The guide was made according to measured data, and the safety was tested in the 5 simulation pelvis （10 cases of sacroiliac joint）. Results Both in passage of sacroiliac sagittal and transverse plane, even at its narrowest, the width and cross-sectional area were sufficient for placing screw; When locating pin in the center point of S,, the safety angle in sagittal and transverse section between different gender： Man （16.93±6.14）°, （7.11±7.18）°, women （17.60±2.74）°,（28.28±6.12）°, there was no significant difference （P 〉0.05）. The guide, designed by data analysis, was successfully used to place pedicle screw in 10 cases of sacroiliac joint, no screws were poorly located, or failed. Conclusion The screw placement by the pedicle positioning is safe and feasible. It is simple to place pedicle screw by director, and the indications and contraindications are the same as traditional pedicle screw way. The guide could be used to patients unsuitable for traditional pedicle screw, such as greater next angle of sacrum lateral mass, narrow sacroiliac channel, if there is enough space for screws.

关 键 词：骶髂关节 导向器 研制 骶髂螺钉 安全区 

分 类 号：R318.6[医药卫生—生物医学工程]