经皮横向骶髂关节螺钉固定骶骨纵形骨折的数字化分析与临床应用  

Digital analysis and application of percutaneous transverse sacroiliac screw fixation for longitudinal sacral fracture

作　　者：张元智[1,2] 王军强[3] 路全立[1] 李志军[2] 李亚光[4] 裴国献[5] 

机构地区：[1]内蒙古医科大学附属医院骨科,呼和浩特010050 [2]内蒙古医科大学数字医学中心 [3]北京积水潭医院创伤骨科 [4]内蒙古医科大学第二附属医院环骨盆科 [5]第四军医大学西京医院骨科

出　　处：《中华创伤骨科杂志》2014年第5期377-380,共4页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（61372178）

摘　　要：目的 利用CT三维重建和逆向工程技术,探讨经皮横向骶髂关节螺钉固定骶骨纵形骨折的最优钉道建立及其临床应用效果.方法 选取50名健康成年志愿者,男30名,女20名;年龄为18～56岁,平均34.6岁.行腹部连续螺旋CT扫描,将原始.dicom格式数据导入Mimics InnovationSuite 15.0软件,三维表面重建骨盆,以.stl文件格式存储,导入Imageware 12.0软件,对标准骶骨前后位进行多层剖分,确定最优钉道.2011年1月至2012年8月共收治12例骶骨纵形骨折患者,男8例,女4例;年龄为18 ～53岁,平均39.5岁;骶骨骨折按Denis分型：Ⅰ型7例,Ⅱ型5例.采用上述方法计算最优通道.手术采用标准仰卧位,C型臂X线机获得骶骨侧位图像,定位骶髂关节螺钉通道,在皮肤上做标记,置入2.5 mm克氏针,沿克氏针以7.3mm空心螺钉固定,术后通过CT扫描及三维重建验证其准确性.结果 最优通道位于S1中后1/3交界,最优通道与垂线的夹角平均为85.6°±7.3°,通道长度平均为（131.3±7.7） mm.术后X线片及CT平扫断层图像显示所有患者骶髂关节螺钉位置及长度满意,平均长度为（114.2±4.2） mm,平均手术时间为35.1 min.所有患者均未发生神经、血管损伤、骶髂关节螺钉松动及断裂等并发症. 结论 通过CT数据构建的横向骶髂关节螺钉通道可为经皮横向骶髂关节螺钉固定骶骨纵形骨折提供可靠的解剖学基础,且简化了手术过程.Objective To explore the optimal channel for percutaneous sacroiliac screw fixation in the treatment of longitudinal fracture of the sacrum using three-dimensional （3D） reconstruction of CT images and reverse engineering technique.Methods Firstly,abdomen CT scanning images of 50 healthy adult volunteers （male 30,female 20,18 to 56 years of age,34.6 years on average）,were transformed into Mimics Innovation Suite 15 software for 3D reconstruction of the pelvis.Models of the pelvis reconstructed were stored in.st1 format and then transferred into Imageware 12.0 software.In standard antero-posterior position,the sacrum was segmented and the points of 2D image coordinate geometry boundary were extracted to generate the optimal screw channel.Secondly,we treated 12 patients with sacrum longitudinal fracture from January 2011 through August 2012 （male 8,female 4,18 to 53 years of age,39.5 years on average）.By Denis classification,7 cases were type Ⅰ and 5 type Ⅱ.The optimal screw channel was calculated by the way described above.Standard images of lateral sacrum were acquired before operation by C-arm X-ray.The operation was conducted in standard supine position.After the skin was marked,a 2.5 mm Kirschner wire was drilled into the bone.Along the Kirschner wire,a 7.3 mm hollow screw was used for fixation.Postoperative CT scans and 3D reconstruction models were analyzed to validate the accuracy of screw channel.Results The optimal channel was at the 1/3 borderline of S1; its average angle to the vertical line was 85.6°± 7.3°; its average length was 131.3±7.7 mm.The postoperative X-ray and CT scanning images showed that the position and length of the screw were satisfactory,with an average length of 114.2 ±4.2 mm.The average operation time was 35.1 minutes.No nerve or vascular injury,sacroiliac screw loosening,fracture or other complications occurred in all patients.Conclusion The optimal screw channel which is constructed with CT data may provide a reliable anatomical basis and simplify the operationa

关 键 词：骶骨 骨折 骨钉 成像 三维 骶髂关节 

分 类 号：R687.3[医药卫生—骨科学]