经皮空心拉力螺钉技术治疗耻骨联合分离的定量解剖研究  

Quantitative anatomical study of percutaneous cannulated lag screw fixation for treatment of symphysis pubis diastasis

作　　者：尹成国[1] 刘军 徐鹏[1] 刘志勇[1] 鲁嘉良 潘文龙[1] 穆卫东[1] 

机构地区：[1]山东大学附属省立医院创伤骨科,济南250021 [2]山东省阳信县人民医院外科

出　　处：《中华创伤杂志》2014年第6期589-593,共5页Chinese Journal of Trauma

基　　金：国家自然科学基金资助项目（81171708）;山东省自然科学基金资助项目（z2008c17）

摘　　要：目的通过对人尸体骨盆标本的局部解剖，确定经皮固定耻骨联合分离空心螺钉技术的安全进出钉点、进钉角度、长度及其与周围重要结构距离，为该技术临床应用提供理论基础。方法取成人防腐尸体骨盆标本15具，逐层显露耻骨联合及周围重要血管神经、精索或子宫圆韧带。测量耻骨联合多个部位的厚度及耻骨结节外缘至精索或子宫圆韧带距离。确定进、出针点并测量距上述重要结构的距离；测量进针深度及角度。模拟手术并通过拍片及CT重建证实手术效果。结果耻骨联合部位骨质厚度由上向下逐渐变薄，以耻骨结节部位最厚，该部位可完全容纳1枚7．3mm空心螺钉。进、出钉点距离股血管神经及精索或子宫圆韧带均〉5mm，手术操作安全。空心螺钉的适宜长度：男（73．6±1．3）mm，女（72．4±1．7）mm（t=3．146，P〈0．05），螺纹完全包埋于一侧耻骨结节内。导针在人体冠状面及横断面向尾侧、背侧倾斜成角，男性为（7．3±1．1）°、（6．4±1．0）°，女性为（6．8±1．5）°、（6．1±0．6）°。模拟手术标本拍片及CT检查证实空心螺钉钉道均位于骨质内，螺钉角度、长度均在所得实验数据范围内。结论经皮空心加压螺钉技术治疗耻骨联合分离是可行的、安全的。Objective To perform anatomic study on percutaneous cannulated-screw fixation of symphysis pubis diastasis in human cadaveric pelvic specimens so as to provide a basis for clinical practice of the technique. Methods Fifteen adult pelvic cadaveric specimens were dissected to expose pubic symphysis, peripheral major vascular nerve, spermatie cord and round ligament of the uterus. Thickness of pubic symphysis and distance between the outer edge of pubic tubercle and spermafic funicle or round ligament of uterus were measured respectively. Distances were measured respectively from entry and exit points to the above-mentioned structures in the direction of guide pin. Entry depth and angles of guide pin with the coronal plane and cross section of the human body were measured. Surgery was simula- ted to prove the surgery effect through post-surgery filming and CT. Results Thickness of symphysis pubis was gradually reduced from up to down. Pubic tubercle part was the most thick and it could accommodate a 7.3 mm cannulated-screw. Entry and exit points of cannulated-screw were in certain distances with the important nervusvascularis and spematicfunicle （ or round ligament of uterus） in the periphery, which were invulnerable to damages in the process of surgery. Proper lengths of cannulated screws were （73.6 ±1.3 ） mm for males and （72.4 ±1.7 ） mm for females （ t = 3. 146, P 〈 0.05 ）. Screw thread was completely embedded in pubic tubercle. Angles of guide pin with coronal plane and cross section of human body were （7.3± 1.1 ）° and （6.4 ±1.0） ° for males （6.9 ±1.5 ） ° and （6.1 ± 0.6） ° for females. Radiography and CT findings confirmed that all pin tracks were in the bone substances with angle and length of screws staying within the scope of experiment. Conclusion Percutaneous cannulated screw fixation is reliable and safe for symphysis pubis diastasis.

关 键 词：耻骨联合分离 骨钉 骨折固定术 内 解剖学 局部 

分 类 号：R687.3[医药卫生—骨科学]