带前柱顺行拉力螺钉导向装置髋臼后方解剖钢板的设计与验证  

Clinical anatomic study of the lag screw guide device for the acetabulum anterior column

作　　者：张立峰[1] 林创鑫 曹生鲁 汪秫然 彭赓[1] 徐勇强[3] 冯永增[4] 王钢[1] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州501515 [2]南方医科大学第三附属医院骨科,广州510630 [3]湖南省人民医院,长沙410005 [4]温州医科大学第二附属医院,325027

出　　处：《中华骨科杂志》2016年第9期546-552,共7页Chinese Journal of Orthopaedics

基　　金：广东省自然科学基金（10151051501000085）;广州市科技计划基金（2013J4100104）;AO创伤亚太研究基金（2010）

摘　　要：目的设计带顺行前柱拉力螺钉导向装置的髋臼后方解剖钢板，并验证其可行性及疗效。方法收集2012年7月至2014年8月因多发伤而行完整骨盆螺旋cT扫描的56例患者cT扫描数据，男27例，女29例；年龄20～77岁，平均（42．7±20．7）岁。导入Mimics重建骨盆的数字模型并在髋臼后方模拟向前柱置入拉力螺钉，测量进钉点的位置和进针方向及拉力螺钉的最大直径，设计出实体的导向器装置，并在19具骨盆标本上进行验证。结果进针点与坐骨大切迹顶点的距离女性为（25．11±5．91）mm，男性为（17．51±2．94）mm；进针点到坐骨棘的距离，女性为（60．11±5．37）mm，男性为（52．64±6．30）mm；进钉方向前倾角〈θ，女性为69．72°±5．66°，男性为78．14°±3．50°；进钉方向外倾角〈￡，女性为75．55°±13．66°，男性为62．18°±8．60°；拉力螺钉的直径，女性为（6．18±1．73）mm，男性为（6．43±2．16）mm。男性与女性在进钉点位置和进针方向上存在统计学差异。在19具骨盆标本上进行验证，结果显示导向器辅助置钉组的成功率为84．21％（16／19），传统置钉组的成功率为31．58％（6／19）。结论设计带有导向装置的髋臼后方解剖钢板可提高前柱顺行拉力螺钉置钉的成功率和准确性，从而降低手术风险和减轻手术损伤。Objective To measure anatomical parameters of the guide device for antegrade lag screw fixation for the frac- tures in the anterior column of acetabulum. Methods 56 cases （29 female and 27 male） pelvis CT scans were collected to this clinical anatomic study. After virtual antegrade lag screw was successfully implanted in the anterior column of acetabulum, the screw entry point and entry angle of inclination were separately measured and statistically analyzed. These parameters were then used to design the guide device and be verified on 19 pelvis specimens. Results The average distance from the entry point to apex of greater sciatic notch was 25.11 ±5.91 mm in female and 17.51±2.94 mm in male, while the distance from the entry point to ischial spine was 60.11 ±5.37 mm in female and 52.64±6.30 mm in male. The average anteversion angle of screw was 69.72°± 5.66° in female and 78.14°±3.50°in male, while the extraversion angulation was 75.55°± 13.66° in female and 62.18°±8.60° in male. The maximum diameter of the lag screw was 6.18±1.73 mm in female and 6.43±2.16 mm in male. The success rate of the screw implantation assisted by the guide device was 84.21% （16/19）; while the rate decreases to 31.58% （6/19） in traditional meth- od. Conclusion Guide device for antegrade lag screw could improve the success rate and accuracy of the screw implantation in the anterior column of acetabulum and reduce the surgery risk, as well as minimize operative trauma.

关 键 词：髋臼 骨折 内固定器 

分 类 号：R687.3[医药卫生—骨科学]