基于数字模型设计髋臼后柱拉力螺钉固定导向器的可行性  

Feasibility of acetabular posterior column lag screw guide based on digital model design

作　　者：胡守力[1] 梅继文[1] 穆尚强[1] 李坤[1] 孙海光[1] 

机构地区：[1]吉林医药学院附属医院骨外科,吉林省吉林市132013

出　　处：《中国组织工程研究》2016年第48期7200-7205,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:髋臼前后柱骨折通常行切开复位钢板内固定修复效果较好,但此术式切口长,创伤大,出血多,手术时间较长。髋臼前后柱骨折应用松质骨螺钉固定早在1988年即被提出,且具有手术创伤小、骨折愈合快等优点。目的:通过计算机数字化技术建立髋臼骨折拉力钉固定数字模型,由此设计出髋臼后柱拉力螺钉进针导向装置,并应用于临床。方法:选取吉林医药学院附属医院自2012年6月至2015年6月行骨盆螺旋CT扫描的82例数据资料,行骨盆髋臼三维模型重建,根据资料数据制定髋臼后柱模拟置入拉力螺钉方案,并应用数字化技术进行模拟操作,由此设计髋臼后柱拉力螺钉进针导向装置,对导向装置进行体外髂骨标本测试,总结装置应用经验并最终应用于临床。结果与结论:(1)82例虚拟拉力螺钉置入全部获得成功,测得男性髂前上棘及髂后上棘骨突间距离为(158.13±6.94)mm,女性为(152.45±7.41)mm;虚拟拉力螺钉长度男性为(140.12±7.48)mm,女性为(126.37±9.17)mm;虚拟拉力螺钉直径男性为(12.21±1.86)mm,女性为(10.38±2.01)mm;(2)导向装置体外试验全部成功,其中准确定位8例,良好定位2例,优良率100%;(3)导向装置临床应用成功,术后患者无特殊不适,术后复查CT结果满意;(4)结果提示,通过髂前上棘、髂后上棘骨性突出点连线中点与坐骨结节连线置入螺钉固定髋臼后柱骨折是可行的,由此设计出的导航装置置钉成功率高,该导航装置在髋臼后柱骨折中可给予骨折固定更强的稳定性,效果可靠。BACKGROUND： Acetabular posterior column fracture is usually treated by open reduction and internal fixation, but this type of operation has a long incision, big trauma, bleeding, and long operation time. The application of cancellous bone screw fixation in the anterior and posterior column fractures of acetabulum has been put forward in 1988, and it has the advantages of less surgical trauma, and fast healing of fracture. OBJECTIVE： To establish acetabular fracture lag screw fixed digital model through the technology of digital computer, and then design an acetabular posterior column lag screw into the needle guide for clinical application. METHODS： Data of 82 cases receiving pelvic CT scanning in Affiliated Hospital of Jilin Medical College from June 2012 to June 2015 were selected. Pelvic and acetabular three-dimensional models were reconstructed. According to the data, acetabular posterior column simulation lag screw placement method was set. Simulation was operated by digital technology. Acetabular posterior column lag screw guide device was designed and tested in vitro bone specimens. The experience of device applications was summarized, and could be used in clinic. RESULTS AND CONCLUSION：（1） 82 cases of virtual lag screw implantation succeeded. The distance between anterior superior iliac spine and iliac bone spinous was（158.13±6.94） mm in males,（152.45±7.41） mm in females. Virtual lag screw length was（12.21±1.86） mm in males and（10.38±2.01） mm in females.（2） Guiding device in vitro tests was successful, including the accurate positioning in 8 cases, good positioning in 2 cases, with the excellent and good rate of 100%.（3） A guide device was successfully used in clinical application. Patients did not have special discomfort and postoperative CT showed satisfactory results.（4） These findings demonstrated that screw fixation through anterior superior iliac spine, posterior superior iliac spine bony prominent line midpoint and ischial tuberosity connection for acetab

关 键 词：髋臼 骨钉 内固定器 组织工程 骨科植入物 数字化骨科 三维重建 导向装置 经皮拉力螺钉 

分 类 号：R318[医药卫生—生物医学工程]