经S3侧块髂骨螺钉在成人脊柱骨盆内固定术中的置钉路径研究  

Study on the nailing path of S3 ala - iliac screw in adult spinal pelvis fixation

作　　者：惠宝锋 王志杰[1] 褚言琛[1] 侯庆先[1] 杨文玖[1] 宫硕 Hui Baofeng;Wang Zhijie;Chu Yanchen;Hou Qingxian;Yang Wenjiu;Gong Shuo(Department of Spinal Surgery, Affiliated Hospital of Qingdao University Qingdao University, Qingdao 266000, Chin)

机构地区：[1]青岛大学附属医院脊柱外科,266000

出　　处：《中华实验外科杂志》2018年第4期770-772,共3页Chinese Journal of Experimental Surgery

摘　　要：目的通过3D打印脊柱骨盆模型及计算机软件辅助导航，介绍S3髂骨螺钉内固定的置钉入路及参数分析。 方法通过3D打印模型及计算机软件相关数据确定S3节段的置钉空间，并选取本次髂骨螺钉进针点位置。随机抽取已进行过骨盆三维CT重建扫描的男女成年患者图像各20份，选取本次已确定可以进钉的螺钉入点（O），以身体冠状面或骶骨水平横切面为水平切面（X），测量球形探针进针偏角最小角度范围（A）、最大角度范围（B）及最佳进钉角度范围（Z），并测量本次进针点位置螺钉钉道长度及宽度。对应成人3D打印模型中证实本次新型置钉方式的准确性及安全性。 结果进针角度由最小角度OA范围至最大角度OB角度范围内，在最窄横径超过7 mm的条件下，均可安全置入万向髂骨螺钉（平均长度80～90 mm）进行固定。进针角度范围：男性X-OA-OB平面[（47.1±1.9）°～（56.7±1.4）°]，最佳角度X-OZ范围[（52.3±1.1）°]；女性X-OA-OB平面[（49.6±0.8）°～（59.9±1.1）°]，最佳角度X-OZ范围[（53.7±0.8）°]。钉道长度范围：男性OA平面为（91.4±2.3） mm，OB平面为（89.5±4.6） mm，OZ平面范围为（94.2±2.1） mm；女性OA平面为（90.4±1.9） mm，OB平面为（85.6±2.3） mm，OZ平面范围为（96.4±1.7） mm。在最佳置钉角度OZ，男性与女性比较，置钉角度（F＝4.276，P＝0.001）及置钉长度比较差异均有统计学意义（F＝3.647，P＝0.001）；OA中，男性与女性的置钉偏角数值比较，差异有统计学意义（F＝5.268，P＝0.001），置钉长度数值比较差异无统计学意义（F＝1.513，P＝0.139 ）。OB中，男性与女性比较，置钉角度（F＝8.153，P＝0.001）及置钉长度比较差异均有统计学意义（F＝3.341，P＝0.002）。在相同的置钉平面上，不同性别的成人钉道尾向偏角数值差异无统计学意义（P〉0.05）。 结论经S3侧�ObjectiveThe screw insertion and parameters of S3 ala-iliac screw fixation were introduced by 3D printing spinal pelvis model and computer software-assisted navigation. MethodsDetermine the nailing space of the S3 segment by 3D printing model and computer software related data, and select the position of the iliac screw into the needle point. Twenty of the male and female adult patients who had undergone three-dimensional pelvic CT reconstruction scans were randomly selected. The screw point O was selected, the horizontal section X was the coronal or sacral horizontal cross-section. Spherical probe into the minimum angle of the needle angle range A, the maximum angle range B and the optimal range of nailing angle Z was measured, and the needle point screwed into the screw pin length and width. The accuracy and safety of this new method of nailing were confirmed in the corresponding adult 3D printing model. ResultsThe needle angle is within the range of the minimum angle OA to the maximum angle OB. If the narrowest diameter is more than 7 mm, the fixation can be safely done with a universal Iliac screw （average length 80-90 mm）. The range of needle angle was （47.1±1.9）°-（56.7±1.4）° for the male X-OA-OB plane and （52.3±1.1）° for the optimal angle. The X-OA-OB plane for women was 49.6±0.8）°-（59.9±1.1）°, the best angle X-OZ range （53.7±0.8）°. The range of nail path length was （91.4±2.3） mm for OA, （89.5±4.6） mm for OB and （94.2±2.1） mm for OZ. The OA level of female was （90.4±1.9） mm, （85.6±2.3） mm, OZ plane range （96.4±1.7） mm. The statistical results showed that in the best setting angle OZ, nail angle differences （F=4.276, P〈0.05） and nail length were statistically significant （F=3.647, P〈0.05） in men and women in comparison; OA, men and women, nail angle The difference was statistically significant （F=5.268, P〈0.05）, nail length lost statistical significance （F=1.513, P〉 0.05）. OB, male and female, nail angle differe

关 键 词：脊柱骨盆固定 髂骨螺钉 螺旋计算机导航 3D打印及三维重建 

分 类 号：R687.3[医药卫生—骨科学]