骶髂螺钉治疗骶髂关节损伤时钉道参数的CT测量  

The measurement of the screwing trajectory′s parameters of the sacroiliac screw for iliosacral joint disruption by the computed tomography

作　　者：魏巍[1] 王晖[2] 夏志勇[2] 王磊 WEI Wei;WANG Hui;XIA Zhi-yong;WANG Lei(Second Department of Orthopedics,Halixun International Peace Hospital,Hebei Province,Hengshui 053000,China;Fourth Department of Orthopedics,Handan Branch of Jizhong Energy Fengfeng Group General Hospital,Hebei Province,Handan 056000,China;Department of Anatomy,the School of Medical College,Hebei Medical University,Shijiazhuang 050017,China)

机构地区：[1]哈励逊国际和平医院骨二科,河北衡水053000 [2]冀中能源峰峰集团总医院邯郸院区骨四科,河北邯郸056002 [3]河北医科大学基础医学院人体解剖学教研室,河北石家庄050017

出　　处：《河北医科大学学报》2018年第3期293-296,300,共5页Journal of Hebei Medical University

基　　金：河北省科技计划项目(15277751D)

摘　　要：目的实施精确骶髂螺钉钉道参数的CT测量,为骶髂螺钉治疗骶髂关节损伤提供理论基础。方法对20例(40侧骶髂关节)正常中国成人骨盆标本进行研究,模拟骶髂螺钉内固定手术方法,进行螺旋CT扫描,对骶髂螺钉的理想钉道参数包括进针点与不同解剖结构之间的距离、进针方向、螺钉长度、安全角度等进行测量。结果骶髂螺钉的理想长度为(86.927±1.813)mm,最大直径为(20.541±1.412)mm。进针点距臀肌线的距离为(20.121±2.986)mm,距坐骨大切迹的距离为(40.424±2.018)mm。距髂后上棘及下棘的距离分别为(36.987±1.596)mm、(37.412±1.328)mm。距对侧前皮质、椎体中点、及椎弓根中心的距离则分别为(86.967±4.210)mm、(71.615±3.932)mm和(52.428±2.981)mm。骶髂螺钉与冠状面、水平面的夹角分别为(25.065±1.121)°和(20.019±1.524)°。冠状位及轴位CT测量进针与髂骨外板的交角分别为(90.621±3.672)°和(90.476±2.993)°。骶髂螺钉在冠状面、轴状面上的安全角度分别为(19.623±1.617)°和(24.514±1.672)°。结论骶髂螺钉治疗骶髂关节脱位具有效果好、创伤小、费用低、操作简单、定位准确等优点。术前行CT扫描,可为患者骶髂螺钉治疗骶髂关节损伤提供安全、快速、准确的个体化手术方案。Objective To explore a more accurate and simple method which measures the screwing trajectory′s parameters of the sacroiliac screw by the computed tomography,so as to provide the related theoretical basis for the safty of the sacroiliac screw path during the iliosacral screw fixation for iliosacral joint disruption.Methods Twenty pelvis specimens(40 sacroiliac joint)of native adults were studied.The iliosacral screw fixation had been taken on all pelvis specimens,and then the CT scans were done.The screwing trajectory′s parameters of the sacroiliac screw were measured,including the distances from the inserting point to various structures of pelvis,such as the inserting direction of the guidewire,the length from the inserting point and the safety angle.Results The diameter of the deal screw was(86.927±1.813)mm,and the maximum length was(20.541±1.412)mm.The diatance from the entry point to the crista glutea,the greater sciatic notch,the posterior superior iliac spinethe,posterior inferior iliac spine,the contrary anterior cortex of vertebral body,the central part of vertebral body,and the most narrow part of pedicle of vertebral arch were(20.121±2.986)mm,(40.424±2.018)mm,(36.987±1.596)mm,(37.412±1.328)mm,(86.967±4.210)mm,(71.615±3.932)mm,and(52.428±2.981)mm,respectively.The angles of the ideal screw was(25.065±1.121)°to coronal plane,and(20.019±1.524)°to the horizontal plane.The angles between guide wire and iliac surface in axial CT scans and in coronal CT scans were(90.621±3.672)°and(90.476±2.993)°.The safe angle of the screw trajectory was(24.514±1.672)°to the axial plane,and(19.623±1.617)°to the coronal plane.Conclusion The techinque of the sacroiliac screw fixation for iliosacral joint disruption has the advantage of good results,mall trauma,and little cost,which was a simple and accurate method.The measurement of the screwing trajectory′s parameters of the sacroiliac screw through the computed tomography before the operation of internal fixtion,could provide a safe,simple and accura

关 键 词：骶髂关节 创伤和损伤 骶髂螺钉 

分 类 号：R684.75[医药卫生—骨科学]