外固定架在骨盆骨折中应用的解剖学研究  

Anatomical study on the application of external fixator in pelvic fractures

作　　者：郑军成 李晓涛[1] 李海龙 原义强 ZHENG Jun-cheng(The first affiliated hospital of Jiamusi University,Jiamusi 154000,China)

机构地区：[1]佳木斯大学附属第一医院,黑龙江佳木斯154000

出　　处：《牡丹江医学院学报》2020年第2期25-28,共4页Journal of Mudanjiang Medical University

摘　　要：目的在临床研究的基础上,应用解剖学方法探讨骨盆外固定架螺钉的入钉部位及安全角度,以给予临床应用相关的理论数据支持。方法于佳木斯大学解剖实验室中选取成人尸体样本12具,男性、女性各6具。采用前后双侧入路解剖,暴露完整骨盆,测量其髂前上棘及髂前下棘间距。后模拟手术操作,分别于距髂前上棘顶点5mm、15mm、25mm、35mm、及45mm五处入钉5cm深度,并测量各入钉点置入螺钉后钉头于各方向穿出骨质的临界角度。结果 (1)实验测得髂前上棘间距于性别间差异具有统计学意义(t=4.56,P=0.001)。(2)由髂前上棘顶点后5mm、15mm、25mm、35mm、及45mm处入钉后,其钉头穿出骨盆外侧骨质时与矢状面的角度于男性样本中分别为(30.41±0.62)°、(37.56±0.51)°、(37.66±0.69)°、(42.88±0.38)°、(41.88±0.32)°;女性则分别为(36.04±0.32)°、(36.60±0.35)°、(40.78±0.32)°、(36.48±0.42)°、(32.41±0.37)°;钉头向骨盆内侧面穿出骨质与矢状面的临界角度为男性(36.73±0.69)°、(40.58±0.65)°、(40.34±0.61)°、(49.73±0.45)°、(43.87±0.34)°,而女性分别为(40.24±0.30)°、(41.89±0.30)°、(45.78±0.31)°、(40.86±0.33)°、(37.42±0.40)°。以上数据于性别间差异均具有统计学意义(P<0.05)。(3)于5mm处入钉时钉头易向足侧穿出骨质,此时螺钉与横断面的临界角度男性为(38.45±1.25)°,女性(51.47±2.14)°;而于45mm处入钉时,钉头易向髂窝方向穿出,此时螺钉与横断面的临界角度为男性(32.08±0.32)°,女性(36.00±0.28)°。以上数据于性别间差异均具有统计学意义(P<0.05)。结论骨盆外固定架于髂前上棘处入钉的范围可位于距离髂前上棘顶点5~45mm之间,但5mm处需注意钉头易于髂前上棘方向穿出,而45mm处则易于髂窝方向穿出。除在术中应把握好螺钉大小、长度、入钉位置及安全入钉角度外,还需注意性别间数据的差异,以增加该术式于临床治疗中的成功率�Objective On the basis of clinical research,the anatomical method was used to discuss the nail insertion site and safety angle of the pelvic external fixation screw,so as to provide theoretical data for clinical application.Methods In the dissection laboratory of Jiamusi University,12 adult cadaver samples were selected,6 male and 6 female.The anterior and posterior bilateral approaches were used for anatomy,the complete pelvis was exposed,and the distance between the anterior superior iliac spine and the anterior iliac spine was measured.After simulating the operation,insert the nail 5 cm deep at 5 mm,15 mm,25 mm,35 mm,and 45 mm from the apex of the anterior superior iliac spine,and measure the screw head to penetrate the bone in all directions after placing the screw Critical angle.Results(1)Experimentally measured the difference of anterior superior iliac spine spacing between genders was statistically significant(t=4.56,P=0.001).(2)After inserting the nail 5 mm,15 mm,25 mm,35 mm,and 45 mm behind the apex of the anterior superior iliac spine,the angle between the nail head and the sagittal plane when passing through the lateral pelvic bone was(30.41±0.62)°,(37.56±0.51)°,(37.66±0.69)°,(42.88±0.38)°,(41.88±0.32)°,respectively,in the male samples.For the female samples,they were(36.04±0.32)°,(36.60±0.35)°,(40.78±0.32)°,(36.48±0.42)°,(32.41±0.37).The critical angle between the nail head penetrating the bone and the sagittal plane to the medial side of the pelvis was(36.73±0.69)°,(40.58±0.65)°,(40.34±0.61)°,(49.73±0.45)°,(43.87±0.34)°,while females are(40.24±0.30)°,(41.89±0.30)°,(45.78±0.31)°,(40.86±0.33)°,(37.42±0.40)°,respectively,in male samples.The above data were statistically significant between genders(P<0.05).(3)When the nail was inserted at 5 mm,the nail head easily penetrates the bone side of the foot.At this time,the critical angle between the screw and the cross section was(38.45±1.25)°for males and(51.47±2.14)°for females.When the nail was inserted at 45 mm,th

关 键 词：骨盆外固定架 髂前上棘 骨盆骨折 

分 类 号：R322.71[医药卫生—人体解剖和组织胚胎学] R687.3[医药卫生—基础医学]