髋臼下螺钉置入方式及不同性别置钉参数的影像解剖学研究  

Infra-acetabular screw placements and gender difference:an imaging anatomical study of placement parameters

作　　者：鲁全义 高仕长[1] 余科权 杨海涛[2] Lu Quanyi;Gao Shichang;Yu Kequan;Yang Haitao(Department of Orthopaedics,The First Affiliated Hospital to Chongqing Medical University,Chongqing 400016,China;Department of Radiology,The First Affiliated Hospital to Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院骨科,400016 [2]重庆医科大学附属第一医院放射科,400016

出　　处：《中华创伤骨科杂志》2020年第12期1062-1068,共7页Chinese Journal of Orthopaedic Trauma

基　　金：重庆市技术创新与应用发展面上项目(cstc2020jscx-msxmX0062)。

摘　　要：目的探讨髋臼下螺钉的置入方式,并比较不同性别的置钉参数。方法回顾性纳入2018年10月至2019年10月期间重庆医科大学附属第一医院的100例成人正常骨盆CT数据,男、女各50例,年龄为18~86岁,平均49.0岁。利用Mimics19.0软件三维重建骨盆并导入Geomagic Studio软件。测量髋臼下螺钉通道直径(IACD)及髋臼内侧壁最小厚度(MTMAW),比较男、女性之间的差异,并分析IACD与MTMAW的关系。当IACD≥5 mm时置入3.5 mm全部埋入螺钉;当IACD<5 mm时,置入3.5 mm部分埋入螺钉。测量并比较男、女性置钉参数。结果男性IACD、MTMAW[(6.15±1.24)、(4.40±1.23)mm]显著大于女性[(5.42±1.01)、(3.60±0.81)mm],差异均有统计学意义(P<0.05);IACD与MTMAW呈正相关(r=0.859,P<0.001)。男性全部埋入螺钉进钉点位于髂耻隆起顶点后侧(8.03±2.01)mm、内侧(8.49±2.68)mm,女性分别为(8.68±2.35)、(8.87±2.79)mm;男性部分埋入螺钉进钉点位于髂耻隆起顶点后侧(10.49±2.58)mm、内侧(6.17±1.84)mm,女性分别为(10.10±2.63)、(6.63±1.49)mm;男性全部埋入螺钉与冠状面夹角后倾53.77°±7.64°,女性后倾54.20°±7.31°;男性部分埋入螺钉与冠状面夹角后倾55.85°±6.37°,女性后倾53.15°±7.89°,以上数据男、女性之间比较差异均无统计学意义(P>0.05)。男性全部埋入螺钉与矢状面夹角内倾1.02°±6.31°,女性外倾8.19°±6.81°;男性部分埋入螺钉与矢状面夹角外倾1.48°±6.97°,女性外倾7.90°±5.45°,男、女性之间比较差异均有统计学意义(P<0.05)。结论通过术前CT测量MTMAW可确定髋臼下螺钉的置入方式。部分埋入螺钉的进钉点较全部埋入螺钉偏外、偏后约2 mm,女性髋臼下螺钉通道直径较男性偏小,与矢状面夹角较男性偏外倾。Objective To investigate the infra-acetabular screw placements and compare the differences in placement parameters between genders.Methods The CT data of 100 normal adult pelves were retrospectively included,involving 50 males and 50 females,aged from 18 to 86 years(average,49.0 years).The three dimensional pelves were reconstructed using Mimics 19.0 software and imported into Geomagic Studio software.The diameters of the infra-acetabular screw corridor(IACD)and the minimum thickness of t he medial acetabular wall(MTMAW)were measured to analyze the relationship between them.All-in screws with a diameter of 3.5 mm were placed when the IACD was greater than or equal to 5 mm while in-out-in screws with a diameter of 3.5 mm were placed when the IACD was less than 5 mm.Screw placement parameters were compared between genders.Results The IACD and MTMAW in males(6.15 mm±1.24 mm and 4.40 mm±1.23 mm)were significantly larger than those in females(5.42 mm±1.01 mm and 3.60 mm±0.81 mm)(P<0.05);IACD was linearly correlated with MTMAW(r=0.859,P<0.001).The entry points of all-in screws were located at 8.03 mm±2.01 mm posterior and 8.49 mm±2.68 mm medial to the iliopubic eminence apex in males and 8.68 mm±2.35 mm posteriorly and 8.87 mm±2.79 mm medially in females,respectively.The entry points of in-out-in screws were located at 10.49 mm±2.58 mm posterior and 6.17 mm±1.84 mm medial to the iliopubic eminence apex in males and 10.10 mm±2.63 mm posteriorly and 6.63 mm±1.49 mm medially in females,respectively.The posterior inclination angle between all-in screw and coronal plane was 53.77°±7.64°in males and 54.20°±7.31°in females while the posterior inclination angle between in-out-in screw and coronal plane was 55.85°±6.37°in males and 53.15°±7.89°in females,showing no statistically significant differences between males and females(P>0.05).The medial inclination angle between all-in screw and sagittal plane in males was 1.02°±6.31°and the lateral inclination angle 8.19°±6.81°in females;the lateral incl

关 键 词：髋臼 骨折 成像 三维 骨钉 螺钉通道 

分 类 号：R687.3[医药卫生—骨科学]