骶骨近端发育异常与骶髂螺钉精准置入的影像学及临床研究  

Imaging and clinical study on the relationship between abnormal development of the proximal sacrum and precise insertion of sacroiliac screws

作　　者：孙玉玺 贾健[1] 田维[1] 刘兆杰[1] 戚浩天 李鹏飞[1] 白树财 Sun Yuxi;Jia Jian;Tian Wei;Liu Zhaojie;Qi Haotian;Li Pengfei;Bai Shucai(Department of Pelvic Trauma,Tianjin Hospital,Tianjin 300211)

机构地区：[1]天津市天津医院创伤骨盆科,天津300211

出　　处：《中华骨科杂志》2023年第12期797-804,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨机器人辅助骶髂螺钉置入治疗骶骨近端发育异常骶骨骨折患者的临床疗效。方法回顾性收集2016年5月至2021年1月天津市天津医院骨盆科行机器人辅助骶髂螺钉置入治疗的骶骨骨折患者191例,男105例、女86例,年龄(38.5±6.5)岁(范围19~69岁)。骶骨近端发育异常85例,按骶骨近端发育异常分型方法分为骶骨翼斜坡陡峭组60例、乳突样凸起组30例、腰椎骶化组25例、骶孔卵圆变组23例及S1前侧皮质凹陷组10例;余106例为发育正常者。对85例骶骨近端发育异常者进行髂骨皮质密度线(iliac cortical density,ICD)分型;记录骶髂螺钉置入完成情况、术后螺钉位置Gras评分、术后并发症发生情况、测量S1螺钉通道最小直径R1、测量S1骶髂螺钉在冠状面与头侧的夹角∠A,在水平面与腹侧的夹角∠B,分别与106例发育正常患者通道直径及置入后角度进行比较。结果骶骨翼斜坡陡峭发生率最高(31.4%,60/191),24例存在两种或两种以上发育异常;85例骶骨近端发育异常者ICD线Ⅰ型8例、Ⅱ型12例、Ⅲ型65例。49例(58.8%,49/85)能够完成S1骶髂螺钉置入,36例(35.3%,36/85)仅能完成S2骶髂螺钉置入。术后螺钉位置Gras评分Ⅰ级90.05%、Ⅱ级9.94%、Ⅲ级0。术后1例骶髂螺钉穿出骶骨前侧皮质,1例螺钉部分螺纹进入骶孔内,无医源性神经损伤症状。术前骶骨翼斜坡陡峭组、乳突样凸起组、骶孔卵圆变组、腰椎骶化组、S1前侧皮质凹陷组、发育正常患者组R1分别为(11.4±3.0)、(11.6±3.2)、(9.8±3.0)、(8.8±4.2)、(6.5±4.4)、(11.4±3.4)mm,腰椎骶化组、骶孔卵圆变组及S1前侧皮质凹陷组分别与发育正常患者比较差异有统计学意义(t=-3.05,P=0.005;t=-2.32,P=0.022;t=-3.45,P=0.006)。术后六组∠A分别为33.8°±4.2°、20.8°±3.5°、25.8°±2.5°、35.5°±4.5、27.8°±3.5°、26.8°±5.0°,∠B分别为27.8°±3.5°、36.2°±3°、26.3°±1.8°、29.8°±2.7°、14.8°±1.5°、37.2±4Objective To investigate the clinical efficacy of robot-assisted sacroiliac screw implantation in the treatment of proximal dysplasia sacral fractures.Methods A retrospective analysis was conducted on 191 patients admitted to the Pelvic Department of Tianjin Hospital from May 2016 to January 2021 who underwent robot assisted sacroiliac screw implantation with sacral fractures,including 105 males and 86 females,aged 38.5±6.5 years(ranging from 19 to 69 years old).Among them,there were 85 patients with dysplasia of proximal sacrum.According to the classification of proximal sacral dysplasia,the patients were divided into five groups:the steep sacral alar slope group(n=60),the mastoid protrusion group(n=30),the lumbar sacralization group(n=25),the sacral foramen oval degeneration group(n=23)and the S1 anterior cortical depression group(n=10).The remaining 106 patients were normal group.Iliac cortical density(ICD)line typing was recorded in the 85 patients.The the completion of sacroiliac screw implantation,the Gras score of screw position after operation,the postoperative complications,the minimum diameter of S1 screw channel(R1),the angle∠A between the S1 sacroiliac screw in the coronal plane and the cephalic side,and the angle∠B between the S1 sacroiliac screw in the water plane and the ventral side were recorded and compared with those of normal development patients.Results The incidence of steep sacral alar slope was the highest(31.4%,60/191).There were 2 or more developmental abnormalities in 24 cases.In 85 cases with dysplasia of proximal sacrum,ICD line type I was found in 8 cases,type II in 12 cases and type III in 65 cases.49 patients(58.8%,49/85)were able to complete the implantation of S1 sacroiliac screw,while 36 patients(35.3%,36/85)were only able to complete the implantation of S2 sacroiliac screw.The Gras score of postoperative screw position was 90.05%for grade I,9.94%for grade II,and 0 for grade III.In 1 case the sacroiliac screw pierced through the anterior cortex of the sacrum,and in 1 case t

关 键 词：骶骨 骨疾病 发育性 骨折固定术 内 机器人手术 

分 类 号：R687.3[医药卫生—骨科学]