逆向骶骨翼⁃髂骨螺钉固定Tile C型骨盆骨折骶髂关节的最佳进针点及其初步临床应用  

Optimal insertion point of reverse sacral alar‑iliac screws in sacroiliac joint fixation for Tile type C pelvic fracture and its preliminary clinical application

作　　者：李栋[1] 王玮 周金华[2] 殷渠东 马运宏 Li Dong;Wang Wei;Zhou Jinhua;Yin Qudong;Ma Yunhong(Department of Radiology,Liyang People′s Hospital,Liyang 213000,China;Department of Orthopedics,Liyang People′s Hospital,Liyang 213000,China;Department of Orthopedics,Wuxi Ninth People′s Hospital,Wuxi 214062,China)

机构地区：[1]溧阳市人民医院放射科,溧阳213000 [2]溧阳市人民医院骨科,溧阳213000 [3]无锡市第九人民医院骨科,无锡214062

出　　处：《中华创伤杂志》2024年第7期614-622,共9页Chinese Journal of Trauma

基　　金：江苏大学2023年度医教协同创新基金(JDYY2023157);2020年度无锡市“太湖人才计划”顶尖医学专家团队项目(Wuxi⁃THTP⁃10)。

摘　　要：目的探讨逆向骶骨翼⁃髂骨螺钉(RSAIS)固定Tile C型骨盆骨折骶髂关节的最佳进针点及其初步临床应用效果。方法收集2022年1月至2023年1月溧阳市人民医院放射科数据库中的90例骨盆结构无异常患者CT数据,男女各45例;年龄21~69岁[(45.5±6.4)岁]。利用CT数字重建技术模拟RSAIS固定方法,测量前方可进针范围面积;分别取自位于髋臼后上方的髂骨⁃髋臼隐窝(A1),以及自A1横向向后1 cm(A2)、2 cm(A3)和纵向向下1 cm(A4)、2 cm(A5)共5个进针点,以S1椎弓根螺钉进针点作为出针点,行前、后连线所在5种钉道(对应5组)的横断面和矢状面CT扫描。2名观察者分别测量钉道解剖参数,包括钉道长度、宽度和高度,并分析观察者间的组内相关系数(ICC)。20具3D打印第5腰椎⁃骨盆⁃股骨标本,制作Tile C型骨盆骨折模型,分为5组,每组4具,前环均采用交叉螺钉固定,后环5组分别按上述5种钉道各置入1枚RSAIS固定,生物力学试验机测量300 N垂直载荷下各组整体位移和骶髂间隙局部位移。利用上述解剖和力学试验结果的最佳进针点规划钉道,沿规划钉道经皮置入1枚直径7.3 mm RSAIS固定治疗1例Tile C1型骨盆骨折患者,记录螺钉置入透视时间、螺钉位置,以及末次随访时骨折愈合、疼痛数字评分、Oswestry功能障碍指数(ODI)和骨盆骨折Majeed功能评分等情况。结果前方可进针范围面积为(1236.64±12.04)mm2。3个横向进针点所在钉道长度自前向后逐渐减少,其中A1组的长度最大为(104.9±10.4)mm,A2组其次为(98.5±9.8)mm,A3组最小为(92.7±9.7)mm(P<0.01),而钉道宽度和高度差异均无统计学意义(P>0.05);3个纵向进针点(A1、A4和A5组)所在钉道长度、宽度和高度比较,差异均无统计学意义(P>0.05),但A1较A4、A5距离髋臼缘更远。2名观察者测量三个钉道解剖参数ICC的最小值为0.88,最大值为0.98;95%CI下限最小值为0.90,最大值为0.96;95%CI上限最小值为0.95,最大�Objective To explore the optimal insertion point of reverse sacral alar⁃iliac screws(RSAIS)in sacroiliac joint fixation for Tile type C pelvic fracture and the effectiveness of its preliminary clinical application.Methods CT data from 90 patients with no abnormal pelvic structures in the Radiology Department database of Liyang People's Hospital from January 2022 to January 2023 were selected.There were 45 males and 45 females,aged 21-69 years[(45.5±6.4)years].With CT digital reconstruction technology,the RSAIS fixation was simulated and the anterior insertable area was measured.Five insertion points were at the ilium⁃acetabular recess in the area superior posterior to the acetabulum(A1),at 1 cm(A2)and 2 cm(A3)posterior transversal to A1,at 1 cm(A4)and 2 cm(A5)inferior longitudinal to A1.With the entry point of S1 pedicle screw as the exit point,the transverse and sagittal CT scans were conducted on 5 screw trajectories of anterior posterior lines(corresponding to five groups).The anatomical parameters of the screw trajectories,including the length,width and height of the screw trajectories were measured by two observers independently and the intraclass correlation coefficient(ICC)between the observers was analyzed.Tile type C pelvic fracture models were established from 203D⁃printed L5⁃pelvis⁃femur specimens and divided into 5 groups,with 4 specimens in each group.The anterior rings were fixed with cross screws while the posterior rings with one RSAIS in each group using one of the aforementioned 5 screw trajectories.The overall displacement and local displacement of the sacroiliac space under 300 N vertical load in all the groups were measured with a biomechanical machine.The screw trajectory was designed according to the optimal insertion point shown in the above anatomical measurements and mechanical experiments.An RSAIS with a diameter of 7.3 mm was inserted percutaneously to treat a patient with Tile type C1 pelvic fracture.The fluoroscopy time of screw insertion and screw position were recorded a

关 键 词：骶髂关节 骨盆 骨折固定术 内 生物力学 骶骨翼⁃髂骨螺钉 

分 类 号：R687.3[医药卫生—骨科学]