髋臼后柱螺钉固定安全性的解剖学研究  

Anatomic study of plate-screw fixation of the posterior column of the acetabulum

作　　者：宋朝晖[1] 张英泽[1] 潘进社[1] 彭阿钦[1] 白晓谊[2] 韩长玲[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心,石家庄050051 [2]河北省人民医院,石家庄050051

出　　处：《中国临床解剖学杂志》2004年第2期136-138,共3页Chinese Journal of Clinical Anatomy

基　　金：河北省科技攻关计划项目 (0 32 761 96D - 2 8)

摘　　要：目的 :探讨髋臼后柱的解剖学结构和螺钉放置的安全角度和范围。方法 :取 2 0具骨盆标本 ,在X线透视下确定髋臼上缘距坐骨大切迹顶点和髋臼下缘距坐骨棘基底中点的距离 ,CT垂直扫描后柱 ,测量距髋臼上缘 0 .5 ,1.0 ,1.5 ,2 .0 ,2 .5 ,3 .0 ,3 .5 ,4.0cm的CT断面上后柱宽、髋臼宽。根据髋臼在后柱表面的投影 ,将后柱分为髋臼区 ,相对危险区和危险区 ,并测量距后柱内缘 1cm处 2 .5cm螺钉进钉的安全角度。结果 :髋臼上缘在坐骨大切迹顶点下 (1.0± 0 .2 )cm ,髋臼下缘在坐骨棘基底中点下 (1.2± 0 .2 )cm ,距髋臼上缘 0 .5 ,1.0 ,1.5 ,2 .0 ,2 .5 ,3 .0 ,3 .5 ,4.0cm的CT断面上 ,后柱宽分别为 (5 0 .6± 3 .8)、(4 7.9± 3 .0 )、(4 6.1± 3 .6)、(4 1.5± 4.8)、(4 3 .5± 4.8)、(4 3 .0± 4.4)、(4 3 .2± 4.6)、(4 2 .6± 4.3 )mm ;髋臼宽分别为 (15 .4± 3 .6)、(2 0 .3± 3 .3 )、(2 3 .7± 3 .4)、(2 4.7± 3 .5 )、(2 6.0± 3 .6)、(2 4.7± 3 .0 )、(2 1.7± 4.6)、(18.3± 7.2 )mm ;在不同断面上只要进钉角度小于 10 9°均可满足螺钉放置的安全要求。结论 :危险区内不能垂直打钉 ,相对危险区内可以以适当的角度放置螺钉。Objective: To investigate the anatomical structures of the posterior column of the acetabulum and to develop a safe path for screw placement into it. Methods: Twenty pelvis specimens were used to test the distance from the top of greater sciatic notch(TGSN) to the superior acetabular margin(SAM), and from the fundus midpoint of sciatic spina(FMSS) to the inferior acetabular margin(IAM). CT scan was performed. The plane of the cross-section was perpendicular to the posterior column. The average width of the posterior column and the acetabulum at 0.5, 1.0, 1.5, 2.0,2.5,3.0,3.5,4.0 cm inferior to the superior acetabular boundary was tested. According to the projection of the acetabulum onto the anterior surface of the posterior column, the posterior column was divided into the acetabulum region, the relatively danger zone, and the danger zone. The safe angulation of screw placement was also calculated. Results: The distance from TGSN to SAM and from FMSS to IAM were (1.0±0.2)cm ,( 1.2±0.2)cm respectively. The average width of the posterior column at 0.5, 1.0,1.5, 2.0,2.5,3.0,3.5,4.0 cm inferior to the superior acetabular boundary were( 50.6±3.8)mm,(47.9±3.0)mm,(46.1±3.6)mm,(41.5±4.8)mm,(43.5 ±4.8)mm,(43.0±4.4)mm,(43.2±4.6)mm,(42.6±4.3)mm, respectively;The average width of the acetabulum were (15.4±3.6)mm,(20.3±3.3)mm,(23.7±3.4)mm,(24.7±3.5)mm,(26.0±3.6)mm,(24.7±3.0)mm,(21.7±4.6)mm,(18.3±7.2)mm respectively; The safe angulation at various section should smaller than 109°. Conclusion: Screws directed perpendicularly to the posterior column in the danger zone will violate the hip joint. Screws can be safely placed into the relative danger zone at proper angulation.

关 键 词：髋臼 解剖 内固定 

分 类 号：R683.3[医药卫生—骨科学]