逆行螺钉置入固定骨盆耻骨上支骨折的数字解剖学参数

Digital anatomical parameters of retrograde screw placement for superior pubic ramus fractures

  • 摘要: 目的 对骨盆3D模型进行数字螺钉模拟及置入,以获取逆行螺钉在耻骨联合下角入钉时的最佳通道参数,为临床安全置入螺钉固定骨盆耻骨上支骨折提供理论依据。 方法 随机收集解放军总医院CT室于2016年7月-2017年9月归档的50例非骨盆骨折患者的CT图像,导入MIMICS软件重建骨盆3D模型。分别用数字螺钉进行模拟置入,从耻骨结合处开始测量逆行钉道的直径和钉道长度以及钉道与矢状面和冠状面的夹角。 结果 男性最狭窄区平均直径为(7.54±1.02) mm;女性最狭窄区平均直径为(6.23±1.61) mm;以φ4.5 mm数字螺钉模拟置入时,样本中钉道与矢状面、冠状面和横截面的平均夹角:男性(51.10±3.26)°、(8.24±1.33)°、(39.47±2.58)°,女性(53.44±3.78)°、(8.45±2.15)°、(35.26±4.76)°。 结论 根据Nakatani骨折分型,当耻骨上支骨折发生在Ⅰ区时,以耻骨联合下角作为穿针点,参考上述夹角可以获得内侧骨折部分足够的螺钉通道长度。

     

    Abstract: Objective To obtain the optimal channel parameters of the retrograde screw with subpubic symphysis joint as optimal entry point through 3D pelvic model reconstruction and virtual optimal insertion, so as to provide a theoretical basis for the clinical safety screw fixation for superior pubic ramus fractures. Methods CT images of 50 patients with non-pelvic fracture from Chinese PLA General Hospital from July 2016 to September 2017 were randomly collected and imported into MIMICS software to reconstruct pelvic 3D models. Digital screws were used to simulate insertion from the pubic symphysis. The diameter and length of the screw were measured, as well as the angle between the screw axis and three planes. Results The average diameter of the narrowest zone was (7.54±1.02) mm in male and (6.23±1.61) mm in female. For φ4.5 mm digital screw, the angle between the screw track and sagittal plane, coronal plane and transverse palne were (51.10±3.26)°, (8.24±1.33)°, (39.47±2.58)° in male, and(53.44±3.78)°, (8.45±2.15)°, (35.26±4.76)° in female, respectively. Conclusion Based on Nakatani fracture classification, when the suprapubic fracture occurs in zoneⅠ, the entry point can be selected in the subpubic symphysis to achieve adequate screw track length to fix fracture.

     

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