摘要
目的探讨髋臼前柱髓内螺钉治疗髋臼前柱骨折的解剖影像学参数，为临床应用提供参考。方法取30具国人尸体（男18具，女12具）完整骨盆标本。直视下分别置入右侧顺行和左侧逆行双侧髋臼前柱空心拉力螺钉，通过肉眼观测和多排螺旋CT二维重建，测量螺钉的进钉点、角度、钉道长度、螺钉与髋臼和盆腔的关系，确定最佳进钉点和安全角度。结果髋臼前柱逆行置钉点在耻骨结节处，距耻骨联合中线垂直距离为（17．15±1．82）mm，距耻骨上缘垂直距离为（20．51±2．19）mm；顺行置钉点距坐骨大切迹顶点的水平距离为（33．25±2．35）mm。逆行进钉的安全角度在矢状面头倾（32．1±2．7）°，冠状面外倾角度为（46．5±3．6）°，顺行置钉角度与逆行置钉角度相同，在矢状面和冠状面呈相反方向，左右侧略有不同（P〉0．05）。螺钉钉道长度为（119．5±2．2）mm，左右侧比较差异无统计学意义（P〉0．05）。螺钉的最大直径为7．2mm。结论髋臼前柱髓内螺钉固定有较高的准确性，可作为髋臼前柱钢板固定的一种有益的补充。
Objective To discuss the anatomical and radiographic parameters of medullary screw fixation of anterior acetabular column so as to provide reference for clinical application. Methods Thirty cadaveric pelvic specimens （including 18 males and 12 females） were involved in the study and fixated respectively with 30 retrograde medullary cannular lag screws through pubic tubercle to acetabular posterosuperior on the left side and with 30 anterograde medullary cannular lag screws through acetabular posterosuperior to pubic tubercle on the right side. Then, two-dimensional multiplanar CT reconstruction was done to measure the angle and length of the anterograde and retrograde medullary screw trajectory, the relationship of screws with acetabular bone and pelvis and determine optimal point and angle of screw insertion. Results The entrance of the retrograde medullary screw was located at pubic tubercle, with vertical dimension of （17.15±1.82） mm to pubic symphysis and that of （20.51 ± 2.19 ） mm to superior margin of pubis. For the anterograde medullary screw, the distance from the entrance of the screw to greater sciatic notch was （33.25 ±2.35 ） mm, with safe insertion angle of （32.1 ±2.7 ）° of cephalon tilting at the sagittal plane and （46.5 ±3.6）° of lateral tilting at the coronal plane. The entrance angle of the anterograde and retrograde medullary screw trajectory was similar, with only opposite direction and minor difference between the left and the right sides （ P 〉 0. 05 ）. The length of medullary screw trajectory was （ 119.5 ±2.2 ） mm, with insignificant difference between both sides （ P 〉 0.05 ）. The maximum diameter of the screw was 7.2 mm. Conclusions Medullary screw fixation of anterior acetabular column is clinically feasible but needs rather high accuracy and can be used as an alternative to plate fixation.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2009年第1期15-19,共5页
Chinese Journal of Trauma
基金
宁波市科技局择优委托社会发展基金资助项目（2008C50020）
关键词
髋臼
骨折固定术
髓内
解剖学
Acetabulum
Fracture fixation, intramedullary
Anatomy
