摘要
目的运用CT三维重建及3D打印技术进行改良髂骨螺钉技术的相关解剖学观测及钉道设计,探讨改良髂骨螺钉技术的可行性。方法回顾性纳入2015年4月—2017年3月佛山市中医院60例患者骨盆CT检查数据,其中男女各30例,年龄21~65岁,骨骼发育均成熟且排除骨盆疾病。首先采用患者CT DICOM数据,使用Mimics Research 21.0软件进行骨盆CT三维重建,利用3D打印技术制作骨盆3D打印模型。在60例骨盆CT三维重建模型上,分别按照传统髂骨螺钉(对照组)和改良髂骨螺钉(改良组)两种不同方法模拟植钉,测量最大进钉深度、尾向倾角、外向倾角、入钉点与髂后最高点垂直距离、与中线距离、钉道最窄髂骨厚径,测量数据分别纳入对照组和改良组,并进行组间、组内比较。在骨盆3D打印模型上采用改良髂骨螺钉技术分别植入直径7.5 mm长80 mm的髂骨螺钉,观察植钉成功率以及有无螺钉穿出或钉道受阻情况。结果改良组以髂后上棘向尾侧1 cm处、髂骨缘内半中心点为进钉点,以髂前下棘与髋臼上缘中点为进钉方向,尾向倾角为28.6°±4.2°、外向倾角为32.8°±4.9°,为改良组的髂骨螺钉钉道。对照组的最大进钉深度(123.6±5.0)mm、钉道最窄髂骨厚径(14.5±3.6)mm、尾向倾角29.5°±2.1°、外向倾角31.4°±5.1°,与改良组的最大进钉深度(122.1±5.8)mm、钉道最窄髂骨厚径(15.4±2.7)mm、尾向倾角28.6°±4.2°、外向倾角32.8°±4.9°比较,差异均无统计学意义(P值均>0.05)。对照组的入钉点与髂后最高点垂直距离(0.0±0.0)mm、与中线距离(44.3±4.9)mm,与改良组的入钉点与髂后最高点垂直距离(16.5±2.9)mm、与中线距离(32.1±4.3)mm比较,差异均有统计学意义(t=44.072、14.496,P值均<0.05)。改良组中男性最大进钉深度(124.9±6.1)mm、外向倾角33.4°±5.6°、入钉点与髂后上棘垂直距离(17.3±1.9)mm、与中线距离(33.2±3.8)mm、钉道最窄髂骨厚径(15.5±2.9)mm,与
Objective To investigate the feasibility of improved iliac screw technique by using 3D printing technique to observe the related anatomy and design the screw track.Methods From April 2015 to March 2017,60 mature skeletal development patients without other causes of pelvic diseases were randomly selected in Foshan Hospital of Traditional Chinese Medicine,30 males and 30 females,aged 21-65 years old.With the patient's CT DICOM data,the 3D model of all the patient's pelvic were reconstructed using Mimics Research 21.0 software,and the model was manufactured with 3D printing technology.On the 3D model of pelvis of 60 cases,two different methods of traditional iliac screw(control group)and modified iliac screw(modified group)were used to simulate the screw implantation.The maximum depth of screw insertion(Maximum depth,MD),Sagittal angle(SA),Transverse angle(TA),the vertical distance between the point of screw insertion and the highest point of posterior iliac crest(Distance to highest point,DHP),the distance between the point of screw insertion and the midline(Distance from med-line,DM),and the diameter of the narrowest iliac bone(Iliac width,IW)were measured.The data were included in the control group and the modified group.and were compared between groups and within groups.The modified iliac screw technique was used to simulate on the 3D printed model using iliac screw with diameter of 7.5 mm and length of 80 mm,to observe the success rate of screw implantation and whether the screw was penetrated or the nail path was blocked.Results In the group of modified iliac screw canal,which chose 1 cm to the caudal side of the posterior superior iliac spine and the inner half central point of the ilium as the screw entry point,the best direction was the middle point of anterior inferior iliac spine and superior border of acetabulum,the sagittal angle was 28.6°±4.2°and transverse angle was 32.8°±4.9°(P>0.05).The measurements from the control group for MD,IW,SA and TA were(123.6±5.0)mm,(14.5±3.6)mm,29.5°±2.1°and 31
作者
付忠泉
丁玲
王永琪
禤天航
罗荣森
文磊
关宏刚
曹正霖
Fu Zhongquan;Ding Ling;Wang Yongqi;Xuan Tianhang;Luo Rongsen;Wen Lei;Guan Honggang;Cao Zhenglin(Department of Orthopedics,Foshan Hospital of Traditional Chinese Medicine,Guangzhou University of Traditional Chinese Medicine,Foshan 528000,China;School of Information Engineering,Southwest University of Science and Technology,Mianyang 621010,China)
出处
《中华解剖与临床杂志》
2019年第4期358-363,共6页
Chinese Journal of Anatomy and Clinics
基金
佛山市科技创新项目(2018AB001351).
关键词
内固定器
3D打印
骨盆
改良髂骨螺钉技术
髂腰固定
Internal fixators
3D printing
Pelvic model
Modified technique of iliac screw technique
Iliolumbar fusion
