【摘要】 目的探讨逆行髋臼后柱螺钉的进钉位置、方向及固定范围。方法收集100例正常成人骨盆CT数据(男、女各50例),利用交互式医学图像控制系统(Mimics) 17. 0软件三维重建骨盆并导入Geomagic Studio 2015软件。从坐骨结节至髂窝方向进行透视,垂直后柱"三棱柱"通道横断面放置虚拟螺钉,测量螺钉的最大直径、进钉点、方向、出钉点及螺钉安全倾角。确定螺钉固定的范围,螺钉在后柱通道易穿出部位及术中判断螺钉是否穿出的透视体位。结果髋臼后柱安全通道近似"三棱柱"形,进钉点位于坐骨结节内外侧缘中线上,距离坐骨结节最远端男性为(12. 99±1. 99) mm,女性为(13. 26±2. 58) mm,男女差异无显著性(P>0. 05);髂窝出钉点距离同侧前方骶髂关节线男性为(23. 65±2. 42) mm,女性为(24. 94±2. 39) mm;距离真骨盆缘男性为(19. 33±2. 60) mm,女性为(17. 63±2. 00) mm;最大螺钉直径男性为(17. 21±1. 41) mm,女性为(15. 54±1. 51) mm;髋臼后柱逆行置钉方向与矢状面夹角男性为(10. 52±3. 04)°,女性为(7. 72±2. 99)°;与冠状面夹角男性为(15. 00±4. 92)°,女性为(12. 94±4. 72)°,以上数据男女间差异均有显著性(P <0. 05)。逆行经坐骨结节置钉可固定股骨头中心所在水平面近端4 cm以下所有的髋臼后柱骨折,易穿出部位分别为髋臼后壁与坐骨支移行处、髋臼中部、坐骨大切迹水平下1 cm。"三棱柱"的3个侧面的切线位分别是髂骨斜位10°,闭孔斜位60°,髂骨斜位60°。结论逆行髋臼后柱螺钉进钉点位于坐骨结节内外侧缘中线,距离坐骨结节最远端1. 3 cm,方向约外倾10°,前倾15°,可固定股骨头中心所在水平面近端4 cm以下的髋臼后柱骨折。更多还原

【Abstract】 Objective To investigate the position,direction and fixation range of retrograde screw of the posterior column of acetabulum based on CT data. Methods Totally 100 cases( 50 males,50 females) of normal adult pelvic CT data were collected from the First Affilated Hospital of Chongqing Medical University. The pelvis was reconstructed by Mimics 17. 0 software and imported into Geomagic Studio 2015 software. The virtual screw was placed in the posterior column from the ischial tuberosity to the iliac fossa,the maximum diameter,the entrance point,the exit point,the direction,safe fixation inclination angles of the screw were measured. The range of the screw fixing,the best fluoroscopic views and the easy-topenetrate site of the screw in the posterior column were assessed. Results The safe corridor the posterior column of the acetabulum was similar to the"triangular prism"shape. The entrance point was located on the midline of the medial edge and lateral edge of the ischial tuberosity,which were( 12. 99±1. 99) mm in male and( 13. 26±2. 58) mm in female from farthest end of the ischial tuberosity. There were no stitistical significant differences between male and female( P > 0. 05). The exit points was located at the iliac fossa,which were( 23. 65 ± 2. 42) mm in male and( 24. 94 ± 2. 39) mm in female to the ipsilateral anterior sacroiliac joint line,and( 19. 33 ± 2. 60) mm in male and( 17. 63 ± 2. 00) mm in female to the arcus marginalis. The maximum diameters of screw were( 17. 21±1. 41) mm in male and( 15. 54±1. 51) mm in female. The angles between screw and coronal plane were( 15. 00±4. 92) ° in male and( 12. 94±4. 72) ° in female; the angles between screw and sagittal plane were( 10. 52 ± 3. 04) ° in male and( 7. 72 ± 2. 99) ° in female. The abore data had statistially significant differences between male and female( P < 0. 05). Percutaneous retrograde screw could fix the acetabular posterior column fracture that below the 4. 0 cm proximal the horizontal plane of the femoral head center. The easy-to-penetrate sites were the junction of the acetabular posterior wall and the sciatic branch,the middle part of the acetabulum,and below 1. 0 cm of the highest point of greater sciatic notch. The tangential position of three lateral faces of the"triangular prism"were ilium oblique position 10°,the ilium oblique position 60°,and obturator oblique position 60°. Conclusion The entrance point of the retrograde screw is located on the midline of the ischial tuberosity,which is 1. 3 cm from farthest end of the ischial tuberosity and the direction is forward inclination about 15°,external inclination about 10°. The acetabular posterior column fracture that below 4. 0 cm proximal plane to the femoral head center can be fixed by the retrograde screw.更多还原