逆行耻骨上支髓内螺钉固定应用解剖研究

Applied Anatomy of Retrograde Lag Screw of Superior Ramus of Pubis

目的探讨耻骨上支髓内螺钉的正确进钉方法和位置,为临床应用提供解剖学基础。方法解剖6具成人尸体,制成骨性骨盆标本。在直视下,以克氏针模拟逆行耻骨上支髓内螺钉固定法。分别测量钉长、进钉点与耻骨结节的关系、螺钉与两侧髂前上棘和耻骨结节构成平面的夹角、与矢状面的夹角及耻骨上支直径等。结果对于耻骨上支内1／2、外1／2的骨折,平均钉长、螺钉与两侧髂前上棘和耻骨结节构成平面及矢状面的夹角,最窄处直径为皆有差异。结论耻骨上支髓内螺钉固定对于耻骨支不同部位的骨折进钉点和进钉方向不同,用于治疗骨盆前环的耻骨支骨折是安全、可行的。

Objective To investigate the precise approach and location of medullary screw for superior ramus of pubis, and to provide the basis for the anatomical evidence for clinical surgery treatment. Methods Six adult specimens were provided by anatomy department of Nanjing medical university and were processed into the bone models. K wires were used for simulating the retrograde medullary screws of superior ramus of pubis for fixation. The screw length, the distance between the entry point and the pubic tubercle, the angle （angle 1 ） between the screw and the plane which was defined by anterior superior iliac spine and pubic tubercle, the angle （angle 2） between the screw and the sagittal plane and the diameter of superior ramus of pubis were measured for each model. Results In condition of the inner half and outer - half pubic ramus fractures, the mean screw length, the degree of angle 1 and 2, the narrowest diameter were different. Conclusion The entry point and direction of medullary screw of superior ramus of pubis is different for the fracture of different parts of pubic ramus, which is secure and reliable for the treatment of the anterior ring of pelvis.