经皮骶髂螺钉内固定术的应用解剖学研究

Applied anatomy of percutaneous fixation using sacroiliac screw

目的:为骶髂关节骨折脱位经皮螺丝钉固定提供解剖学依据。方法:50块干燥成人骶骨及30个骨盆防腐标本,测量S1、S2侧突、侧块厚度等指标,观察骶髂关节周围神经血管分布,定位进针点;通过标本断层及正常骨盆CT片测量螺钉进针方向及深度。结果:S1侧突高度为(22.1±4.6)mm,厚度为(27.8±3.1)mm,S2侧突高度为(13.4±3.6)mm,厚度为(20.9±2.2)mm。S1进针点位于髂前上棘-髂后上棘连线中后1/3交点附近,S2进针点位于髂结节-髂后上棘连线前4/5与后1/5交点附近。S1侧突中轴与矢状面夹角约为55°,S2则约为80°,S1侧突中轴与冠状面的夹角约为36°,S2则约为15°。结论:(1)S1侧突能容纳直径为6.5～7.0mm的螺丝钉2枚,S2侧突可容纳1枚。(2)S1侧突螺丝钉进针方向与矢状面夹角约为55°,与冠状面夹角约为36°;对S2则分别约为80°和15°。S1进针深度为68mm,S1为55mm。(3)经皮骶髂螺丝钉固定手术应严格限制在骨折精确复位的病例。

Objective： To provide anatomic basis for percutaneous fixation using sacroiliac screw. Met.hods： 50 adult dry sacrum and 30 pelvic specimens were used. The contour of sacrum and relationship between axis of pedicle and auricular surface of sacroiliac joint were observed. The height and thickness of S1, S2 pedicle, and other operation parameters were determined. The inserting point for the screw on ilium was ascertained, and the neighbour structures around the point were observed. Optimal angle and distance for the screw through the S1, S2 pedicles were also determined on 50 cases of CT film. Results： The height and thickness of S1 pedicle was （22. 1 ±4.6 ）mm and （27.8 ±3. 1 ）mm, the height and thickness of S2 pedicle was （ 13.4±3.6 ）mm and（ 20.9±2.2 ）mm respectively. The S1 inserting point on out lamellar of ilium lay（ 3. 1 ± 1.2 ）mm around the point which was on the crossing point of posterior-middle third of the line from anterior superior ＂ iliac spine to posterior superior lilac spine. The $2 inserting point lay （4.2±1.7）mm around the point which was on the crossing point of anterior four-fifths and posterior one-fifths of the line from iliac tubercle to posterior inferior iliac spine. The optimal angle of S1 pedicle axis with sagittal plane was 55°, for S2 was 80°, with coronary plane for S1 was 36°, for S2 was 15°. Conclusions： （l）S1 pedicle could hold 2 sacroiliac screws whose diameter is around 6.5 -7.0 mm, while S2 pedicle could only hold one. （2） The angle of screw with sagittal plane for S, was 55°, for S2 was 80°, with coronary plane for S, was 36°, for S2 was 15° The optimal depth of screw for S1 was 68mm, for S2 was 55mm. （3） The operation of percutaneous fixation using sacroiliac screw should be strictly defined on the condition when iliosacral dislocation was completely reducted.