髋臼前柱钢板内固定的解剖学研究

Anatomic study of internal fixation of acetabular anterior column plate technique

目的研究髋臼前柱钢板内固定技术中螺钉的最佳进钉点、方向和长度,预防发生螺钉穿入关节内的严重并发症。方法取成年男性半骨盆标本20个,分别测量髋臼前、后缘到髂前下棘、髂耻隆起和耻骨结节的距离,确定和制作髋臼前柱系列断面,分别测量各断面上各进钉点的安全进钉角度,将测量数据输入到SPSS10.0软件进行统计学分析。结果髋臼前缘到髂前下棘、髂耻隆起和耻骨结节的距离分别为(25.4±1.4)mm,(11.8±0.7)mm和(37.4±1.5)mm,后缘到髂前下棘和髂耻隆起的距离分别为(15.5±0.9)mm和(29.1±1.6)mm。在各断面距离骨盆界线0.5cm点、1.0cm点和1.5cm点上螺钉的安全进钉角度的最大值分别为(8.2±2.2)°、(14.9±3.4)°和(26.1±4.5)°。结论在前柱髋臼区使用钢板内固定时,可以采用3种方法避免螺钉穿入关节内。第一种方法是使用短螺钉,螺钉方向随意;第二种方法是使用长螺钉紧贴骨盆界线进钉,方向平行于四方区;第三种方法为根据不同的进钉点选择不同的进钉角度和长度。

Objective To study the best entry points, direction and length of screw in acetabular anterior column plate technique, and to prevent the serious complications of screw penetrating the joint surface. Methods Twenty male cadaveric adult semipelvic specimen were taken, and the distance from anterior acetabular margin, posterior acetabular margin to anterior inferior iliac spine, iliopubic eminence and pubic tubercle were measured respectively. Determine and make serial cross-sections of the acetabular anterior column, measure the safe angle of screw entry on all entry points of each cross-section, and put all data into software SPSS 10. 0 for statistics process. Results The distance from anterior acetabular margin to anterior inferior iliac spine, iliopubic eminence and pubic tubercle was （ 25.4± 1.4 ） mm, （ 11.8 ± 0. 7 ） mm and （37. 4 ± 1.5 ） mm respectively, the distance from posterior acetabular margin to anterior inferior iliac spine, iliopubic eminence was （15.5 ±0. 9） mm and （29. 1 ± 1.6） mm respectively. On each crosssection, the maximum of the safe entry angle of inclination in 0. 5 cm, 1.0 cm and 1.5 cm entry point lateral to the linea terminalis of pelvis was （8.2 ± 2.2）°, （ 14.9 ± 3.4） ° and （26.1 ± 4.5） ° respectively. Conclusions When plate for internal fixation on acetabular region of anterior column is used, there are three ways to avoid screw penetrating the joint surface. The first way is using short screw, the direction of the screw as one＇s pleases; the second way is using long screw close to the linea terminalis of pelvis, the direction of the screw is parallel to the quadrilateral plate; the third way is using different entry angle and length according to different entry point.