不稳定骨盆损伤中骶髂关节脱位的临床解剖研究

The Study of Displacement Changes of the Sacroiliac Joint in Unstable Pelvic Injury

目的分析骶髂关节在不同脱位情况下耳状关节面接触面积的变化。方法采用30具除去韧带结构的正常成人干燥左侧半骨盆标本,男女各15具,年龄20-57岁。对标本的骶髂关节进行螺旋CT扫描,构建骶髂关节模型图像,图像输入到Photoshop 11.0图像处理软件,应用计算机定量测量骶骨侧及髂骨侧关节面图像的长度及面积。将骶骨固定于标本平台上,分别向后、上及后上3个方向移动髂骨,模拟不稳定性骨盆骨折中旋转不稳及垂直不稳,造成骶髂关节的三维空间移位,相对位移分别依次递增5 mm,同时进行螺旋CT扫描,直至骶髂关节完全脱位。在每一种模拟移位中,使用Photoshop 11.0软件由计算机测量骶髂关节髂骨与骶骨关节面的接触面积。结果正常情况下,男性骶髂关节的耳状关节面接触面积是1 138.3 mm2,女性为992.5 mm2,男性比女性大12.8%(P<0.05)。当髂骨向后上方移位时,骶髂关节髂骨侧与骶骨侧的接触面积最小,其次是向后及向上移位(P<0.05)。结论骶髂关节在不同移位情况下,髂骨侧与骶骨侧关节面接触面积变化较大,有较明显的性别差异,这对骶髂关节损伤复位内固定或关节融合术有临床指导意义。

Objective To determine the average articular contact area between the sacrum apd ilium at the sacroiliac joint using computer analysis. Methods Thirty normal adult dry-bone sacrum and ilium specimens（left sides of pelvis） were used. Simulating all unstable pelvic injury, the sacroiliac joint was displaced in three directions by moving the ilium posteriorly, superiorly, and posterosuperioriorly. After each displacement, using Photoshopll. 0 software computer analysis system to calculated the contact area between the sacrum and ilium at the sacroiliac joint. Results The data showed that the average articular surface area of the male sacroiliac joint （ 1138. 3 mm^2） was approximately 12. 8 % greater than the average surface area of the female sacroiliac joint （992. 5 mmz） （P〈0. 05）. The average articular contact area between the sacrum and ilium at the sacroiliac joint was lowest with the ilium displaced posterosuperiorly compared to equal displacements superiorly or posteriorly （P〈0. 05）. Conclusion This study quantitatively illustrated the loss of contact surface area between the sacrum and ilium during various displacements of the ilium, thus indicating the clinical cross-section area available for open reduction and internal fixation or fusion.