经皮坐骨小切迹拉力螺钉内固定髋臼后柱骨折的应用解剖与临床应用

Applied anatomy of lag screw placement internal fixation in posterior column of acetabulum via lesser sciatic notch

目的:研究经皮坐骨小切迹置入拉力螺钉内固定髋臼后柱骨折。方法:观测45具成人骨盆标本髋臼后柱的纵轴走向、上下穿出骨皮质的位置及其毗邻。用直径3.5mm的斯氏针经坐骨小切迹中点沿髋臼后柱纵轴打入,测量钉道深度、后柱纵轴与额状面夹角α及矢状面的夹角β。结果:拉力螺钉的进钉点为坐骨小切迹中点,后柱纵轴长男(105.7±6.3)mm、女(99.1±3.1)mm,α角男26.3°±5.6°、女21.5°±3.0°,β角男27.5°±3.8°、女24.1°±4.0°,男、女性均有显著性差异(P<0.01)。临床应用取得满意疗效。结论:经坐骨小切迹中点行后柱拉力螺钉内固定术,具有创伤小,操作简便、内固定可靠等优点。

Objective： To provide anatomic basis for internal fixation of acetabular posterior column fracture using percutaneous lag screw placement via lesser sciatic notch. Methods： The direction of longitudinal axis of acetabular posterior column was observed on 45 adult pelvis specimens, as well the points where it running out of bone cortex and its adjacency. A 3.5mm Steinmann pin was pinned along the longitudinal axis of the acetabular posterior column via the midpoint of lesser sciatic notch, and then the depth of the nail path, α angle between the longitudinal axis and the frontal plane, and β angle between the longitudinal axis and the sagittal plane were measured. Results： With the midpoint of lesser sciatic notch as the entrance point of the lag screw, the longitudinal axis was about （105.7±6.3） mm （male） and （99.1±3.1） mm （female） in length, α angle about 26.3°±5.6° （male） and 21.5°±3.0° （female）, and β angle 27.5°±3.8° （male）and 24.1°±4.0° （female）, with difference （P〈0.01） between both sexes. The clinical application was satisfactory. Conelusions： Internal fixation of the acetabular posterior column fracture by lag screw placement via the midpoint of lesser sciatic notch is reliable, easy to perform.