骶髂关节脱位直视复位空心螺钉固定解剖学及临床应用

The anatomic study and clinical application of euthyphoria reduction and percutaneous cannulated screws fixation of dislocating sacroiliac joint

目的:报道骶髂关节脱位直视下复位、经皮空心螺钉固定术的解剖学基础,以及临床应用的初步效果。方法:(1)采用12具(24侧)成人福尔马林固定尸体标本,测量骶骨翼上缘L4、L5及闭孔神经到骶髂关节距离。(2)15例病人手术方法及临床分析。结果:(1)L4、L5及闭孔神经距离骶髂关节分别为(20.24±1.12)、(23.80±1.43)、(16.26±2.07)m m。(2)临床治疗15例骶髂关节脱位病人,门诊随访平均1.9年,根据M atta(1996)骨盆骨折术后评定标准,均为优良。结论:(1)骶髂关节内侧骶骨上缘20m m是该术式的安全区域,可有效的避免神经损伤。(2)该固定术临床效果好,操作简便,便于临床推广应用。

Objective： To explore anatomic basis and preliminary clinical effects of euthyphoria reduction and percutaneous cannulated screws fixation on treating sacroiliac joint dislocation. Methods： （ 1 ）The distances from L4, L5 spinal nerves and obturator nerve on the superior border of sacrum ala to sacroiliac joint were measured on 12 adult cadavers （24sides）. （2）Operative methods and clinical effects of 15 cases were analyzed. Results： （ 1 ）The distances from L4,L5 spinal nerves and obturator nerve to sacroiliac joint were （20.24±1.12） mm, （23.80± 1.43 ）mm and （ 16.26±2.07 ）mm respectively. 2 ）After following up 1.9 years averagely, all of 15 cases showed good results according to Matta score （1996）. Conclusions： The safe region of the fixation is on the superior border of sacrum ala about 20mm from sacroiliac joint, which is reliable to avoid nerve injury and make good clinical effects.