髂骨钉三种置入通道的影像解剖学研究

Radiographic measurements of three iliac screws passage

目的通过对各髂骨钉通道的影像学测量，了解髂骨钉三种不同置入通道的参数并为其安全置入提供帮助。方法选择40例髂骨外伤患者，男21例（16～75岁，27个髂骨翼），女19例（16～78岁，28个髂骨翼），均采用三维螺旋CT重建骨盆，并对髂结节到髂前下棘、髂后上棘到髂前下棘、髂后下棘到髂前下棘髂三种不同的髂骨钉通路进行测量，评价参数分别是长度、内径以及皮质厚度。结果髂后上棘到髂前下棘通道有着最长的骨性通道，男性长为141mm，女性长为129mm，两髂骨板间可容纳在男性直径最大8mm、女性6～7mm的内植物，最佳髋关节上通道皮质骨厚度男性为5．2mm、女性为4．7mm术中髂骨钉的置入。结论本研究提示为安全置入髂骨钉，男性长度140mm直径8mm、女性长度130mm直径6mm左右的髂骨钉是较为妥当的。

Objective To research the iliae screws placement and to supply reference data for iliae screw manufacturing, by radiographic measurements for secure placement of screws of Chinese adult ilium. Methods Measurements were made using three - dimensional computed tomographie reformations in 40 consecutive trauma patients（27 measurements in 21 males, 16 to 75 years old;28 measurements in 19 females, 16 to 78 years old）. The parameters were the intrailiac length inner width,and cortical thickness of three different transiliac screw anchor paths aimed toward the anterior inferior iliac spine and initiated at the iliac tubercle, posterior superior iliac spine, or posterior inferior iliac spine. Results The posterior superior iliac spine - anterior inferior iliac spine path had the largest bony canal lengths, with 141 mm in male and 129 mm in female patients. Two stereotypie iliac constrictions allowed placement of 8 mm implants in male and 6 -7 mm implants in female patients. Cortical thickness at that optimal extraartieular path was 5.2 mm in the male and 4.7 mm in the female patients. Conclusions Our radiographically performed morphometric study revealed that ＂safe＂ transiliac screw placement and iliac anchoring for lumbopelvic fixation can be optimized by using 6 -8 mm screws with a length of up to 130 mm and 140 mm in female and male patients, respectively.