骶髂关节空心钉内固定导向器的研制及临床应用

Design and application of a drilling guide for iliosacral screw insertion in internal fixation of sacroiliac join

目的自行设计并研制一种骶骼关节空心钉内固定导向器，以期提高S1椎弓根空心钉置入的成功率及置入质量。方法 自行设计并研制的骶髂关节空心钉内固定导向器由带有测量长度的定位器、带有角度刻度表的水平面S1椎弓根空心钉置入角（TSA）、矢状面置入角（SSA）调节器及固定螺丝等组成。2006年6月至2009年10月共收治15例不稳定型骨盆骨折累及骶髂关节者，男6例，女9例；年龄19～60岁，平均45．6岁。不稳定型骨盆骨折经骶髂关节韧带3例，经骶骨I区5例，累及骶骨Ⅱ区5例，累及骶骨Ⅲ区2例。15例患行均采用骶髂关节空心钉内固定导向器引导术中空心钉的操作，并置入18枚空心钉。结果术后CT及X线片示18枚空心钉置入位置准确，与术前设计相比，具有相同或相近的TSA及SSA。结论骶骼关节空心钉内固定导向器设计合理，使用方便，能提高S1椎弓根空心钉置入的准确性发置入质量，且可显著减少C型臂X线机的透视次数。

Objective To design a drilling guide which can impruve the success rate and quality of insertion of SI pedicle iliosacral cannulated serew in internal fixation of the sacroiliac joint. Methods We designed a drilling guide. It consisted of a seale which could make measurement of length, a dial regulator which could adjust the transverse iliosacral screw angle （TSA）, sagital iliosaeral screw angle （SSA） and the distance from the iliosaeral screw entrance point to the backbone （DIS） for the internal fixation of the sacroiliac joiul. The device was used in clinic for 15 patients with unstable fracture of the pelvis involving the sacroiliac ligaments （3 cases）, sacral zone Ⅰ （5 cases）, sacral zone Ⅱ （5 eases）, sacral zone Ⅲ （2 cases）. They were 6 men and 9 women, aged from 19 to 60 years （mean, 45.6 years） . Altogether 18 cannulated SI pedicle iliosaeral screws were inserted through the guide using the data of TSA, SSA and DIS measured on the preoperative CT and X-ray films of the patients. Results The postoperative CT and X-ray examinations revealed that all the S1 pedicle iliosaeral screws were aecurately inserted with the same or similar TSA and SSA. Conclusions The drilling guide is reasonable in design and convenient in use. Moreover, it can improve the aceuracy and quality of insertion of S1 pedicle iliosacral serews and reduce X-ray exposure to the operation staff.