髋臼前柱骨折后入路拉力螺钉内固定应用解剖及临床应用

Applied anatomy of lag screw placement internal fixation in anterior column of acetabular bone via kocher-langenback surgical approach

目的为髋臼前柱骨折后入路置入拉力螺钉固定提供解剖学基础。方法 (1)50侧(男32,女18)成人髋骨标本,观测前柱纵轴走向,将纵轴穿出髂骨翼外面的点定为进钉点。用直径3.5 mm导针经进钉点沿纵轴置入,经耻骨结节下方穿出。测量导针与矢状面夹角α及与冠状面夹角β,纵轴长度,导针易穿出骨皮质的薄弱区及穿出点与耻骨结节的距离,对测量数据行统计学处理。(2)34侧尸体标本解剖,观测进针点毗邻,模拟置钉,经X线、CT扫描验证结果。结果进钉点位于髂结节和坐骨结节连线与髂前上棘和坐骨大切迹顶点连线的交点,出钉点于耻骨结节下方,男(6.62±2.79)mm,女(11.71±1.66)mm,α(50.62±3.55)°,β男(22.32±3.66)°,女(19.57±2.07)°;纵轴长,男(108.64±5.49)mm,女(100.92±6.25)mm。以上数据除角α外男女间均有显著性差异。验证结果及临床应用疗效满意。结论髋臼前、后柱均骨折时,在后入路复位固定后柱的同时,经该方法置入拉力螺钉固定前柱安全、简捷。

Objective To provide anatomic basis for lag screw placement internal fixation in anterior column of acetabular bone via kocher-langenback surgical approach.Methods（1）50 adult hip bones（32 males,18 females） were observed and measured the direction of the long axis of acetabular anterior column,and then the point where the long axis penetrated the outside of the iliac wing was set as the entering point.A guiding pin（3.5mm in diameter） was inserted in the entering point along the long axis,and the penetration was below the pubic tubercle.α angle between the guiding pin and the sagittal plane,and β angle between the pin and coronal plane,the length of the longitudinal axis,the ＂weak zone＂ where the guiding pin may easily penetrated bone cortex,and the distance from the penetration point to the pubic tubercle,were measured and analyzed.（2） 34 cadaveric specimens were dissected to explore the distribution of the vessels and nerves around the entrance point of the guiding pin.The screw fixation of the anterior column was simulated and confirmed by X-ray and CT.Results The screw entrance point was at the intersection between the line from tubercle of iliac crest to the middle of the ischial tuberosity and the line from anterior superior iliac spine to greater sciatic notch vertex.The exit point of the screw was（6.62±2.79）mm and（11.71±1.66）mm below the pubic tubercle in male and female respectively.α angle was about（51.29±3.48）°,while β angle（22.32±3.66）° in males and（19.57±2.07）° in females,respectively.The length of longitudinal axis of the acetabular anterior column was（108.64±5.49）mm in males and（100.92±6.25）mm in females,respectively.All data presented remarkable sexual significance except for α angel.The simulated fixation showed satisfied effects.Conclusions It is convenient and safe to place the lag screw to fix the anterior column while fix the posterior column via kocher-langenback surgical approach in case of compound fracture of both anterior and posterior columns of acetabular bone.