骶髂关节空心钉内固定导向器的研制及临床应用

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

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复合体,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例患者均采用骶髂关节空心钉内固定导向器引导术中S1椎弓根空心钉的操作,共置入18枚S1椎弓根空心钉。结果术后CT及X线片示18枚S1椎弓根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,提高置入质量,且可显著减少X线机的透视次数。

Objective To design a drilling guide for iliosaeral screw insertion in internal fixation of the sacroiliac joint, which can improve the success rate and quality of insertion of Si pedicle iliosaeral screw. Methods We designed a drilling guide for iliosacral screw insertion in interhal fixation of the sacroiliac joint, which was consisted of the fixed component for length measuring, the adjustable angle component to measure the transverse iliosaeral screw angle （TSA） and sagittal iliosacral screw angle （SSA）, and the fix screw. 15 patients with unstable fracture of the pelvis involving complex of the sacroiliac joint were admitted to our department from June 2006 to October 2009. They were 6 men and 9 women, aged from 19 to 60 years （mean, 45.6 years）, involving the sacroiliac ligaments （3 cases）, sacral zone Ⅰ （5 cases）, sacral zone Ⅱ （5 cases）, and sacral zone Ⅲ （ 2 cases）. The drilling guide was used in all 15 patients when the S1 pedicle iliosacral screws were inserted. Altogether 18 S1 pediele iliosacral screws were inserted with the help of the drilling guide. Results The post-operative CT and X-ray examinations revealed that the 18 S1 pedicle iliosacral screws were accurately inserted with the same or similar TSA and SSA compared with the design of the pre-operative CT and X-ray examinations of the patients. Conclusion The drilling guide is reasonable in design and convenient in use. Moreover, it can improve the accuracy and quality of insertion of Si pediele iliosacral screws and reduce the X-ray exposure.