髋臼后壁钢板螺钉固定安全区域的应用解剖学研究

Applied anatomic study of surgical safe zone for placement plates and screws in treatment of fracture of the posterior wall of acetabulum

目的测量髋臼后壁三维重建模型参数和行虚拟钢板螺钉固定,明确髋臼后壁钢板放置的安全位置及螺钉置入角度。方法用Mimics软件对25例(50侧)骨盆薄层CT行三维重建,切割出髋臼后壁三维模型,测量相关参数。用SolidWorks2010软件设计髋臼后壁虚拟钢板,导入Mimics软件,得出髋臼后壁虚拟钢板放置位置和螺钉安全角度。然后在15具(30侧)尸体髋臼后壁标本上进行钢板螺钉固定。结果髋臼纵径为55 mm,横径为52 mm。髋臼后壁最宽处位于上缘,为51 mm,最窄处位于髋臼后壁中下部,为38 mm。螺钉能够拧入Zimmer重建钢板钉孔所允许最小角度范围为50-66°。Mimics模拟置钉后,将钢板放置在距尸体标本髋臼后壁外缘6 mm处行钢板螺钉固定,螺钉未进入髋臼。结论重建钢板放置在距髋臼后壁外缘6 mm以远时,螺钉可以安全置入,且钢板距外缘越远,螺钉的安全范围越大。

Objoctive To investigate the safe position of the plates and safe angles of the screws through measurement of the parameter of the acetabulum and virtual plate-screw placement in the three-dimensional posterior wall of the acetabulum. Methods The thin slice CT data of 50 pelvics and 15 normal cadavers were used in this study. Three-dimensional reconstruction of pelvics were achieved by Mimics 10.0; then the virtual 3-dimensional acetabulum was resliced ,and the transverse, longitudinal diameter of the acetabulum and the width of the posterior wall of the acetabulum were measured, respectively. The virtual plate was designed by the software of Solidworks2010 and was introduced into the software of Mimics 10.0. The position of the plates and the angle of the screws were measured and the safe zones of the plate and the safe angles of the screws were deduced. Based on the above-mentioned data, the plates were fixed on the 30 posterior walls of the acetabulurn 6mm away from the posterior edge of the acetabulum. Results The longitudinal and transverse diameter of the acetabulum were 55 mm and 52 ram, respectively. The widest width of posterior wall was 51 mm, which was at the superior edge; The narrowest was 38 mm, which was at the edge of middle-lower part of the posterior wall. When the screws could be drived into the hole of the plates, the smallest angle between the reconstructive plate and the screws were from 50° to 66°. The screws were not inserted into the acetabulum ,when plate-screw fixation were palced in the posterior wall of the acetabulum in cadavers 6mm away from the lateral edge of acetabulum. Conclusion When the plate is at least 6mm away from the posterior edge of the acetabulum, the screws could safely avoid entering the hip joint. As the distance of the plate away from the lateral edge of the acetabulum grows, the safe range of for screw placement increases.