经后外入路距骨颈螺钉置入的数字解剖学研究

Digital anatomic study of talar neck screw fixation via posterolateral approach

目的利用数字技术模拟经后外入路距骨颈螺钉置入,评价经距骨颈进钉通道内边界的形态特点。方法采集30例成人足踝(36个距骨)的16排螺旋CT扫描数据,利用Mimics 10.01软件重建距骨三维模型,采用轴位透视法手动模拟由后外入路经距骨颈置入螺钉。螺钉均由距骨后外侧固定点置入,到达距骨头颈60%以上的边界深度。循距骨颈内、外侧内边界分别置入最内、最外侧螺钉各1枚,循大于80%头颈深度置入最长螺钉1枚。利用软件中的测量工具测量各置入螺钉的直径、长度。结果最内侧螺钉直径(7.80±1.03)mm,长(47.51±4.01)mm;最外侧螺钉直径(11.47±1.28)mm,长(47.57±4.09)mm;最深螺钉直径(10.10±1.51)mm,长(51.71±3.87)mm。男性与女性组各螺钉直径及长度差异均有统计学意义(P<0.05),男性大于女性。左侧与右侧组各螺钉直径及长度差异均无统计学意义(P>0.05)。结论经距骨颈进钉通道的上述形态特点可为不同性别患者的距骨颈不同部位骨折内固定螺钉的使用提供参考。

Objective To evaluate the morphological characteristics of the talar neck＇s inner boundary which is suitable for screw inserting, by using digital techniques to simulate the operation process into the talar neck via the posterolateral approach. Methods The present study collected the CT scan data of 36 taluses from 30 adult patients who undergone ankle joint CT scanning. The 3D talus models were reconstructed by Mimics 10.01 software. Axial perspective was adopted to simulate manually on inserting screws into talar necks. All the screws were inserted from the fixation point of the posteriolateral talus, to meet more than 60% of talar necks＂ depth of its boundary. The inserted screws were fixed at the innermost side of talar necks, the inside boundary of its lateral border and the deepest inserting area. The measuring tools were used on software to aeqnlre the diameter, length, of all screws. Male and female, right and left sides on the base of the measuring data above were compared. Results The mean diameter and length of the innermost screw were （7.80±1.03）mm and （47.51±4.01）mm. The mean diameter and length of the outermost screw were （11.47±1.28）mm and （47.57±4.09）mm. The mean diameter and length of the deepest screw were （10.10±1.51）mm and （51.71_＋3.87）mm. There were significant differences between male and female groups （P〈0.05）, while no distinct differences between the left and right side groups （P 〉0.05）. Conclusion The morphological features of inserting approach on talus neck could east enlightenment onto the application of screws used to be operated on fractures of its different parts.