耻骨上支骨折髓内螺钉进钉通道的数字解剖学研究

Digital anatomical study of the superior pubic ramus screw channel

目的以数字解剖学的方法评估耻骨上支骨折髓内螺钉内固定的安全进钉通道。方法回顾性分析我科17例成人患者(34例半骨盆)的骨盆计算机断层扫描(CT)图像,采用Mimics软件,依据耻骨上支骨折的常见部位,置入虚拟圆柱体,采用三维测量工具,测量最大进钉通道,最大长度,探寻进钉点位置,进钉通道大小与角度之间的特征规律,确定安全范围。结果对于内侧1/2骨折,虚拟三维圆柱体的最大直径平均为(9.64±0.79)mm,长度为(67.88±6.07)mm,螺钉与矢状面的夹角变化范围为(44.03±2.29)°～(50.41±3.33)°;对于外侧1/2骨折,虚拟三维圆柱体的最大直径平均为(11.25±1.45)mm,长度为(96.82±6.76)mm,螺钉与矢状面的夹角变化范围为(36.12±2.76)°～(43.38±3.30)°。在男性和女性之间的差异有统计学意义,内外侧两组数据之间的差异有统计学意义。结论耻骨上支进钉通道的确定可提高耻骨上支骨折髓内螺钉固定的安全性与准确性。

Objectivc To investigate the safe range of intramedullary screw channel of superior pubic ramus fractures with the methods of digital anatomy. Methods A retrospective analysis was conducted with computed tomography （CT） images of pelvis froml7 adult patients （34 cases ofhemipelvis）. We built virtual cylinder of intramedullary screw channel with Mimics according to the common types of superior pubic ramus fracture. With three-dimensional measurement tools, we measured the maximum width, depth, range of entry points and angles of the screw channels, determined the patterns of them and the scope of the security, Results For medial 1/2 fractures, the virtual cylindrical was of an average of （9.64±0.79） mm in maximum diameter, （67.88±6.07） mm in length and sagittal screw angle ranged from （44.03±2.29）° to （50.41±3.33）°; in terms of the lateral 1/2 fracture, the maximum diameter of the virtual cylindrical was （11.25±1.45） mm, （96.82±6.76） mm in length, the angle between the screw and the sagittal plane ranged from （36.12±2.76）° to （43.38± 3.30）°. The differences between men and women were statistically significant, the data of different location of fractures between the two groups were statistically significant. Conelusioa Digital anatomical studies of the safe range of intramedullary screw channel of superior pubic ramus fractures increase the safety and accuracy of the intramedullary screws fixation.