髋臼后柱解剖形态的三维重建模型研究

A morphological study of the posterior column of the acetabulum based on three-dimensional reconstruction models

目的通过骨盆数字化三维重建模型探讨髋臼后柱及股骨头的解剖形态学特征，为术中接骨板塑形及髋臼后柱解剖型接骨板的研发提供依据。方法111例因单侧髋臼、骨盆损伤行骨盆螺旋CT扫描的成年患者，男72例，女39例；年龄18-80岁，平均45．4岁。依据CT扫描数据建立骨盆数字化三维模型。于模型中测量股骨头直径，髋臼后柱接骨板途经的髋臼后壁、近端、远端三段近似圆弧的曲率半径（R1、R2和R3）和反映三段圆弧相对位置关系的髋臼后壁圆弧展角。结果股骨头直径平均（47．43±3．74）mm，R1（47．96±7．80）mm，R2（67．71±13．35）mm，R3（9．76±0．43）mm，髋臼后壁圆弧展角平均51-38°±6．83°。男女两组股骨头直径及髋臼后壁圆弧展角的差异有统计学意义（t=12．37，P=0．00；￡=2．63，P=0．01），而R1、R2、R3两组差异无统计学意义（f=1．05，P=-0．30；t=1．36，P=-0．18；t=0．72，P=-0．47）。髋臼后壁圆弧展角与股骨头直径呈正相关（r=0．37，P=0．00），R1、R2和R3与股骨头直径不相关（r=0．09，P=0．34；r=0．08，P=0．43；r=0．00，P=0．98）。R2总体上随R1增大而增大，髋臼后壁圆弧展角随R1及R2增大而减小，R3变化范围不大。结论髋臼后柱的解剖形态存在个体差异，其形态与股骨头直径及患者性别不相关，其中髋臼后壁弧度是决定髋臼后柱接骨板形态的主要因素。

＂Objective To investigate the morphological characteristics of the posterior acetabular column femoral head by three-dimensional reconstruction models for providing an anatomical basis for intraoperative plate molding and the development of anatomical plate of the posterior acetabular column. Methods Three-dimensional reconstruction models of the pelvis were established based on CT scan data of 111 adult patients, including 72 males and 39 females, aged from 18 to 80 years （average, 45.4 years）. According to the models, the femoral head diameter was measured; along the posterior acetabular col- umn plate path, three approximate arcs with a corresponding radius of curvature （R1, R2 and R3） were created to fit the posterior wall, proximal end and distal end of the acetabulum. The angle , which reflected the relative position between the three arcs, was recorded. Results The average femoral head diameter, R1, R2, R3 and angle et was 47.43±3.74 mm, 47.96±7.80 mm, 67.71±13.35 mm, 9.76±0.43 mm and 51.38±6.83°, respectively. There was statistical difference in femoral head diameter and angle cL between females and males （t=12.37, P=0.00; t=2.63, P=0.01）, while no statistical difference was found in R1, R2 and R3 between them （t=l.05, P=0.30; t=1.36, P=0.18; t=0.72, P=0.47）. There was a positive correlation between the femoral head diameter and angle ct （r=0.37,P=0.00）, while no correlation was found between the femoral head diameter and R1, R2 and R3 （r=0.09, P=0.34; r=0.08, P=0.43; r=-0.00, P=0.98）. R2 increased with R1, while angle of decreased with increase of R1 and R2, and R3 was independent with a little variation. Conclusion The morphology of the posterior acetabular column has variances among individuals, with no obvious correlations with femoral head diameter and gender. The radian of posterior acetabular wall determines the shape of the posterior acetabular column plate.