骨盆Teepee像的影像解剖研究

Radiographic anatomical analysis of the pelvic Teepee view

目的 :研究骨盆Teepee像主体结构的影像解剖,包括其方位走行及影像解剖构成。方法 :对2013年6月至2014年6月进行骨盆CT检查的成人检查结果进行筛选,排除骨骼畸形及由肿瘤、创伤等所导致骨盆骨性破坏的患者。将所筛选出的9例全骨盆2.0 mm层厚轴向CT扫描图像作为研究对象,其中男7例,女2例;年龄(41.2±10.3)岁。应用Mimics 10.01对9例无病损全骨盆2.0 mm层厚轴向扫描数据进行三维重建。将重建出的骨盆三维图像进行透明化处理后向髋臼闭孔斜位及骨盆出口位逐渐旋转,直至髋臼上方区域出现标准的"圆锥形帐篷"(即Teepee)样外观。此时的图像即骨盆Teepee像,"圆锥形帐篷"即此投照像的主体。沿主体的边缘进行剪切,对主体及其以外的骨盆结构同时显示,然后研究其于整个骨盆内的方位走行及影像解剖构成。结果:骨盆Teepee像所示主体起自髂前下棘后外侧骨皮质,经尾端、前方、外侧到头端、后方、内侧的指向,止于髂后上棘及髂后下棘之间的骨皮质。其由一顶、一底及两缘围成。其顶由髂骨的内板(形成其内缘)及外板(形成其外缘)的骨皮质相交形成,其底由坐骨大切迹形成。其内侧、下部、后方总包括小部分骶髂关节及所对应的骶骨侧骨质。结论:骨盆Teepee像的主体为丰富的骨性结构,除其内下方小部分区域外可作为容纳某些类型骨盆、髋臼骨折固定物的安全区域。骨盆Teepee像可用于指导固定物的安全置入。

Objectives：To research radiographic anatomy of the main structure of the pelvic Teepee view,including its azimuth direction and view anatomy structure. Methods：From June 2013 to June 2014 adult pelvic CT examination results were filtered,excluding skeletal deformities and pelvic osseous destruction caused by tumors,trauma,etc. The data of 2.0 mm contiguous CT scan of 9 adults＇ intact pelves was selected and input into Mimics 10.01 involving 7 males and 2 females with an average age of（41.2±10.3）years old. Utilizing the software,the 3D CT reconstructions of the pelves were completed. Set-ting the transparency being high,the pelvic 3D reconstructions were manipulated from the pelvic anteroposterior view to the combined obturator oblique outlet view and fine tuned till the regular Teepee or teardrop shaped appearance emerges. Cutting tools of the software were at the moment applied to separate the＂Teepee＂from the main pelvis for each reconstruction. Then the＂Teepee＂and the rest（main）part of the pelvis were displayed in different color to facilitate the analysis on the Teepee,ili-ac oblique,and anteroposterior views. Results：The＂Teepee＂started from the posterolateral aspect of the anterior inferior iliac spine and finished at the cortex between the posterior superior iliac spine and the posterior inferior iliac spine in a direction of being from caudal anterior lateral to cranial posterior medial. The radiographic anatomical composition of the＂Teepee＂con-tained one tip,one base,and two aspects. With the inner and outer iliac tables being the inner and outer aspects of the＂Tee-pee＂,the tip is consequently formed by their intersection. The base is imaged from the cortex of the greater sciatic notch. The medial inferior posterior portion of the＂Teepee＂contains a small part of sacroiliac joint and its corresponding side of bone of the sacrum. Conclusions：The＂Teepee＂is a zone of ample osseous structures of the pelvis,aside from a small medial inferior posterior portion,the main zone of which can be accepted as a safe osseous zone for the anchor of implants stabilizing certain pelvic and acetabular fracture patterns. The Teepee view can be utilized as guidance for the safe percutaneous insertion of such implants.