经皮髋臼成形术穿刺部位的解剖学研究

Anatomic study on the puncture point of the percutaneous acetabular reconstruction

目的从解剖学角度探讨经皮髋臼成形术治疗髋臼转移瘤患者手术入路的最佳穿刺点、深度。方法选用30具经防腐固定处理的成人去肌肉骨盆髋关节标本和2具完整成人尸体标本。以髋臼中点为O点,过髂前上棘和O点做1条直线,再做1条过O点且垂直于该直线的直线,2条直线分别与髋臼边缘交于A、B点,并把髋臼分为4个象限。∠AOB的角平分线与髋臼边缘交于C点。设髋臼顶点为0时,测量大转子顶点所在水平面与A、B、C各点所在水平面的垂直距离及A、B、C 3点在髋臼边缘外10mm相对应A’、B’、C’3点处的髋臼后壁厚度。根据测量的数据得出最佳穿刺点和深度,对2具完整尸体标本行髋臼穿刺操作并灌注骨水泥验证。结果A’点位于大转子顶点上方31.6～38.4mm,男性平均34.9mm,女性平均34.2mm;B’点位于与A’点相同距离的10～11点钟位置;C’点位于转子顶点上方33.8～42.5mm,男性平均距离36.7mm,女性35.5mm的0点钟位置。A’、B’、C’对应的体表投影点即为穿刺部位。其穿刺深度分别为6.7～8.4、17.7～20.4、14.7～17.9mm,平均深度约分别为7.5、18.5、16.5mm。经验证髋臼成形术最佳进针点结果成立。结论 A’、B’、C’3点的体表投影点均可为行髋臼成形术的穿刺点,3个穿刺点可以较短距离到达髋臼后上象限区的肿瘤。

Objective To discuss the optimal puncture point and depth of percutaneous acetabulum forming operation for treatment of acetabular tumor on the basis of anatomical angle.Methods 30 adult pelvis and hip specimens without muscle fixed with formol and 2 complete cadavers were anatomized and measured.Set the central of acetabulum as point O,from the point O,let a vertical line intersected line which went through the point of spina iliaca anterior superior and the point O,respectively generating intersecting point A,B on acetabular margin,dividing the acetabulum into four quadrants.The angle bisector of∠AOB intersected with the edge of acetabulum generating intersecting point C.Based on the assumptions of acetabular vertice is 0o′clock,measure the distance between the horizontal plane of trochanter vertice and the horizontal planes of point A,B,C and the thickness of acetabular posterior wall in the location of point A＇,B＇and C＇10mm away from point A,B and C.And then study results verified by the operation on the 2 complete cadavers.Results The range of distance between point A＇and the femoral greater trochanter was 87.69±4.45 mm,The average for males was 34.9mm,females 34.2mm.Point B＇was located at the same position but for 10-11 o′clock location.The range of distance between point C＇located at0o′clock and the femoral greater trochanter was 33.8-42.5mm,The average for males was 36.7mm,females 35.5 mm.The puncture point were the surface projecting points of A＇,B＇and C＇,the depth of puncture for the 3 puncture point were respectively 6.7-8.4,17.7-20.4 and 14.7-17.9mm,and the average value of it were respectively 7.5,18.5 and 16.5 mm.Conclusion A＇,B＇and C＇points were the puncture point of percutaneous acetabulum forming operation with shorter distance to the tumor in the posterosuperior quadrant of the acetabulum.