34例Stoppa入路髋臼安全置钉解剖学分析

Anatomic Study of Safe Zone for Screw Insertion Around the Acetabulum in Stoppa Approach

目的了解螺钉安全置入髋臼的方法。方法通过测量Stoppa入路髋臼周围螺钉的安全区将34例成年人干燥的髋骨标本作为研究对象,与真骨盆缘平行下移,重建钢板宽度的一半使之垂直于真骨盆内表面,完成截骨工作,髋骨横切面拓印出来,将髂耻隆起作为基准点进行作图分析,并测量出髋臼周围螺钉的危险区、相对安全区和安全区的范围。结果髂耻隆起内侧(9.64±8.30)mm和外侧(12.57±7.95)mm间的区域为置入危险区;髂耻隆起内侧(9.67±8.27)mm^(16.54±6.56)mm,外侧(12.60±7.92)mm^(21.10±6.08)mm间的区域则为相对安全区;髂耻隆起外侧大于(21.10±6.08)mm与内侧大于(16.54±6.56)mm区域则是髋臼周围螺钉置入的安全区,在该区域内远离髋臼或是垂直钢板将螺钉置入皆不会穿进髋臼。在髋臼周围安全置入螺钉的长度最大值为:外侧(38.32±6.11)毫米,内侧(25.29±3.59)毫米。左右侧的对比无统计学差异。结论在进行Stoppa入路髋臼周围螺钉固定时,可将髂耻隆起作为标志进行螺钉的安全置入。置入时应选在安全区或相对安全区。

Objective To study the safe zone for screw around the acetabulum in Stoppa approach for treating pelvic and acetabular fractures with plate and screws along pelvic brim, and to afford anatomical data for inserting screw around the acetabulum safely. Method 34 dry human adult innominate bones were seen vertically to the inner surface along the line parallel and inferior to the pelvic brim about half width of the reconstruction plate. Then the authors copied the boundary of the transection of the acetabulum on the white paper and measured the safe zone, relatively safe zone and danger zone for screw insertion around the acetabulum using the figure on the paper referring to iliopectineal eminence. Results The district between （9. 64 ± 8. 30） mm medial to iliopectineal eminence and （ 12. 57 ± 7. 95 ） mm lateral to iliopectineal eminence was the danger zone for screw insertion around the acetabulum,screw would penetrate into the hip joint within this district ; the districts from（9. 67 ± 8. 27 ） mm to（ 16. 54 ± 6. 56） mm lateral and（12.60 ±7.92）mm to（21. 10 ±6.08）mm medial to iliopectineal eminence was the relatively safe zone for screw insertion around the acetabulum, using maximum angle away from acetabulum screw would not penetrate into the hip joint within this district; the districts exceed （21 . 10 ± 6. 08 ） mm lateral and（ 16. 54 ±6. 56） mm medial to iliopectineal eminence was the safe zone for screw insertion around the acetabulum,inserting screw perpendicularly or away from acetabulum would not penetrate into the hip joint within this district. The longest length for inserting screw safely in the lateral district was the （38. 32 ± 6.11） mm ; in the medial district was （ 25. 29 ± 3 . 59 ） mm. There was no statistical meaning of the difference of each data between the left and right side. Conclusion The iliopectineal eminence can act as the guidance for inserting screw safely around the acetabulum in modified Stoppa approach. The screw around the acetabulum should be used in the safe and relatively safe zone, avoiding in the danger zone. We recommend the method in safe zone firstly.