骨盆CT三维重建指导髂骨钉置入

Three-dimensional reconstruction of pelvic CT in guiding iliac nail implantation

背景:目前行髂骨钉置入没有统一路径标准,因人体个体差异性较大,在置入前行骨盆CT三维重建,可测量出所置入髂骨钉的直径、深度、角度等,最大程度保证置入的准确性。目的:通过骨盆的CT三维重建测量髂骨钉置入路径的相关数据,指导髂骨钉置入,使修复手术更为精确。方法:选择2013年1月至2016年12月在山东省立第三医院接受骨盆病变、骨折治疗的患者50例。对患者进行骨盆CT扫描三维重建,将A点(S1骶后孔上缘连线与髂后上棘交点)位置作为髂骨钉置入点,在此点上分别测量3条路径:(1)髂前上棘路径标记为AD路径;(2)髂前下棘路径标记为AC路径;(3)坐骨大切迹上方至髋臼顶部路径标记为AB。在此3条路径平面上对髂骨做切面,分别在每个切面上设计髂骨钉所穿入的通道,测量出髂骨螺钉通道的直径、长度以及置入角度,根据测得的数据,选定合适的髂骨钉。结果与结论:(1)同一置入路径的男性、女性髂骨钉通道长度比较,差异无显著性意义(P>0.05)。经配对t检验,AB路径与AC路径,AC路径与AD路径的髂骨钉通道长度、直径比较,差异均有显著性意义(P<0.05);(2)同一置入路径男性、女性的尾向偏角比较,差异无显著性意义(P>0.05)。经配对t检验,男性、女性患者通过不同路径的尾向偏角比较,差异有显著性意义(P<0.05);男性、女性患者通过不同路径的外倾角比较,差异亦有显著性意义(P<0.05);(3)结果提示,骨盆CT三维重建可以测得可置入髂骨钉的长度、直径及角度,从而指导手术治疗。

BACKGROUND:Iliac screw implantation has no unified standard.Because of the large individual differences,preoperative pelvic three-dimensional(3D)CT reconstruction can measure the diameter,depth and angle of the screws,which increases the placement accuracy.OBJECTIVE:To measure the screw placement-related data by pelvic 3D CT reconstruction,so as to guide the screw placement and improve its accuracy.METHODS:Fifty patients with pelvic lesions or fractures admitted in Shandong Provincial Third Hospital from January 2013 to December 2016 were selected,and the pelvis was scanned with CT and then was reconstructed.The point A(the intersection of S1 posterior sacral posterior wall and posterior superior iliac spine)was as the screw placement point,and three paths were measured on the point:posterior superior iliac spine path(AD path);anterior inferior iliac spine path(AC path);top of greater sciatic notch to the acetabular roof(AB path).On the plane of these three pathes,the section was made on the iliac bone,respectively;in each section,the channel for iliac nail was designed.RESULTS AND CONCLUSION:(1)In the same path,there was no significant difference in the path length of the screw between male and female patients(P>0.05).Paired t test showed that the diameter and length depth and angle of the screws were significantly different between AD and AC paths,AC and AD(P<0.05).(2)There was no significant difference in the inclination angle of the spiral channel between male and female patients(P>0.05).The inclination angle of the spiral channel and lateral angle at different paths showed significant difference between male and female patients(P<0.05).(3)To conclude,3D reconstruction of pelvis CT can be used to measure the length,diameter and angle of the iliac screw,and to guide the surgical treatment.