经皮Magic螺钉固定髋臼后柱骨折的影像解剖学

Percutaneous Magic screw fixation for acetabular posterior column fracture: an imaging anatomical study

目的探讨Magic螺钉固定髋臼后柱骨折的进钉点、方向与固定范围。方法应用Mimics19. 0软件对100例骨盆CT数据进行三维重建,在髋臼后柱置入虚拟Magic螺钉,确定螺钉进钉点、方向、长度、直径和安全范围。对有Magic虚拟螺钉固定的髋臼后柱进行截骨并建立模型,应用Geomagic Wrap 2017软件测量该螺钉通道的解剖参数。结果 Magic螺钉骨面进钉点男性位于髂前下棘向后(33. 37±5. 53) mm及髋臼顶头侧(13. 40±3. 70)mm;女性分别为(33. 97±5. 46) mm及(9. 01±3. 86) mm。男性螺钉后倾(57. 40±6. 57)°,内倾(52. 09±5. 65)°,与髂骨翼的夹角为(15. 21±3. 42)°;女性为后倾(55. 64±8. 01)°,内倾(51. 55±5. 58)°,与髂骨翼夹角(9. 85±3. 68)°。男性螺钉最大直径为(6. 97±0. 98) mm,女性为(6. 39±0. 85) mm;男性螺钉长度为(76. 73±9. 20) mm,女性为(63. 64±8. 37) mm。男性直径5. 5 mm螺钉后倾和内倾安全范围分别为(7. 19±3. 30)°和(9. 41±3. 95)°,女性直径5. 2 mm螺钉后倾和内倾安全范围分别为(8. 37±2. 82)°和(10. 32±3. 93)°。在螺钉方向上,男性螺钉固定后柱的范围长度为(56. 87±7. 60) mm,20/50的标本螺钉可固定的骨折位于髋臼顶上,女性螺钉固定范围长度为(41. 71±7. 97) mm,8/50的标本螺钉可固定的骨折位于髋臼顶上。结论经皮Magic螺钉是手术难度较大的后柱骨折微创固定方式,可固定位于后柱中上段的骨折。

Objective To investigate the entry point,direction and fixation range of Magic screw for acetabular posterior column fracture. Methods The 3 D models of 100 pelvis were reconstructed by Mimics 19. 0 software based on CT data,and the virtual magic screw were placed in acetabular posterior column,then the screw ’s entry point were determined,and the direction,length,diameter and safe range were measured respectively. Acetabular posterior column with magic screw was osteotomy modeling by Mimics 19. 0 and imported the Geomagic Wrap 2017 software,after that anatomical parameters of the screw path were measured. Results The entry point of Magic screw on bone surface was located at( 33. 37±5. 53) mm of the anterior inferior iliac spine moving posteriorly,and( 13. 40±3. 70) mm of the apex of the upper margin of acetabular moving celphalad in male,which were( 33. 97±5. 46) mm and( 9. 01±3. 86) mm in female.The posterior inclination angle,interior inclination angle of magic screw and the angle between screw and iliac wing were( 57. 40±6. 57) °,( 52. 09±5. 65) ° and( 15. 21±3. 42) ° in male,which were( 55. 64±8. 01) °,( 51. 55±5. 58) ° and( 9. 85±3. 68) °in female. The maximum diameter of male screw was( 6. 97±0. 98) mm,which was( 6. 39±0. 85) mm in female. The length of male screw was( 76. 73± 9. 20) mm,which was( 63. 64 ± 8. 37) mm in female. The safe range of posterior inclination and interior inclination of were( 7. 19 ± 3. 30) ° and( 9. 41 ± 3. 95) ° in male screw with 5. 5 mm diameter,which were( 8. 37±2. 82) ° and( 10. 32±3. 93) ° in female screw with 5. 2 mm diameter. In the direction of the screw,the length range of the posterior column which is fixed by screw was( 56. 87 ± 7. 60) mm,and the proportion of fractures fixed with screws which were located on the top of the acetabular was 20/50 in male,which were( 41. 71±7. 97) mm and 8/50 in female. Conclusion Percutaneous Magic screw is a minimally invasive treatment for acetabular posterior column fracture,which is difficult to operate. The screw can fix the fracture which is located at the middle and upper part of the acetabular posterior column.