前路动力化方形区钛板螺钉系统钢板轨迹长度测量的解剖学研究

Anatomic study on the measurement of track length of dynamic anterior plate-screw system

目的探讨前路动力化方形区钛板螺钉系统(DAPSQ)钢板轨迹长度及各分区数字化测量的可行性及临床意义。方法在14具(22侧)无畸形或骨缺损的成年人干燥骨盆标本上画出DAPSQ钢板轨迹,再用PDS缝线沿DAPSQ钢板轨迹摆放并做好各分区的标记,用游标卡尺在标记后的PDS缝线上分别测量DAPSQ钢板轨迹在耻骨区、方形区、髂骨区的标本实测长度。再将测量后的骨盆标本行CT扫描并三维重建,得到Dicom格式数据,导入Mimics 20.0软件中,将各分区看作圆的一部分,分别测出各圆的直径及各分区对应的弦长,根据公式分别计算耻骨区、方形区、髂骨区DAPSQ钢板轨迹数字化测量长度值。采用组内相关系数分析测量者间的一致性;采用配对t检验比较两种测量方法所得测量值的差异,采用Bland-Altman检验分析两种测量方法的一致性。结果数字化测量DAPSQ钢板轨迹长度值为:耻骨区(60.60±3.79)mm、方形区(67.48±4.63)mm、髂骨区(88.20±6.03)mm;标本实测值为:耻骨区(60.38±3.90)mm、方形区(66.08±3.19)mm、髂骨区(89.19±4.38)mm;配对t检验显示,差异均无统计学意义(P值均>0.05)。两测量者组内相关系数均>0.8,均为优。Bland-Altman分析显示,除髂骨区两种方法测量有4.5%(1/22)的差值在95%一致性界限以外,其余差值均在95%一致性界限内,一致性较好(P值均>0.05)。结论数字化测量DAPSQ轨迹长度方法可靠,为大数据测量DAPSQ轨迹长度提供可行性的影像学测量方法,进而为标准化DAPSQ钢板的设计与制作提供相关解剖学参数支持。

Objective To explore the feasibility and clinical significance of the the trajectory length measurement of the dynamic anterior plate-screw system for quadrilateral area(DAPSQ),and to provide a method for measuring the trajectory length of DAPSQ plate and the proportion of each region.Methods The DAPSQ plate trajectory was drawn on 14 adult dry pelvis specimens(22 sides)without deformity or bone defect.Then,PDS suture was placed along the DAPSQ plate trajectory and marked each area.The length of the pubic region,quadrilateral surface region and tibia region were measured by vernier calipers.Then,the measured pelvis was scanned by CT and reconstructed in three dimensions to get DICOM format data,which was imported into the software of Mimics 20.0.Each partition was regarded as a part of the circle,the diameter of each circle and the corresponding chord length of each partition were measured respectively.According to the formula,the digital measurement length of the DAPSQ plate trajectory in the pubic region,square region,and sacrum region was calculated respectively.The intraclass correlation coefficient(ICC)was used to analyze the consistency between the two measurers.The paired T-test was used to compare the differences between the two measurement methods,and the Bland-Altman test was used to analyze the consistency between the two measurement methods.Results The track length of DAPSQ plate was(60.60±3.79)mm in pubic region,(67.48±4.63)mm in square region and(88.20±6.03)mm in sacrum region.The measured values of specimens were(60.38±3.90)mm in pubic region,(66.08±3.19)mm in square region and(89.19±4.38)mm in sacrum region.The paired t-test showed that there was no significant difference(all P values>0.05).The ICC of the two measurements were both greater than 0.8,and both were excellent.Bland-Altman analysis showed that except for the difference of 4.5%(1/22)measured by the two methods in the iliac region,the other differences were within the 95%consistency limit,with good consistency(all P values>0.05).Conclusions The method of digital measurement of DAPSQ track length is reliable,which can provide a feasible imaging measurement method for large data measurement of DAPSQ track length,and provide anatomical reference support for the standardization of DAPSQ plate.