自髂骨前方植入骶髂螺钉固定的仿真研究

Simulation study of sacroiliac screw fixation by implanting screw from the front of the ilium

目的探讨自髂骨前方植入骶髂螺钉(SIS-FI)固定的解剖可行性和仿真植入效果。方法回顾性分析2019年1月至2020年5月无锡市第九人民医院影像科数据库中80例(男、女各40例)成年正常骨盆CT扫描数据资料。利用CT数字重建技术模拟SIS-FI固定,测量螺钉通道解剖参数。以髋臼后上缘2点或10点钟位置向后6 mm处为进针点,以S1上关节突基底与横突水平中位线交点为出针点,利用瞄准器控制下在40具3D打印(1∶1)骨盆模型两侧分别植入直径6.5、7.3 mm和长度均为90 mm螺钉,观察螺钉植入情况。结果进针点为距离髋臼后缘水平向后(5.78±1.35)mm、距离髋臼上缘垂直向下(2.48±0.50)mm处;进针方向:向上与S1上终板平行线成角(42.99±5.16)°、向内与躯干纵轴线成角(43.79±2.83)°。通道长度为(102.55±6.15)mm,最小横径为(16.55±1.77)mm,最小纵径为(18.78±1.44)mm。植入螺钉均未穿破钉道,但1例螺钉过长、穿出钉道后部少许。结论国人骨盆可植入至少一枚直径6.5~7.3 mm、长度85~95 mm的SISFI。利用瞄准器植入SIS-FI的精确度高,但是其临床价值还需进一步研究。

Objective To investigate the anatomic feasibility and simulation effect of sacroiliac screw implanted from the front of the ilium(SIS-FI).Methods Pelvis CT data for 80 healthy adults(40 males and 40 females)collected from Imaging Department database of Wuxi No.9 People's Hospital from January 2019 to May 2020 were analyzed retrospectively.Anatomic parameters of screw channel were measured by CT digital reconstruction technique to simulate SIS-FI fixation.Under the control of an aiming device,taking 6 mm backward from 2 o'clock or 10 o'clock of the posterior edge of the acetabulum as the entry point,and the base of the superior facet of S1 as the exit point,SIS-FIs with a diameter of 6.5 mm and 7.3 mm respectively,and a length of 90 mm were implanted on the two sides of the 403D printed models of the pelvis(1∶1).The implantation of screw was observed.Results The entry point was located at the position of(5.78±1.35)mm horizontally backward from the posterior edge of the acetabulum and(2.48±0.50)mm vertically downward from the upper edge of the acetabulum.The upward angle between the central axis of the channel and the line parallel to the superior endplate of S1 was(42.99±5.16)°,and the inward angle between the central axial of the channel and the longitudinal axis of the human trunk was(43.79±2.83)°.The length of the screw channel was(102.55±7.64)mm,the minimum width was(16.55±1.77)mm,and the minimum height was(18.78±1.44)mm.All the implanted screws were located within the channel,but screws in one case were longer and penetrated a little behind the posterior part of the channel.Conclusions At least one screw with a diameter of 6.5-7.3 mm and a length of 85-95 mm for SIS-FI can be implanted into the pelvis of Chinese.SIS-FI implanted with the aid of an aiming device has high accuracy.However,its clinical value needs further study.