改良LC-Ⅱ螺钉固定钉道的数字化分析与验证

Digital analysis and optimization of the modified LC-Ⅱscrew fixation path

目的通过数字医学软件,构建改良LC-Ⅱ螺钉最优钉道并行分析及测量,以期提高置钉的安全性及准确性。方法收集2021年1月至2022年12月期间南方医科大学第三附属医院的40例成人正常骨盆CT数据,男、女各20例,年龄为20~65岁,平均(48.72±14.95)岁。运用Mimics 19.0软件三维重建骨盆模型确定最优钉道测量其直径和长度,并导入3-Matic 13.0软件测量改良LC-Ⅱ螺钉中轴线与皮肤交点距离髂前上棘的垂直距离Dv1、水平距离Dh1;测量改良LC-Ⅱ螺钉中轴线与冠状面、矢状面、水平面的夹角∠α、∠β、∠γ及在骨盆正位、入口位状态下改良LC-Ⅱ螺钉中轴线与骨盆正中线的夹角∠LPM、∠LPM’,比较不同性别、不同侧别之间的差异。结果40例骨盆中,双侧置钉区域均可规划出全程改良LC-Ⅱ螺钉钉道。通过观察数字化骨盆三维模型,改良LC-Ⅱ螺钉骨性进钉点均位于髋臼顶上缘,髂前下棘偏外后侧。改良LC-Ⅱ的最大通道直径男、女性分别为(12.33±1.04)mm,(10.33±0.90)mm;通道最大长度男、女性分别为(95.37±6.60)mm,(92.51±5.59)mm。改良LC-Ⅱ螺钉与正中矢状面夹角∠β,男、女分别为(33.04±4.04)°,(35.18±2.84)°(P<0.05);螺钉轴线与骨盆水平面夹角∠γ,男、女分别为(35.97±4.70)°,(39.83±6.16)°(P<0.05);在骨盆入口位状态下,螺钉轴线与骨盆正中线夹角∠LPM’,男、女分别为(35.09±2.85)°,(33.35±3.14)°(P<0.05)。结论数字医学是研究改良LC-Ⅱ螺钉骨通道解剖结构的理想工具,运用数字医学软件测量,改良LC-Ⅱ通道是存在且安全的。我们的数字化测量为改良LC-Ⅱ螺钉的临床应用提供了理论依据。

Objective Using digital medical software,the modified LC-Ⅱscrew optimal path has been designed for parallel analysis and measurement to improve the safety and accuracy of nail placement.Methods We collected CT data from 40 adult normal pelvic patients from the Third Affiliated Hospital of Southern Medical University between January 2021 and December 2022.They were 20 men and 20 women,aged 20 to 65 years old(mean 45.6 years).First,the Mimics19.0 software was used to reconstruct the pelvic model to determine the optimal nail path and measure its diameter and length,then the 3-Matic13.0 software was used to measure the vertical distance Dv1 and the horizontal distance Dh1 of the central axis of the modified LC-Ⅱscrew between the anterior iliac skin junction and the anterior superior iliac spine,the included angles between the central axis of the modified LC-Ⅱscrew and the coronal,sagittal and horizontal planes,∠α、∠β、∠γ,and the angles of∠LPM and∠LPM'between the central axis of the modified LC-Ⅱscrew and the midline of the pelvis under the condition of the pelvis in the upright position and the entry position were measured and compared between sexes and sides.Results In 40 pelvic cases,the entire modified LC-Ⅱscrew path could be planned in both lateral screw placement areas.Based on the three-dimensional digital pelvic model,the bony entry points of the modified LC-Ⅱscrews were located at the superior bor-der of the acetabulum and at the outer and posterior sides of the anterior inferior iliac spine.The maximum channel diameter of the modified LC-Ⅱwas(12.33±1.04)mm for male and(10.33±0.9)mm for female.The maximum channel length was(95.37±6.6)mm for male and(92.51±5.59)mm for female.The angle of∠βbetween the modified LC-Ⅱscrew and the median sagittal plane was(33.04±4.04)°for male and(35.18±2.84)°for female(P<0.05).The angle between the axis of the screw and the horizontal plane of the pelvis is∠γ,which is(35.97±4.70)°for males and(39.83±6.16)for females(P<0.05),the angle of∠LPM'between the axis of the screw and the median line of the pelvis is(35.09±2.85)°for males and(33.35±3.14)for females(P<0.05).Conclusions Digital medicine is an ideal tool to study the anatomy of the modified LC-Ⅱscrew bone channels.As measured by digital medical software,the modified LC-Ⅱchannels exist and are safe.Our digital measurement provides a theoretical basis for the clinical application of the modified LC-Ⅱscrews.