微创髂板间虚拟螺钉固定髋臼后柱骨折的解剖学研究

Minimally invasive fixation with virtual self-designed screws between the iliac plates for acetabular posterior column fractures:an anatomic study

目的设计一种微创髂板间虚拟螺钉置钉方法固定髋臼后柱骨折,并比较置钉解剖学参数的性别差异。方法收集2021年6月至2022年6月期间厦门市第三医院因体检或外伤等原因而行骨盆CT扫描的80例正常骨盆CT数据。男40例,女40例;年龄(45.0±12.4)岁。通过3D建模与设计软件规划微创髂板间虚拟螺钉并测量入钉点、螺钉长度、螺钉直径、螺钉与骨盆冠状面夹角、螺钉与骨盆矢状面夹角、螺钉与坐骨大切迹前缘骨嵴线ε夹角及骨性通道体积等,比较以上数据的性别差异。结果微创髂板间螺钉入钉点在髂前上棘与髂结节之间,方向朝向坐骨棘和坐骨小切迹之间的区域。螺钉长度为(139.64±8.46)mm,直径为(8.95±1.16)mm,骨性通道体积为(51.91±10.77)cm^(3)。男性微创髂板间螺钉长度[(144.34±7.58)mm]、直径[(9.50±0.98)mm]、螺钉与骨盆矢状面夹角(31.14°±2.74°)、骨性通道体积[(57.82±8.82)cm^(3)]显著大于女性[(134.95±6.48)mm、(8.40±1.07)mm、26.72°±2.74°、(46.01±9.22)cm^(3)],螺钉与骨盆冠状面夹角(35.74°±3.85°)、与坐骨大切迹前缘骨嵴线ε夹角(11.96°±4.57°)显著小于女性(36.89°±2.96°、14.17°±5.15°),差异均有统计学意义(P<0.05)。结论微创髂板间螺钉固定为治疗髋臼后柱骨折提供了一种新的固定方式,其既可以经皮微创置入,也能顺行置入。男性螺钉的长度、直径、骨性通道体积及与骨盆矢状面夹角均大于女性,螺钉与骨盆冠状面夹角小于女性,置钉时应根据性别不同调整髂板间螺钉与骨盆矢状面、冠状面的角度。

Objective To study the minimally invasive fixation with virtual self-designed screws between the iliac plates for acetabular posterior column fractures and compare the differences between genders.Methods The CT data were collected from the 80 patients with normal pelvis who had undergone pelvic CT scan due to physical examination or trauma at Department of Orthopaedics, The Third Hospital of Xiamen from June 2021 to June 2022. There were 40 males and 40 females with an age of (45.0±12.4) years. The virtual screws between the minimally invasive iliac plates were designed with design software after 3D modeling. The insertion point, screw length, screw diameter, angle between the screw and the coronal plane of the pelvis, angle between the screw and the sagittal plane of the pelvis, angle ε between the screw and the anterior edge bone crest line of the greater sciatic notch, and bone channel volume were measured. Comparisons of the above data were made between genders.Results The insertion point of the screw between the minimally invasive iliac plates was located between the anterior superior iliac spine and the iliac tubercle nodule, going toward the area between the ischial spine and the small ischial notch. The screw length was (139.64±8.46) mm, the screw diameter (8.95±1.16) mm, and the bone channel volume (51.91±10.77) cm^(3). The screw length [(144.34±7.58) mm], screw diameter [(9.50±0.98) mm], angle between the screw and the sagittal plane of the pelvis (31.14°±2.74°), and bone channel volume [(57.82±8.82) cm^(3)] for males were significantly larger than those for females [(134.95±6.48) mm, (8.40±1.07) mm, 26.72°±2.74°, and (46.01±9.22) cm^(3)], while the angle between the screw and the sagittal plane of the pelvis [(35.74°±3.85°) mm] and angle ε between the screw and the anterior edge bone crest line of the greater sciatic notch (11.96°±4.57°) for males were significantly smaller than those for females (36.89°±2.96° and 14.17°±5.15°) (all P < 0.05).Conclusions Fixation with screws between the iliac plates provides a new treatment for acetabular posterior column fractures, because the screws can be placed percutaneously in a minimally invasive manner or antegradely. The screw length, screw diameter, angle between the screw and the sagittal plane of the pelvis, and bone channel volume for males are significantly larger than those for females, while the angle between the screw and the sagittal plane of the pelvis and the angle between the screw and the anterior edge bone crest line of the greater sciatic notch for males are significantly smaller than those for females. Therefore, the angles between the iliac plate screw and the sagittal and coronal planes of the pelvis should be adjusted according to gender in screw placement.