后路短螺丝钉固定术治疗骶髂关节骨折脱位实验研究与临床

Posterior Short Screws Fixation Stabilize Sacroiliac Joint Dislocation

目的:探讨后路短螺丝钉固定治疗骶髂关节骨折脱位的安全性和疗效。方法:骶骨应用解剖,骶髂关节脱位模型生物力学实验,11例病人手术方法及疗效分析。结果:应用解剖,(1)骶骨耳状面下缘在S_(2、3)后孔连线中下1/3以下者占86.6％;(2)S_(2、3)侧柱呈直角梯形。S_2侧柱横截面前后径(28.3±1.7)mm,S_3侧柱横截面前后径中部为(21.4±1.5)mm,中下1/3处为(8.4±1.1)mm;(3)骶后中间嵴到耳状面中轴垂直距离:S_2水平处(26.7±2.6)mm,S_3水平处(27.2±2.8)mm。骶后孔连线:S_(1、2)间(17.4±1.6)mm,S_(2、3)间(17.6±2.1)mm。生物力学:(1)2枚短螺丝钉固定可以控制骶髂关节的移位,同时前部固定后明显增加骨盆的强度和刚度,并可以对抗剪切力。临床部分:治疗11例病人平均随访5.4年,优7例,良4例。结论:后路短螺丝钉经过骶骨侧柱中上部,不超过骶孔连线固定骶髂关节,不但能获得牢固的固定,同时能有效的避免神经损伤,骶髂关节植骨融合其远期疗效好。

Objective: To explore the safety and efficacy of the treatment of sacroiliac joint dislocation by posterior fixation with short screws. Methods: Applicable anatomy of sacrum and biomechanic test of pelvic fractrue model were studied. Operative methods and efficacies of 11 cases were analyzed.Results:Applicable anatomy (1)In 86.6% of the cases,inferior border of auricular surface was below the one third of posterior sacral forament of 82 and 83. (2) The lateral column of S2 and S3 was trap-zoid. The distance between the anterior and the posterior of the lateral column was 28.3 ± 1.7mm (S2) ,21.4 ± 1.5mm (median, S3) ,8.4 ± 1.1mm (one third of median-inferior,83). (3)The distance between median sacral crest and auricular surface was 26.7 ±2.6mm (S2),27.2 ±2.8mm (S3). The distance between each posterior sacral forament was 17.4±1.6mm (S1-2),17. 6±2.1mm(S2-3).Biomechanic:(1)Fixation used two screws could limit the shift of sacroiliac joint. Fixation in both posterior and anterior could increase the degrees of stiffness and firmness. Significantly as well as load tangent motion. Clinical:Followed up for an average of 5.4 years. Excellent:7; good:4. Conclusion:The posterior fixation with screws through the superior-median of sacral lateral column, without exceeding the link line of sacral foramen,not only can attain a stable fixation but also can avoid effectively nervous injury. The efficacies of sacroiliac joint's bone graft and arthrodesis is well in the long term observation.