骶骨上关节突关节面5点7点螺钉进钉点的应用解剖学

Applied anatomic study on the placement of sacral screw through the five-seven o'clock point on the articular facet of the superior articular process

目的 :研究以骶骨上关节突关节面 5点 7点处为螺钉进钉点的解剖学基础。方法 :在成人 115块干燥骶骨标本上观测上关节突关节面形态 ,确定其 5点 7点处的部位 ,观测该点与骶骨外侧沟的关系及该点进钉时的角度、深度。并在横断面标本上进行观测 ,在干燥骶标本上进行模拟手术。结果 :骶骨上关节突关节面呈圆形者 63 .5 % ( 14 6侧 ) ,椭圆形者 3 6.5 % ( 84侧 ) ;5点 7点低于骶骨外侧沟最低点的距离 ,左侧 ( 7.4± 1.5 )mm ,右侧 ( 7.3± 1.6)mm。横断面标本上自此点向前与矢状面平行 ( 0°)时 ,进钉深度 ,左侧 ( 3 1.3± 4.3 )mm ,右侧 ( 3 1.9± 4.9)mm。当钉尖向内侧与矢状面呈 10°角时 ,进钉深度 ,左侧为 ( 3 4.1± 4.3 )mm ,右侧 ( 3 4.0± 4.9)mm。结论 :骶骨上关节突恒定存在 ,将每侧上关节突关节面看成一个时钟表盘 ,右侧关节面相当于 5点处、左侧相当于 7点处为螺钉进钉点。其 5点 7点进钉点的确定较为客观 ,不受上关节突关节面方向的影响 ,也不受退变影响 ,可很容易地确定 5点 7点的部位。

Objective: To study the anatomic bases for placement of inserting sacral screw through the five-seven o'clock point on the articular facet of the superior articular process . Methods: (1) 115 dry sacra were used in the present study. The anatomical evaluation was focused on the determination of the five-seven o'clock point of the superior articular process, the shape of the superior articular process of the sacrum, the relation between the five-seven o'clock point and the bottom point of the lateral sulcus of the sacrum, etc. (2) The distance from the five-seven o'clock point to the anterior cortex of the sacrum was measured at 0°and 10° inward to the sagittal plane on 10 transverse sections of dry specimens. Results: The shapes of the articular facets of the superior articular processes are various, round 63.5%(146 cases) and ellipse 36.5% (84 cases). The five-seven o'clock point is lower than the bottom point of the lateral sulcus. The distance between them were (7.4±1.5)mm on the left and (7.3±1.6)mm on the right. The entrance depth of the sacral screw were (31.3±4.3) mm on the left, (31.9±4.9)mm on the right at 0°; and (34.1±4.3)mm on the left, (34.0±4.9)mm on the right at 10° inward to the sagittal plane. Conclusions: The superior articular processes of sacrum exist unvaryingly. If the articular facet of the superior articular process is regarded as a clock, the entrance point of sacral screw is at the five o'clock point on the right , and at the seven o'clock point on the left. The entrance point is not influenced by the direction of the articular facet or the degeneration of the superior articular process. The five-seven o'clock point can be easily exposed and identified during operation.