本文關(guān)鍵詞： 髖臼骨折 閉孔后緣通道 三維成像 解剖學(xué)　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目前就不同類型的髖臼骨折的治療已有許多相關(guān)研究報(bào)道,但是目前幾乎沒有關(guān)于如何在閉孔后緣骨性通道中安全置入拉力螺釘?shù)膱?bào)道,然而根據(jù)相關(guān)生物力學(xué)研究,在該通道中置入一枚拉力螺釘可以顯著提高內(nèi)固定的穩(wěn)定性。然而該通道十分狹窄,所以有必要對(duì)其進(jìn)行詳細(xì)的研究。研究目的測(cè)量閉孔后緣螺釘通道的進(jìn)釘參數(shù),根據(jù)所得參數(shù)在骨性半骨盆標(biāo)本上進(jìn)行模擬置釘,探討合理的置釘方法,為相關(guān)置釘瞄準(zhǔn)器的設(shè)計(jì)提供依據(jù)。研究方法收集50例正常成人骨盆(男女各25例)的螺旋CT掃描數(shù)據(jù),在mimics15.0軟件中重建骨盆三維模型,經(jīng)逆向工程軟件Geomagic Studio 12.0處理后得到100個(gè)內(nèi)部為空、僅有外側(cè)皮質(zhì)的半骨盆模型,將其儲(chǔ)存為.stl文件后重新導(dǎo)入mimics15.0軟件中。通過“軸位透視法”找到閉孔后緣最大的螺釘通道,置入模擬螺釘后自進(jìn)釘點(diǎn)O向骨盆界線作垂線交于點(diǎn)A,連接點(diǎn)A與恥骨聯(lián)合點(diǎn)B。分別測(cè)量最大螺釘直徑和長(zhǎng)度、進(jìn)釘點(diǎn)的位置、進(jìn)釘方向與冠狀面的夾角α和與矢狀面的夾角β,進(jìn)釘方向與骨面所成外傾角θ和后傾角ψ。對(duì)測(cè)量數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理后,挑選13具保存完整、肉眼和X線下均未見畸形和骨折的骨性半骨盆標(biāo)本(男性8具,女性5具),根據(jù)測(cè)量數(shù)據(jù)在13具半骨盆標(biāo)本上進(jìn)行驗(yàn)證,并統(tǒng)計(jì)置釘成功率。研究結(jié)果男性的最大螺釘直徑平均值為(6.48± 1.07)mm,最大螺釘長(zhǎng)度平均值為(98.03±4.08)mm,OA 平均值為(7.93±2.30)mm,AB 平均值為(55.99±4.83)mm,∠α 平均值為(48.93±3.72)°,∠β平均值為(2.42±1.10)°,∠θ平均值為(79.17±9.89)°,∠ψ平均值為(108.72±6.13)°;女性的最大螺釘直徑平均值為(5.87±1.34)mm,最大螺釘長(zhǎng)度平均值為(87.34±4.76)mm,OA平均值為(3.77±1.37)mm,AB平均值為(63.66±4.74)mm,∠α平均值為(47.03±4.18)°,∠β平均值為(5.34± 1.81)°,∠θ 平均值為(71.81±10.61)°,∠ψ平均值為(98.12±7.43)°。所有的測(cè)量參數(shù)均存在男女之間的統(tǒng)計(jì)學(xué)差異(p0.05)。在13具骨性半骨盆標(biāo)本進(jìn)行置釘時(shí),8具男性半骨盆標(biāo)本均于閉孔后緣螺釘通道中安全置入1枚直徑3.5mm的克氏針,置釘成功率100%。5具女性半骨盆標(biāo)本中有1具置釘過程中螺釘穿入關(guān)節(jié),4具成功置入1枚直徑3.5mm的克氏針,置釘成功率80%。研究結(jié)論根據(jù)測(cè)量所得的閉孔后緣螺釘通道的進(jìn)釘參數(shù)和骨性半骨盆標(biāo)本上的驗(yàn)證結(jié)果,我們認(rèn)為于該通道置入一枚長(zhǎng)度合適、直徑3.5mm的拉力螺釘是可行的,同時(shí)可根據(jù)測(cè)量所得的解剖學(xué)參數(shù)設(shè)計(jì)相關(guān)的進(jìn)釘導(dǎo)向裝置。
[Abstract]:There have been many related studies on the treatment of different types of acetabular fractures, but there are few reports on the safe placement of pull screws in the osseous passage of the posterior margin of the obturator. However, according to biomechanical studies, placement of a pull screw in the channel can significantly improve the stability of the internal fixation. However, the channel is very narrow. Therefore, it is necessary to study it in detail. Methods the helical CT scanning data of the pelvis of 50 normal adults (25 males and 25 males) were collected. Three dimensional model of pelvis was reconstructed in mimics15.0 software. 100 internal models were found to be empty after processing with reverse engineering software Geomagic Studio 12.0. The hemipelvis model with only lateral cortex was stored as .stl file and then re-imported into mimics15.0 software. The largest screw passage was found by "axial perspective". The point A and pubic joint point B were used to measure the maximum screw diameter and length, and the position of the point respectively. The angle 偽 between the direction of the nail and the coronal plane, the angle 尾 with the sagittal plane, the angle 胃 and the posterior inclination between the direction of the nail and the bone plane were obtained. After statistical processing of the measured data, 13 specimens were selected for preservation. No deformities and fractures of the pelvis (8 males and 5 females) were observed in the naked eye and under X-ray. The data were tested on 13 hemipelvis specimens. Results the mean maximum screw diameter and maximum screw length were 6.48 鹵1.07mm and 98.03 鹵4.08mm respectively. The average value of OA was 7.93 鹵2.30mb, the mean value of AB was 55.99 鹵4.83mm. the mean value of 偽 was 48.93 鹵3.72 擄. The average value of 尾 is 2.42 鹵1.10 擄, the average value of angle 胃 is 79.17 鹵9.89 擄, and the average value is 108.72 鹵6.13 擄. The mean maximum screw diameter and maximum screw length were 5.87 鹵1.34 mm and 87.34 鹵4.76 mm respectively. The average value of OA was 3.77 鹵1.37mb, the mean value of AB was 63.66 鹵4.74mm, and the mean value of 偽 was 47.03 鹵4.18 擄. The mean value of 尾 is 5.34 鹵1.81 擄, and the average value of 胃 is 71.81 鹵10.61 擄. The mean value of 蠄 was 98.12 鹵7.43 擄. There was a statistical difference between men and women in all the measured parameters (p 0.05). A 3.5mm Kirschner needle was safely placed in the posterior margin screw passage of 8 male hemipelvis specimens. The successful rate of nail insertion was 100.5 female hemi-pelvis specimens. During the process of nail insertion, 4 screws were inserted into the joint and 4 were successfully implanted with a 3.5mm Kirschner needle. The success rate of nail placement is 80%. Conclusion according to the parameters of screw entry and the results of validation on the pelvis specimen, we think it is appropriate to place a piece of nail in this channel. The pull screw with a diameter of 3.5 mm is feasible and can be designed according to the measured anatomical parameters.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687;R322

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