本文選題：骨盆 + 髖臼　； 參考：《山東大學》2007年碩士論文

【摘要】： 目的：累及后柱或后壁的髖臼骨折多數(shù)需要行切開復位內(nèi)固定術，術中最常用的內(nèi)固定技術為髖臼后柱鋼板技術，在內(nèi)固定過程中有時會發(fā)生螺釘穿入關節(jié)內(nèi)、損傷盆腔內(nèi)重要血管或神經(jīng)等并發(fā)癥，尤其在后柱中部區(qū)域放置螺釘時更加危險。目前國內(nèi)外關于使用髖臼后柱支持鋼板技術時，如何既能保證獲得堅強內(nèi)固定，又能防止發(fā)生螺釘穿入關節(jié)內(nèi)等嚴重并發(fā)癥的定量研究資料極少。我們利用髖骨標本制作后柱系列斷面并進行研究，，確定后柱各個區(qū)域放置螺釘?shù)淖罴呀嵌群烷L度，以解決后柱中部區(qū)域擰入螺釘易穿入關節(jié)的難題。 方法：取成年男性防腐尸體標本10具，進行標本制備。確定髖臼上、下緣界限和髖臼后柱系列斷面，制作髖臼后柱系列斷面。在各斷面上測量后柱寬、髖臼寬和髖臼后柱寬度百分比，測量各進釘點的螺釘角度和長度，測量數(shù)據(jù)用SPSS10.0進行統(tǒng)計學分析。 結(jié)果： 1、髖臼上、下緣界限：髖臼上緣在后柱表面的投影在坐骨大切跡頂點上方10.2±2.7 mm，髖臼下緣在在后柱表面的投影在坐骨棘下緣上方11.5±2.6 mm，髖臼上、下緣在后柱表面的投影之間的距離為54.7±4.8 mm。 2、各斷面的后柱寬、髖臼寬和髖臼后柱寬度百分比：A斷面的后柱寬X、髖臼寬Y以及髖臼后柱寬度百分比分別為52.2±4.4 mm，0 mm和0％；B斷面的后柱寬X、髖臼寬Y以及髖臼后柱寬度百分比分別為40.8±2.2 mm，19.2±1.3 mm和47.1％；C斷面的后柱寬X、髖臼寬Y以及髖臼后柱寬度百分比分別為39.3±4.5mm，22.4±1.5 mm和56.9％；D斷面的后柱寬X、髖臼寬Y以及髖臼后柱寬度百分比分別為38.1±3.6 mm，17.6±1.1 mm和46.2％；E斷面的后柱寬X、髖臼寬Y以及髖臼后柱寬度百分比分別為48.2±5.1 mm，0 mm和0％。將斷面A、B、C、D和E的髖臼寬Y的內(nèi)側(cè)端點用弧線連起來形成髖臼的絕對危險區(qū)，含義是在此區(qū)域內(nèi)如果垂直于后柱平面進釘時，螺釘會進入關節(jié)內(nèi)。 3、B、C、D斷面各進釘點的螺釘進釘角度和長度：在B斷面上，B0點的進釘角度和螺釘長度分別為41°和44 mm；B1點分別為66°和42.2 mm；B2點分別為91°和59.5 mm；B3點分別為107°和64 mm；B4點的最大進釘角度和螺釘長度分別為123°和65.47 mm，最小進釘角度和螺釘長度分別為109°和59 mm。在C斷面上，C0點的進釘角度和螺釘長度分別為39°和39 mm；C1點分別為57°和36 mm；C2點分別為74°和36 mm；C3點分別為90°和36 mm；C4點分別為106°和76 mm。在D斷面上，D0點的進釘角度和螺釘長度分別為42°和35.5 mm；D1點分別為61°和33 mm；D2點分別為81°和32 mm；D3點分別為100°和31 mm；D4點分別為120°和74 mm。 結(jié)論：髖臼后柱鋼板技術中，在髖臼區(qū)的外1／4區(qū)、外中1／4區(qū)、內(nèi)中1／4區(qū)和在內(nèi)1／4區(qū)，釘后柱角分別為40°～60°、60°～75°、75°～90°、90°～平行于四方區(qū)，螺釘長度30mm。
[Abstract]:Objective: most acetabular fractures involving posterior column or posterior wall require open reduction and internal fixation. Complications such as injury to important vessels or nerves in the pelvis, especially when screws are placed in the middle of the posterior column, are more dangerous. At present, there are few quantitative research data on how to obtain strong internal fixation and prevent serious complications such as screw penetrating into the joint when using the technique of acetabular posterior column support plate at home and abroad. In order to solve the problem that the screw in the middle region of the posterior column is easily penetrated into the joint, we make a series of cross-section of the posterior column with hip specimen and determine the optimum angle and length of the screw placed in each region of the posterior column. Methods: 10 adult male embalmed cadavers were prepared. The upper and lower edge of the acetabular and the posterior column of the acetabulum were defined and the series sections of the posterior column of the acetabulum were made. The posterior column width, acetabular width and the percentage of acetabular posterior column width were measured on each cross section. The screw angle and length of each point were measured. The measured data were analyzed statistically by SPSS10.0. Results: 1. The superior edge of the acetabular projection on the surface of the posterior column was 10.2 鹵2.7 mm above the top of the great notch of the ischium, and the projection of the lower edge of the acetabulum on the surface of the posterior column was 11.5 鹵2.6 mm above the inferior margin of the sciatic spine. The distance between the projection of the lower edge on the surface of the posterior column is 54.7 鹵4.8 mm. 2, the back column width of each section, Acetabular width and acetabular posterior column width percentage X, acetabular width Y and acetabular posterior column width percentages were 52.2 鹵4.4 mm / 0 mm and 0% for section B, respectively, 40.8 鹵2.2% for acetabular width Y and acetabular posterior column width, respectively. The posterior column width (X), acetabular width (Y) and the percentage of acetabular width (Y) on section C were 39.3 鹵4.5mm, 22.4 鹵1.5 mm and 56.9mm respectively. The percentages of acetabular width Y and acetabular posterior column width were 38.1 鹵3.6 mm 17.6 鹵1.1 mm and 46.2 mm respectively, and the percentages of posterior column width were 39.3 鹵4.5mm and 56.9mm respectively, and the percentages of acetabular width and acetabular posterior column width were 38.1 鹵3.6 mm, 17.6 鹵1.1 mm and 46.2 mm, respectively. The percentage of acetabular width Y and acetabular posterior column width were 48.2 鹵5.1 mm and 0 mm, respectively. The medial end of the acetabular width Y of the cross section of Agna Bu C D and E is connected by arcs to form an absolute dangerous area of the acetabulum, which means that if the screw is perpendicular to the posterior column plane in this area, the screw will enter the joint. (3) the angle and length of screw entry at each point in cross section B: the maximum angle and length of screw at point B 0 are 41 擄and 44 mm / b 1, 66 擄and 42.2 mm B 2, respectively, 91 擄and 59.5 mm B 3 are 107 擄and 64 mm B 4, respectively. The angle and length of screw were 123 擄and 65.47 mm respectively, and the minimum angle and length of screw were 109 擄and 59 mm respectively. On section C, the angle and length of screw at C 0 are 39 擄and 39 mm C 1, 57 擄and 36 mm C 2, 74 擄and 36 mm C 3, 90 擄and 36 mm C 4, 106 擄and 76 mm, respectively. On D section, the angle and length of screw at D 0 were 42 擄and 35.5 mm / d 1, 61 擄and 33 mm D 2, 81 擄and 32 mm D 3, 100 擄and 31 mm D 4, 120 擄and 74 mm, respectively. Conclusion: in acetabular posterior column steel plate technique, the angle of posterior column is 40 擄60 擄60 擄60 擄and 75 擄75 擄75 擄75 擄75 擄75 擄/ 90 擄~ 90 擄~ parallel to the quadrilateral region, and the screw length is 30 mm in the outer 1 / 4 region, the middle 1 / 4 area of the acetabular area, the inner 1 / 4 area and the inner 1 / 4 area.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2007
【分類號】：R322;R687.3

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本文編號：1957445