本文選題：髖臼　切入點：后柱　出處：《蚌埠醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:對于移位型髖臼骨折應(yīng)該采用外科治療。拉力螺釘技術(shù)具有良好的骨折塊間加壓作用,因此可以獲得更好的復(fù)位,這是被廣泛接受及推薦的。同時,僅使用單一的前方入路即可同時固定髖臼前方和后方的骨折,也減小了手術(shù)的創(chuàng)傷。然而,在后柱妥善置入順行拉力螺釘目前仍然面臨巨大的挑戰(zhàn)。在技術(shù)上,由于后柱解剖結(jié)構(gòu)不規(guī)則,缺乏具體的定量解剖學(xué)信息,拉力螺釘存在切割骨皮質(zhì)、損傷關(guān)節(jié)面和髖臼重要血管神經(jīng)的風(fēng)險,這也導(dǎo)致了后柱順行拉力螺釘技術(shù)并不常用。目的:本研究旨在運用mimics 10.01軟件對骨盆三維模型模擬髖臼后柱順行拉力螺釘?shù)闹萌?嘗試找出位于髂骨內(nèi)板上的置釘安全區(qū),進(jìn)而對其相關(guān)解剖學(xué)參數(shù)進(jìn)行測量,為臨床上開展前入路后柱順行拉力螺釘技術(shù)提供理論依據(jù),并為將來研發(fā)的置釘安全區(qū)導(dǎo)板提供應(yīng)用解剖學(xué)依據(jù)。方法:隨機收集掃描范圍涵蓋骨盆的64排CT原始DICOM數(shù)據(jù)40例,男女各20例,將獲取到的40例DICOM原始數(shù)據(jù)依次導(dǎo)入MIMICS 10.01軟件進(jìn)行三維建模。人為定義橫斷位閉孔下緣與坐骨結(jié)節(jié)相交層面的中心點O作為拉力螺釘?shù)拇┏鳇c,并在橫斷位微分髂骨內(nèi)板骨皮質(zhì)及定義拉力螺釘?shù)倪M(jìn)釘點。將進(jìn)釘點和出釘點的位置參數(shù)導(dǎo)入Med CAD模塊構(gòu)建虛擬虛擬拉力螺釘。篩選出所有螺紋均位于髖臼后柱骨質(zhì)內(nèi)的拉力螺釘,這些即是安全區(qū)內(nèi)的拉力螺釘,其進(jìn)釘點在髂骨內(nèi)板骨皮質(zhì)上所構(gòu)成的區(qū)域即是髖臼后柱拉力螺釘置入的安全區(qū)。對每一根拉力螺釘?shù)拈L度及置入角度進(jìn)行測量,獲得拉力螺釘置入的長度范圍和角度范圍,并測量進(jìn)釘點出至髂前上棘、髂前下棘及耳狀面前緣的距離,獲得置釘安全區(qū)的相關(guān)解剖學(xué)參數(shù)。結(jié)果:經(jīng)測量后發(fā)現(xiàn)所有符合篩選條件的虛擬髖臼后柱拉力螺釘?shù)倪M(jìn)釘點在髂骨內(nèi)板的骨皮質(zhì)上圍成了一個形似“三角形”的置釘安全區(qū)�！叭切巍钡娜齻�頂點A、B、C至髂前上棘的距離分別為66.7±2.9mm(61.0-72.6mm),79.9±6.0mm(71.3-93.9mm),58.3±4.8mm(50.1-66.9mm);至髂前下棘的距離分別為47.4±2.8mm(42.0-52.6mm),74.7±7.5mm(62.2-87.8mm),63.6±6.5mm(51.2-74.5mm);至耳狀面前緣的距離分別為32.8±5.3mm(23.4-42.5mm),28.8±5.6mm(20.1-41.0mm),50.9±5.5mm(41.5-59.5mm)。螺釘OA為安全區(qū)內(nèi)最短螺釘,長度為99.5±4.6mm(87.6-108mm),螺釘OC為最長螺釘,長度為133.6±12.3mm(120.0-148.7mm)。所有置釘安全區(qū)內(nèi)的虛擬螺釘在髖臼后柱內(nèi)均呈外展前傾狀態(tài),外展角度范圍為10.4±2.9°(4.4-15.9°),前傾角度范圍為12.0±2.6°(7.2-17.4°)。男性和女性在三個頂點的螺釘長度、螺釘OA與冠狀面及矢狀面的夾角、螺釘OB與矢狀面的夾角、螺釘OC與冠狀面及矢狀面的夾角、點B至髂前上棘、髂前下棘的距離、點C至髂前下棘、耳狀面前緣的距離以及螺釘在前后位與側(cè)位的安全角度范圍等方面差異均有統(tǒng)計學(xué)意義(P0.05),而在螺釘OB與冠狀面的夾角、點A至髂前上棘、髂前下棘、耳狀面前緣距離、點B至耳狀面前緣的距離、點C至髂前上棘的距離等方面差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:通過使用MIMICS 10.01軟件模擬髖臼后柱順行拉力螺釘?shù)闹萌?我們在髂骨內(nèi)板上確實發(fā)現(xiàn)一個形狀近似于“三角形”的置釘安全區(qū),該區(qū)域內(nèi)所有螺釘均位于髖臼后柱骨質(zhì)內(nèi),其出釘點均指向閉孔下緣與坐骨結(jié)節(jié)相交的層面的中點。然而,由于髖臼后柱解剖結(jié)構(gòu)的復(fù)雜,直接將本研究的實驗結(jié)果應(yīng)用于臨床實際后柱順行拉力螺釘?shù)闹萌?對于骨科醫(yī)生來說仍是一項艱巨的任務(wù),未來研發(fā)的置釘安全區(qū)導(dǎo)板可能會使手術(shù)過程變得簡單而安全。
[Abstract]:Background: for displaced acetabular fractures. Surgical treatment should adopt the lag screw technique has good compression effect between fracture reduction, so you can get better, it is widely accepted and recommended. At the same time, using only a single anterior approach to the front and rear of the fixation of acetabular fractures, reduces the surgery trauma. However, in the post column antegrade lag screw properly is still facing a great challenge. Technically, because after the column structures of irregular, lack of quantitative information on specific anatomy, existence of cortical bone screw cutting, the risk of damage to the articular surface of acetabulum and important blood vessels and nerves, which also led to the posterior column antegrade lag screw technique is not commonly used. Objective: the purpose of this study was to implantation using mimics 10.01 software to 3D model of pelvis simulated posterior column antegrade lag screw, trying to find out internal iliac bone Board nailing safety zone, and then carries on the related anatomic parameters for measurement, anterior posterior antegrade lag screw technique provides a theoretical basis for the clinical development, and for the future development of the security zone for the screw plate to provide anatomical basis. Methods: a random collection of scanning range covers the pelvis of 64 row CT original DICOM data in 40 cases, 20 cases of male and female 40 cases, DICOM will gain access to the original data were imported into MIMICS 10.01 software for three-dimensional modeling. Artificially defined transverse obturator and the lower edge of the ischial tuberosity intersection center point O level as the piercing point screw, and the axial differential plate iliac bone cortex and the definition of the lag screw the screw entry point. The point of screw nail and position parameters into Med CAD module to construct virtual virtual screening lag screw. All threads are located in the screw column bone in posterior, which is safe Screw in the region, the region in the iliac screw plate of cortical bone on the safety zone of acetabulum and screw placement. For each screw length and placement angle measurement, length and angle range for screw placement, and measure the entry points out to the anterior superior iliac spine, anterior inferior iliac spine and auricular surface front distance, obtain the related anatomical parameters of screw safety zone. Results: after measuring found all meet the conditions of virtual screening of acetabular posterior column lag screw in the internal iliac bone cortex plate point formed a shape of "triangle" screw "triangle" safe area. The three vertices of A, B, C to the anterior superior iliac spine distance were 66.7 + 2.9mm (61.0-72.6mm), 6.0mm (71.3-93.9mm) 79.9 +, 58.3 + 4.8mm (50.1-66.9mm); to the anterior inferior iliac spine distance were 47.4 + 2.8mm (42.0-52.6mm 74). .7鹵7.5mm(62.2-87.8mm),63.6鹵6.5mm(51.2-74.5mm);鑷寵，

本文編號：1586427