本文選題：骶骨骨折　切入點：側(cè)塊螺釘　出處：《山東大學》2015年碩士論文

【摘要】：目的：研究骶骨側(cè)塊螺釘置釘安全通道的解剖學特征,尋找骶骨各節(jié)段側(cè)塊最佳置釘位置,為臨床應用骶骨側(cè)塊螺釘內(nèi)固定技術(shù)提供理論依據(jù)與參考。材料及方法：1、隨機選擇60例正常成人骶尾椎CT資料,年齡25-78歲,其中男性33例,女性27例。利用mimics 15.0對骶骨CT數(shù)據(jù)進行三維重建骶骨模型,在骶骨模型中分離側(cè)塊及可置釘區(qū)域,并于各節(jié)段側(cè)塊層面繪制出骶骨側(cè)塊螺釘置釘安全通道,測量S1-S4側(cè)塊螺釘置釘安全通道的相關(guān)解剖學數(shù)據(jù)。對測量數(shù)據(jù)進行統(tǒng)計學處理并分析性別間差異統(tǒng)計學意義2、隨機選取6例成人尸體標本,在按照上述測量結(jié)果自制模具輔助下進行置釘驗證試驗,置釘標本觀察置釘位置情況。結(jié)果：1、S1側(cè)塊螺釘最佳進釘點位于骶骨上緣與第1骶孔連線尾側(cè)1/3處、關(guān)節(jié)突外側(cè)處,可使用直徑不超過13mm的螺釘,長度控制在33mm以內(nèi),矢狀位上進釘方向與S1上終板平行,水平位上內(nèi)傾24.05±3.25。；S2側(cè)塊螺釘最佳進釘點位于第1骶孔與第2骶孔連線中點,可使用直徑不超過10mm的螺釘,長度控制在36mm以內(nèi),矢狀位上進釘方向與S2上終板夾角11.23±2.53。,水平位上內(nèi)傾35.79±1.20。(男)、37.92±3.75。(女)；S3側(cè)塊螺釘最佳進釘點位于第2、3骶孔外側(cè)緣連線中點,可使用直徑不超過6.5mm的螺釘,長度控制在30mm以內(nèi),矢狀位上進釘方向與S3上終板夾角5.23±1.05。,水平位上內(nèi)傾46.26±2.56。；S4側(cè)塊螺釘最佳進釘點位于第3、4骶孔外側(cè)緣連線中點下lmm處,可使用直徑不超過6mm的螺釘,長度控制在14mm內(nèi)矢狀位上進釘方向與S4上終板夾角12.15±3.42°,水平位上內(nèi)傾48.52±4.36°。性別問t檢驗顯示僅骶2側(cè)塊置釘方向與正中矢狀面夾角男女性別間存在統(tǒng)計學差異。2、按照測量結(jié)果尸體標本置釘驗證,一枚螺釘于骶2節(jié)段進入骶髂關(guān)節(jié),一枚螺釘于骶3節(jié)段穿出對側(cè)皮質(zhì),其余螺釘均在骶骨側(cè)塊骨質(zhì)內(nèi),未穿透至骶孔、骶管及耳狀面,置釘驗證實驗準確率95.83%。結(jié)論：經(jīng)骶骨側(cè)塊行螺釘固定具有可行性,但需選擇合適的進釘方向及深度以保證置釘?shù)陌踩浴⒗喂绦宰畲蠡?骶骨側(cè)塊螺釘技術(shù)可為骶骨骨折提供科學、可靠的直接固定方式,為臨床骶骨骨折固定提供另一種選擇。
[Abstract]:Objective: to study the anatomical characteristics of the safe passage of sacral lateral mass screw insertion, and to find out the best location of the lateral mass of sacrum. To provide theoretical basis and reference for clinical application of sacral lateral mass screw fixation, materials and methods 60 normal adults, aged 25 to 78 years, including 33 males, were randomly selected for CT data of sacral and caudal vertebrae. Mimics 15.0 was used to reconstruct the sacral model. The lateral mass and the nailable region were separated from the sacral model, and the safe passage of the sacral lateral mass screw screw placement was drawn at each level of the lateral mass of the sacrum. The anatomical data of the safe passage of S1-S4 lateral mass screw insertion were measured. The data were statistically processed and analyzed statistically. 2. Six adult cadavers were randomly selected. According to the above measurement results, the nail placement verification test was carried out with the aid of self-made mould, and the position of the screw was observed. Results the optimal point of insertion of the screw was located at the superior edge of the sacrum and 1 / 3 of the caudal side of the first sacral foramen, and the lateral side of the articular process, and the lateral side of the articular process. Screws with a diameter not exceeding 13mm can be used, the length of which is controlled within 33mm, the direction of the sagittal upward screw is parallel to that of the S1 upper end plate, and the horizontal upward inclination of the screw is 24.05 鹵3.25. The best point of the lateral mass screw is located at the midpoint of the line between the first sacral hole and the second sacral orifice. Screws with a diameter not exceeding 10mm may be used, the length of which is controlled within 36mm, the angle between the direction of the sagittal upward screw and the S 2 upper end plate is 11.23 鹵2.53.3.The horizontal position is 35.79 鹵1.20 (male = 37.92 鹵3.75). Screws not exceeding 6.5mm in diameter can be used, the length is controlled within 30mm, the angle between the direction of sagittal upward screw and S3 upper end plate is 5.23 鹵1.05.The lateral mass screw of S4 lateral mass screw with upward inclination 46.26 鹵2.56.N in horizontal position is located at the lmm below the midpoint of the lateral edge of 3nd-4 sacral foramen, and the angle between the direction of sagittal screw and the upper end plate of S3 is 5.23 鹵1.05. Screws not exceeding 6mm in diameter may be used, The length was controlled at the angle of 12.15 鹵3.42 擄and 48.52 鹵4.36 擄between the direction of the upper sagittal screw and the upper end plate of S4 in 14mm. The gender test showed that there was a statistical difference between male and female in the direction of the screw insertion and the angle between the median sagittal plane and the direction of the screw in the sacral 2 sides. The results of the measurement were confirmed by nail placement in cadaveric specimens. One screw entered the sacroiliac joint at the second sacral segment, the other screw perforated the contralateral cortex at the third sacral segment. The other screws were in the lateral mass of the sacrum and did not penetrate the sacral foramen, sacral canal and auricular surface. Conclusion: it is feasible to use screw fixation through sacral lateral mass, but it is necessary to select the proper direction and depth of screw insertion to ensure the safety and the maximum fastness of the nail placement. The technique of sacral lateral mass screw can provide scientific and reliable direct fixation for sacral fractures and provide another choice for clinical fixation of sacral fractures.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

【參考文獻】

相關(guān)期刊論文 前8條

1 杜明奎,王秋根;骶骨骨折治療進展[J];國外醫(yī)學.骨科學分冊;2005年04期

2 李躍;楊凱;谷方;;第一骶骨椎弓根的形態(tài)觀測及臨床應用[J];泰山醫(yī)學院學報;2007年06期

3 孔建中,郭曉山,潘駿,黃俊武,楊雷,彭茂修,陳龍,翁益民;經(jīng)皮骶髂關(guān)節(jié)螺釘治療骶骨縱形骨折[J];中華創(chuàng)傷雜志;2005年06期

4 宋連新,張英澤,彭阿欽,潘進社,王慶賢;垂直不穩(wěn)定性骨盆骨折內(nèi)固定的生物力學研究[J];中華實驗外科雜志;2000年02期

5 馬江濤,張劍,全仁夫,范順武;Ⅱ、Ⅲ區(qū)骶骨骨折合并神經(jīng)損傷的手術(shù)治療[J];中國矯形外科雜志;2003年Z1期

6 潘進社;張英澤;陳偉;;骨盆骨折伴血流動力學不穩(wěn)定患者的外固定治療[J];中國矯形外科雜志;2007年22期

7 劉景臣;李野;武云濤;高忠禮;朱慶三;;骶2椎弓根置釘?shù)膽媒馄蕦W研究[J];中國脊柱脊髓雜志;2010年02期

8 沈乃剛;尹維剛;史增元;林榮;張楠;;骶骨骨折后路橫置鋼板固定的影像解剖學研究[J];中國臨床解剖學雜志;2012年04期

，

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