本文選題：改良Stoppa入路　切入點：髖臼　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:骨盆、髖臼解剖結(jié)構(gòu)特殊、復(fù)雜,骨折類型多樣,使其在手術(shù)治療上存在巨大難度。改良Stoppa入路的出現(xiàn),簡化了既往復(fù)雜的骨盆、髖臼骨折手術(shù)入路。該入路可以充分的顯露四邊體及骨盆緣,且相對創(chuàng)傷較小,已被廣泛的應(yīng)用于臨床上。但是,由于其不能暴露髖關(guān)節(jié)面,沿真骨盆內(nèi)緣置入的鋼板螺釘幾乎是憑借術(shù)者經(jīng)驗盲打置入,且需要反復(fù)透視確認(rèn),不僅延長了手術(shù)時間,而且此過程中螺釘可能侵入髖關(guān)節(jié),造成軟骨溶解、骨性關(guān)節(jié)炎甚至股骨頭壞死等嚴(yán)重并發(fā)癥,嚴(yán)重影響患者的預(yù)后及生活質(zhì)量。目的:通過測量經(jīng)改良Stoppa入路沿真骨盆緣鋼板螺釘固定時髖臼周圍的置釘危險區(qū)域及目前臨床常用的直型骨盆重建鋼板的孔距,尋找置入鋼板時在置釘危險區(qū)需空置鋼板孔數(shù),為臨床中安全快速置入鋼板螺釘提供指導(dǎo)。方法:選取不同廠家的直型骨盆重建鋼板,測量其孔距及鋼板空置不同孔數(shù)置釘后鋼板的安全長度。選取50例正常成人骨盆正位片,將其髖骨分成左、右側(cè)兩組,以恥骨結(jié)節(jié)為點A,過髖臼下緣作與真骨盆緣垂線交于點B,過髖臼上緣作水平切線交真骨盆緣于點C,以骶髂關(guān)節(jié)于真骨盆緣上的最高點為點D,計算機輔助測量AB、BC、CD的距離。結(jié)合臨床操作可行性及避免螺釘穿入髖關(guān)節(jié),擬定置釘方向為:髖臼近端以與身體縱軸垂直或遠離髖臼方向置釘,遠端以垂直骨面或遠離髖臼方向置釘。結(jié)果:目前臨床常用的直型骨盆重建鋼板(施樂輝、創(chuàng)生、威高、正天)孔距為12mm,辛迪斯鋼板孔距為13mm,空置3孔置釘時鋼板的安全長度,施樂輝、創(chuàng)生、威高、正天為43mm,辛迪斯鋼板為47mm。恥骨支區(qū)ab(右側(cè):49.32±1.24mm;左側(cè):49.07±0.95mm)與臨近骶髂關(guān)節(jié)區(qū)cd(右側(cè):45.22±1.37mm;左側(cè):45.22±1.52mm)為置釘安全區(qū),髖臼區(qū)bc(右側(cè):40.30±0.90mm;左側(cè)40.40±0.78mm)為置釘危險區(qū),左右兩側(cè)比較無統(tǒng)計學(xué)意義。比較骨盆與不同鋼板孔距及置釘后鋼板安全長度可知:在真骨盆緣危險區(qū)空置3孔后置釘是安全的,且空置相同孔置釘時,辛迪斯鋼板更安全;在AB區(qū)(恥骨支區(qū))安全進釘區(qū)域為4孔鋼板長度,辛迪斯鋼板建議3孔;在CD區(qū)(鄰近骶髂關(guān)節(jié)區(qū))安全進釘區(qū)域約為3-4孔鋼板長度。結(jié)論:經(jīng)改良Stoppa入路沿真骨盆緣鋼板螺釘固定時,根據(jù)骨折線的位置不同放置鋼板,在髖臼置釘危險區(qū)空置3孔置釘是安全的,其在指導(dǎo)術(shù)中安全快速置入鋼板螺釘時具有重要臨床意義。
[Abstract]:Background: pelvic and acetabular anatomical structure is special, complex, and fracture types are various, which makes it difficult to treat surgically. The appearance of modified Stoppa approach simplifies the complicated pelvis in the past. Surgical approach for acetabular fractures. This approach can fully expose the quadrangular body and pelvic margin, and has been widely used in clinical practice due to its relatively minor trauma. However, because of its inability to expose the hip joint, The plate and screw placed along the inner margin of the true pelvis was almost blindly inserted with the experience of the operator, and it needed to be confirmed by repeated fluoroscopy, which not only prolonged the operation time, but also caused the screw to invade the hip joint and cause cartilage dissolution during this process. Serious complications such as osteoarthritis and even necrosis of the femoral head, Objective: to measure the peri-acetabular periacetabular risk area and the pore spacing of the orthograde pelvic reconstruction plate after modified Stoppa approach, which has a severe impact on the prognosis and quality of life of the patients. In order to find out the number of empty plate holes in the dangerous area of nail placement, it is necessary to provide guidance for the safe and rapid placement of plate and screw in clinic. Methods: the straight pelvis reconstruction plate from different manufacturers was selected. The distance between the holes and the safe length of the plate after the plate was placed with different holes were measured. Fifty cases of normal adult pelvis were selected and divided into two groups: left group and right side group. Using pubic nodule as point A, transacetabular edge as perpendicular line with verticality of true pelvis, crossing acetabular edge as horizontal tangent line to cross true pelvis at point C, point D of sacroiliac joint on the edge of true pelvis as point D, computer aided measurement of ABN BCU CD. Distance. Combined with clinical feasibility and prevention of screw penetration into the hip joint, The orientation of pin placement was as follows: the proximal end of the acetabular was placed perpendicular to or away from the acetabular axis, and the distal end was placed in the vertical bone or away from the acetabular direction. Results: the current clinical use of straight pelvic reconstruction plate (Schlehui, Genesis, Vigo, The hole spacing is 12mm, the Hole distance of Sindis steel plate is 13mm, the safety length of steel plate when three holes are empty, Schlehui, creation, Whigao, The right sky was 43mm, the Sindis plate was 47mm.The pubic branch area (right: 49.32 鹵1.24mm; left: 49.07 鹵0.95mm) and the adjacent sacroiliac joint area (right: 45.22 鹵1.37mm; left: 45.22 鹵1.52mm) were the safe area of nail placement, and the acetabular area (right side: 40.30 鹵0.90mm; left side: 40.40 鹵0.78mm) was the risk area. Comparing the distance between pelvis and different plate holes and the safety length of plate after nailing: it is safe to put 3 hole post nail in the danger area of the true pelvis, and it is safer to place the same hole nail in the same hole. In the AB region (pubic branch area), the length of the plate was 4 holes in the safe nail area, and 3 holes in the Sindeus plate. The length of steel plate is about 3-4 holes in the safe region of CD (adjacent to sacroiliac joint). Conclusion: the plate should be placed according to the position of fracture line according to the position of fracture line when fixed with plate and screw along the bony pelvic margin via modified Stoppa approach. It is safe to place 3 holes in the dangerous area of acetabular nail placement, which is of great clinical significance in guiding the safe and rapid placement of steel plate and screw during operation.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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