【摘要】：研究背景隨著我國經(jīng)濟(jì)社會的快速發(fā)展,由工業(yè)、建筑及交通事故等高能量損傷造成的髖臼骨折患者日益增多。經(jīng)典的髖臼骨折手術(shù)學(xué)觀點(diǎn)認(rèn)為,手術(shù)入路的選擇由骨折的類型決定。髖臼前柱骨折需選擇前方髂腹股溝入路進(jìn)行固定,髖臼后柱骨折需選擇后方K-L入路進(jìn)行固定。Hirvensalo和Cole最早使用改良Stoppa入路對髖臼骨折進(jìn)行手術(shù)治療,結(jié)果顯示療效令人滿意。此后,越來越多的骨科醫(yī)師開始運(yùn)用此技術(shù)。改良Stoppa入路較傳統(tǒng)髖臼前方入路或后方入路而言優(yōu)勢明顯,具有創(chuàng)傷小、操作安全、并發(fā)癥少等優(yōu)點(diǎn),它能暴露從恥骨聯(lián)合到骶髂關(guān)節(jié)前方之間的整個真骨盆,將鋼板直接支撐于方形區(qū)表面,獲得更好的穩(wěn)定性。本課題組在對髖臼后柱及方形區(qū)解剖關(guān)系的進(jìn)一步理解后,認(rèn)為坐骨大切跡前方骨質(zhì)為髖臼后柱在骨盆內(nèi)側(cè)面的投影,因此在投影區(qū)內(nèi)也能實(shí)現(xiàn)對髖臼后柱的固定,且經(jīng)臨床驗(yàn)證療效確切。而在骨盆內(nèi)側(cè)面固定髖臼后柱(髂骨-坐骨柱)的鋼板則被命名為內(nèi)髂坐鋼板。這種技術(shù)顛覆了傳統(tǒng)的后柱骨折治療理念,為髖臼骨折的治療提供了一種新思路。在臨床上,內(nèi)髂坐鋼板螺釘?shù)陌踩萌腚y度較大,骨科醫(yī)師往往根據(jù)手術(shù)經(jīng)驗(yàn)以及對髖臼和方形區(qū)解剖關(guān)系的理解進(jìn)行置釘,一旦螺釘誤入關(guān)節(jié),可造成關(guān)節(jié)軟骨損傷、創(chuàng)傷性關(guān)節(jié)炎等嚴(yán)重的并發(fā)癥。目前改良Stoppa入路下內(nèi)髂坐鋼板的安全置釘研究較少,本研究將采用計(jì)算機(jī)三維重建技術(shù),建立骨盆數(shù)字模型,測量骸臼后柱內(nèi)髂坐鋼板放置的安全區(qū)及螺釘置入的安全角度,為內(nèi)髂坐鋼板在骨盆內(nèi)表面的安全置釘提供解剖學(xué)依據(jù)。研究目的1.內(nèi)髂坐鋼板治療髖臼后柱骨折的可行性分析。綜合利用Mimics和Geomagic軟件,對髖臼后柱內(nèi)髂坐鋼板放置的安全區(qū)進(jìn)行定義,并測量其絕對大小和相對大小。2.內(nèi)髂坐鋼板治療髖臼后柱骨折的安全性分析。在安全區(qū)內(nèi),分別于不同位置測量內(nèi)髂坐鋼板螺釘置入的通用安全角度,為臨床醫(yī)師的安全置釘提供參考。材料和方法收集52例成年國人(男27例,女25例)正常骨盆的CT掃描數(shù)據(jù),重建出骨盆3D模型。對髖臼進(jìn)行抽殼和增厚5mm處理,測量內(nèi)髂坐鋼板安全區(qū)的寬度d;測量閉孔管頂點(diǎn)到大切跡的垂直距離w并計(jì)算d/w的比值r。過髖臼中心、垂直于方形區(qū)和大切跡對裝配后的髖骨進(jìn)行截骨得到截面。根據(jù)安全區(qū)的大小,男性在大切跡前方1.0、1.5、2.0和2.5 cm處取4點(diǎn),于截面上分別測量方形區(qū)與增厚的髖臼外緣切線所成的角度∠a、∠b、∠c和∠d;女性在大切跡前方1.0、1.5和2.0 cm處取3點(diǎn),測量∠a、∠b和∠c。比較男、女性之間上述參數(shù)的差異。結(jié)果男性和女性放置內(nèi)髂坐鋼板安全區(qū)的寬度(d)平均分別為(28.56±2.44)、(24.36±2.47)mm,r分別約為3/5(0.61)、1/2(0.54)。男性置釘?shù)陌踩嵌取蟖、∠b、∠c 和 ∠d 平均分別為 88.04° ±3.18°、77.81° ±3.85°、68.01° ±4.11° 和 56.81° ±4.81°;女性∠a、∠b 和∠c 平均分別為 91.29° ±4.52°、76.23° ±3.82°和62.79° ±3.51°。男、女性之間d、r、∠a和∠c比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論髖臼后柱內(nèi)側(cè)面有足夠的空間放置內(nèi)髂坐鋼板,在安全區(qū)內(nèi)以一定的置釘角度完全可以避免螺釘誤入髖關(guān)節(jié)。
[Abstract]:Background With the rapid development of economy and society in China, more and more acetabular fractures are caused by high-energy injuries such as industrial, architectural and traffic accidents. Hirvensalo and Cole first used modified Stoppa approach to treat acetabular fractures with satisfactory results. Since then, more and more orthopaedics have begun to use this technique. It can expose the whole true pelvis from the pubic symphysis to the anterior sacroiliac joint, and directly support the plate on the surface of the square area to obtain better stability. For the projection of the posterior column of the acetabulum on the medial side of the pelvis, the fixation of the posterior column of the acetabulum can also be achieved within the projection area, and has been clinically proven to be effective. In clinic, it is difficult to insert the internal iliac plate screw safely. Orthopedics doctors usually insert the screw according to the operation experience and the understanding of the anatomical relationship between acetabulum and square area. Once the screw is misplaced into the joint, it can cause serious complications such as articular cartilage injury, traumatic arthritis and so on. There are few studies on the safety of internal iliac plate screw placement under toppa approach. In this study, a digital pelvic model will be established by using computer three-dimensional reconstruction technology. The safe area and the safe angle of screw placement in the posterior column of the acetabulum will be measured to provide anatomical basis for the safety of internal iliac plate screw placement on the internal surface of the pelvis. OBJECTIVE 1. Feasibility analysis of internal iliac plate in the treatment of acetabular posterior column fractures.The safety zone of internal iliac plate placement in acetabular posterior column was defined by using Mimics and Geomagic software,and its absolute size and relative size were measured.2.Safety analysis of internal iliac plate in the treatment of acetabular posterior column fractures. Materials and Methods CT scan data of 52 adult Chinese (27 males and 25 females) normal pelvis were collected to reconstruct the 3D model of pelvis. The vertical distance W from the apex to the large notch and the ratio r of d/w were calculated. The cross section was obtained by osteotomy through the acetabular center, perpendicular to the square area and the large notch. The angles_a, b, C and_d were measured at 1.0, 1.5 and 2.0 cm in front of the large incision, and the differences of the above parameters between men and women were compared. The average safety angles of nails_a, b, C and_d were 88.04 [3.18], 77.81 [3.85], 68.01 [4.11], and 56.81 [4.81]], respectively. The mean safety angles of nails a, B and C in women were 91.29 [4.52], 76.23 [3.82] and 62.79 [3.51], respectively (P 0.05). The posterior column of the acetabulum has enough space for the internal iliac plate to be placed inside the posterior column of the acetabulum.
【學(xué)位授予單位】：南方醫(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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