發(fā)布時間：2018-08-30 14:12

【摘要】：目的:本課題通過對S1椎體及骶髂通道放射解剖學研究,在前期研究的基礎(chǔ)上進一步驗證經(jīng)椎弓根定位引導骶髂螺釘植入的安全性;應用導向器模擬手術(shù)在尸體標本上置釘和應用于臨床實際病例,為該發(fā)明專利應用于臨床及大面積推廣提供理論基礎(chǔ)和實驗依據(jù)。方法:1、對正常成人50例(男女各25例)骨盆CT片進行測量,測量指標:(1)S1椎體橫徑;(2)S1椎體矢徑;(3)S1椎體前緣高度;(4)S1椎體后緣高度;(5)S1側(cè)塊中軸線與后正中線的夾角;(6)進針點與S1椎體中心距離;(7)進針點與椎體對側(cè)前皮質(zhì)距離;(8)進針點與骶髂通道最窄處中心點距離;(9)冠狀面骶髂通道最窄處高度;(10)水平面骶髂通道最窄處寬度。2、應用骶髂螺釘導向器在尸體標本上(5具成人新鮮尸體標本,10例骶髂關(guān)節(jié))模擬手術(shù)進行置釘。3、使用導向器在臨床手術(shù)中輔助置釘兩例。結(jié)果:1、(1)S1椎體橫徑:男性57.4±4.7mm,女性52.9±5.4mm;(2)S1椎體矢徑:男性35.1±2.4mm,女性33.3±3.7mm;(3)S1椎體前緣高度:男性35.3±2.2mm,女性31.8±2.3mm;(4)S1椎體后緣高度:男性25.4±1.6mm,女性23.4±2.0mm;(5)S1側(cè)塊中軸線與后正中線的夾角:男性:73.1±6.3°,女性68.4±7.5°;(6)進針點與S1椎體中心距離:男性75.5±6.2mm,女性70.2±6.9mm;(7)進針點與椎體對側(cè)前皮質(zhì)距離:男性:93.1±4.6mm,女性90.1±4.3mm;(8)進針點與骶髂通道最窄處中心點距離:男性52.3±1.4mm,女性51.8±1.3mm;(9)冠狀面骶髂通道最窄處高度:男性21.7±3.0mm,女性20.6±3.6mm;(10)水平面骶髂通道最窄處寬度:男性24.3±2.7mm,女性23.3±3.6mm。性別比較(1)(2)(3)(4)(5)(6)(7)指標有統(tǒng)計學意義(P0.05),(8)(9)(10)指標無統(tǒng)計學意義(P0.05);左右側(cè)比較(5)(6)(7)(8)(9)(10)無統(tǒng)計學意義(P0.05)。2、應用導向器在5具成人新鮮尸體標本上對10例骶髂關(guān)節(jié)成功植入10枚螺釘,所有螺釘位置良好,無置釘失敗或螺釘位置不當。3、經(jīng)術(shù)中、術(shù)后透視證實兩例手術(shù)螺釘均準確植入骶髂安全通道,位置良好,無明顯并發(fā)癥發(fā)生。結(jié)論:經(jīng)椎弓根定位骶髂螺釘導向器引導螺釘植入準確安全、簡單方便、透視少、能明顯縮短手術(shù)時間,經(jīng)過短期培訓即可掌握骶髂螺釘內(nèi)固定技術(shù),大大縮短了骨科醫(yī)師的學習曲線,值得臨床推廣應用。該導向器初步應用于臨床,尚未發(fā)現(xiàn)明顯缺陷,目前應用經(jīng)驗不足,有待于在后期使用中進一步積累、改進。
[Abstract]:Objective: to further verify the safety of sacroiliac screw placement guided by pedicle of vertebra S1 and sacroiliac channel on the basis of previous studies. The guide device is used to simulate the operation on the cadaveric specimen and to be used in clinical practice, which provides the theoretical basis and experimental basis for the patent application in clinical and extensive application. Methods CT films of pelvis were measured in 50 normal adults (25 male and 25 male). Measurements: (1) transverse diameter of S1 vertebral body; (2) sagittal diameter of S1 vertebral body; (3) height of anterior edge of S1 vertebral body; (4) height of posterior edge of S1 vertebral body; (5) angle between axis of lateral mass of S1 and posterior median line; (6) distance between needle point and center of S1 vertebrae; (7) distance between entry point and contralateral anterior cortex of vertebral body; (8) distance between entry point and contralateral anterior cortex of vertebral body; The distance between the point of needle and the center of the narrowest point of sacroiliac passage; (9) the height of the narrowest point of sacroiliac passage on coronal plane; (10) the narrowest width of sacroiliac passage in horizontal plane. The iliac joint was operated with analogue operation. 3. 2 cases were treated with guide device. Results: 1, (1) the transverse diameter of S1 vertebral body: male 57.4 鹵4.7 mm, female 52.9 鹵5.4 mm; (2) S1 vertebral body sagittal diameter: male 35.1 鹵2.4 mm, female 33.3 鹵3.7 mm; (3) S1 anterior height: male 35.3 鹵2.2 mm, female 31.8 鹵2.3 mm; (4) S1 posterior edge height: male 25.4 鹵1.6 mm, female 23.4 鹵2.0 mm; (5) S1 lateral mass axis angle to posterior median line: male 73.1 鹵6.3 擄, female: male 73.1 鹵6.3 擄 68.4 鹵7.5 擄; (6) distance between insertion point and S1 vertebral center: male 75.5 鹵6.2 mm, female 70.2 鹵6.9 mm; (7) distance between needle point and contralateral anterior cortex of vertebral body: male: 93.1 鹵4.6 mm, female: 90.1 鹵4.3 mm; (8) distance between needle point and the narrowest point of sacroiliac passage: male 52.3 鹵1.4mm, female 51.8 鹵1.3mm; (9) coronal sacroiliac channel Narrow height: male 21.7 鹵3.0mm, female 20.6 鹵3.6mm; (10) horizontal plane sacroiliac channel narrowest width: male 24.3 鹵2.7mm, female 23.3 鹵3.6mm. Gender comparison (1) (2) (3) (4) (5) (6) (7) had statistical significance (P0.05), (8) (9) (10) had no statistical significance (P0.05), left and right (5) (6) (7) (8) (9) (10) had no statistical significance (P0.05). All the screws were in good position, none of them failed to place the screws or the screw was not in the proper position. After operation and postoperative fluoroscopy, the sacroiliac safe passage was accurately implanted in two cases. There were no obvious complications in the two cases. Conclusion: transpedicular placement of sacroiliac screw guide screws is accurate, safe, simple and convenient, less fluoroscopy, and can significantly shorten the operation time. After short-term training, sacroiliac screw internal fixation technology can be mastered. The learning curve of orthopedic physicians is greatly shortened, and it is worth popularizing and applying in clinic. The application of the guide device in clinical practice has not found obvious defects, but the current application experience is insufficient, which needs to be further accumulated and improved in the later use.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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