【摘要】：目的：對(duì)成人腰椎骨盆融合固定髂骨螺釘置釘位置及釘?shù)绤?shù)進(jìn)行CT測(cè)量,探討腰椎骨盆固定髂骨螺釘?shù)睦硐胫冕斘恢眉爸冕數(shù)目尚行耘c安全性。 方法：隨機(jī)抽取骨盆正常的40例腰椎病變患者,年齡23-65歲,平均47歲,其中男20例,女20例。對(duì)其骨盆行螺旋CT薄層掃描和三維重建,經(jīng)過(guò)骶1、骶2椎板后平面進(jìn)行切割,以髂骨切面遠(yuǎn)端作為髂骨螺釘入點(diǎn)A,對(duì)該點(diǎn)進(jìn)行解剖定位分析。以A為起點(diǎn),指向分別為坐骨大切跡上方、髂前下棘、髂前上棘做切面,對(duì)每條路徑中釘?shù)赖拈L(zhǎng)度及直徑進(jìn)行數(shù)據(jù)分析。 結(jié)果：在骶1、骶2椎板后平面上進(jìn)行切割,髂骨翼切割平面的遠(yuǎn)端與第2骶后孔上緣連線基本位于同一水平,以該點(diǎn)作為髂骨螺釘入點(diǎn)A,設(shè)計(jì)3條置釘路徑,分別指向坐骨大切跡上方(AB路徑)、髂前下棘(AC路徑)、髂前上棘(AD路徑),三個(gè)不同方向均可植入直徑超過(guò)7mm的髂骨釘。正態(tài)性檢驗(yàn)顯示釘?shù)栏鲄?shù)均符合正態(tài)分布。各參數(shù)同性別左右無(wú)統(tǒng)計(jì)學(xué)差異。三條路徑中髓腔曲度依次增大,由“工”形向“S“形過(guò)度,置入髂骨釘?shù)碾y度逐漸增大,釘長(zhǎng)可在以下范圍內(nèi)選擇(男:AD路徑70.0±1.2mm,AB路徑114.6±1.6mm,AC路徑123.4±2.Omm;女：AD路徑69.2±0.9mm,AB路徑102.3±1.4mm,AC路徑116.0±1.7mmP0.05)。統(tǒng)計(jì)結(jié)果顯示女性螺釘釘?shù)牢蚕蚱桥c男性比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),外向偏角與男性相比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。外向偏角可在以下范圍內(nèi)選擇(男25.1±3.0°；女25.2±2.2P0.05)。在該區(qū)間內(nèi),入點(diǎn)偏內(nèi),外向偏角增大時(shí),通過(guò)髓腔狹窄區(qū)、增加置釘長(zhǎng)度相對(duì)容易。 結(jié)論：在骶1、骶2椎板后平面上,位于髂后下棘上方、第2骶后孔的上緣連線水平可實(shí)施髂骨釘植入,以增加骶后區(qū)固定節(jié)段的長(zhǎng)度,指向坐骨大切跡上方、髂前下棘及髂前上棘三個(gè)不同方向,在(男25.1±3.0°；女25.2±2.2°P0.05)度外向偏角區(qū)間內(nèi)可置入直徑超過(guò)7mm,長(zhǎng)度(男：AD路徑70.0±1.2mm,AB路徑114.6±1.6mm,AC路徑123.4±2.0mm；女：AD路徑69.2±0.9mm,AB路徑102.3±1.4mm,AC路徑116.0±1.7mm P0.05)的髂骨釘。是一種理想的腰椎骨盆固定髂骨釘置入方式。
[Abstract]:Objective: to study the feasibility and safety of iliac screw placement and screw placement for lumbar pelvic fusion fixation in adults by CT measurement of the location and nail path parameters of iliac screw fixation. Methods: a total of 40 patients with normal pelvis were randomly selected, ranging from 23 to 65 years old (mean 47 years), including 20 males and 20 females. Spiral CT thin slice scanning and 3D reconstruction were performed on the pelvis. The posterior plane of the sacral and sacral laminae was cut. The distal iliac section was used as the entry point of the iliac screw, and the anatomical location of the point was analyzed. Taking A as the starting point, the length and diameter of the nail passage in each path were analyzed, respectively, at the top of the great notch of the ischium, the anterior inferior iliac spine and the anterior superior iliac spine. Results: the distal end of the incision plane of the iliac pterygoid was located at the same level as the superior margin of the second posterior sacral foramen in the posterior plane of the sacral 1 and 2 vertebrae. This point was used as the insertion point A of the iliac screw, and three ways of nailing were designed. At the top of the great notch of the ischium (AB pathway), the anterior inferior iliac spine (AC pathway), and the superior iliac spine (AD pathway), the iliac nail with diameter larger than 7mm could be implanted in three different directions. Normal test showed that all the parameters of the nail track were in accordance with the normal distribution. There was no statistical difference between each parameter and sex. The curvature of medullary cavity increased in turn from "workpiece" to "S", and the difficulty of placement of iliac nail gradually increased. The length of nail could be chosen in the following range (male: AD path 70.0 鹵1.2 mm AB path 114.6 鹵1.6 mm), The AC pathway was 123.4 鹵2.Omm; Female: AD pathway 69.2 鹵0.9mm / AB 102.3 鹵1.4mm AC path 116.0 鹵1.7mmP0.05). The statistical results showed that there was no statistical difference between female and male (P0.05), and there was no statistical difference between outward angle and male (P0.05). The outward deviation angle can be selected in the following range (male 25.1 鹵3.0 擄; female 25.2 鹵2.2P0.05). In this region, it is easy to increase the length of nail through the narrow area of the medullary cavity when the entry point is inward and the outward deviation angle is increased. Conclusion: iliac nail implantation can be carried out at the level of the superior margin of the second posterior sacral foramen on the posterior laminar plane of sacral 1 and sacral 2, which is located above the posterior iliac spine, so as to increase the length of the fixed segment of the posterior sacral region and point to the superior incisor of the ischium. The anterior inferior iliac spine and the anterior superior iliac spine were in three different directions (male 25.1 鹵3.0 擄). Female 25.2 鹵2.2 擄P 0.05) the diameter and length of the outward deviation angle were more than 7 mm and 123.4 鹵2.0 mm respectively (male: AD path 70.0 鹵1.2 mm) AB path 114.6 鹵1.6 mm AC path 123.4 鹵2.0 mm; Female: iliac nail with AD pathway 69.2 鹵0.9mm AB pathway 102.3 鹵1.4mm AC pathway 116.0 鹵1.7mm P0.05). It is an ideal way to place iliac nail in lumbar pelvis fixation.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R816.8

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 劉斌;張立巖;王濟(jì)緯;魏堯森;林黎明;;不同路徑髂骨釘釘?shù)赖腃T影像學(xué)研究[J];中國(guó)骨傷;2011年02期

2 肖建如,賈連順,陳華江,魏海峰,楊興海,陳德玉,朱秋峰;高位骶骨腫瘤切除與重建方式探討[J];中華外科雜志;2003年08期

3 桑錫光;張立平;劉海春;李牧;湯繼文;;腰椎-髂骨固定的臨床解剖學(xué)研究[J];中國(guó)臨床解剖學(xué)雜志;2007年02期

，

本文編號(hào)：2373228