髖臼前柱拉力螺釘內(nèi)固定的解剖學(xué)研究

1、髖臼前柱拉力螺釘內(nèi)固定的解剖學(xué)研究 11-04-01 11:26:00 編輯：studa20 作者：石成弟，郭曉山，黃俊武，水小龍，周海波【摘要】 目的 ：探討髖臼前柱拉力螺釘內(nèi)固定的解剖學(xué)基礎(chǔ)。方法：取12個(gè)骨盆標(biāo)本，其中男7個(gè)，女5個(gè)。于雙側(cè)髖臼中部垂直于前后柱表面截骨，以逆行法沿前柱中心打入一克氏針，其從髂骨后外側(cè)穿出點(diǎn)為P點(diǎn)，作一參考線AB，其中A為坐骨大切跡頂點(diǎn)，B為髂前上、下棘切跡，由 P點(diǎn)向AB作垂線，與AB相交于D點(diǎn)，與髖臼上緣相交于E點(diǎn)。然后測(cè)量以下數(shù)值：AB,AD,PD,PE的距離；骨盆俯臥位時(shí)前柱克氏針與水平面的夾角，與矢狀面的夾角；測(cè)量髖臼前柱截面的半徑；測(cè)量髖臼前柱克

2、氏針在骨皮質(zhì)內(nèi)的長(zhǎng)度。結(jié)果：PD是AB的中垂線。PD的距離男性為（1.590.25）cm，女性為（1.490.20）cm；PE的距離男性為（3.670.40）cm，女性為（3.280.12）cm；夾角男性為（25.02.6），女性為（23.93.5）；夾角男性為（37.52.5），女性為（37.42.2）；前柱截面的半徑男性為（6.450.27）mm，女性為（6.340.34）mm；前柱克氏針的長(zhǎng)度男性為（11.50.4）cm，女性為（11.20.5）cm。結(jié)論：髖臼前柱拉力螺釘內(nèi)固定在解剖學(xué)上是可行的。 【關(guān)鍵詞】 髖臼 前柱 拉力螺釘 內(nèi)固定 解剖學(xué)Abstract: Objective:

3、 To study anatomical basis for the placement of lag screw in the acetabular anterior column. Methods: Twelve pelves, including seven male and five female pelves were studied. All specimens were sectioned across the middle of the acetabulum perpendicularly to the anterior and posterior surface. A Kir

4、schner pin was forced retrogradely through the center of the anterior column. The exit point of the pin on the post-lateral surface of the iliac bone was named P. A designed line AB was drawn connecting the deepest portion of the incisura ischiadica major (A) and the interspinous notch of the spina

5、iliaca anterior superior and inferior (B). Line PD was perpendicular to the line AB. The intersectal of the line PD and AB was named D ；the intersectal of the line PD and the superior margin of the acetabulum was named E. Then the following data were measured: The distances of AB，AD，PD，PE.The angle

6、between the Kirschner pin of the anterior column and the horizontal plane ()， the angle between the Kirschner pin of the anterior column and the sagittal plane ()， when the pelvis was placed at prone position. The radius of the cross-section of the anterior and column. The length of the the Kirschne

7、r pin in the anterior column. Results: The PD was the middle vertical line of AB. The mean distance of PD was (1.590.25) cm for male and was (1.490.20)cm for female. The mean distance of PE was (3.670.40)cm for male and (3.280.12)cm for female. The mean angle was (25.02.6)for male and (23.93.5)for f

8、emale. The mean angle was (37.52.5)for male and (37.42.2)for female. The mean radius of the anterior columns cross-section was (6.450.27) mm for male and (6.340.34) mm for female. The mean length of the Kirschner pin in the anterior column was (11.50.4) cm for male and (11.20.5) cm for female. Concl

9、usion: Lag screw internal fixation in the anterior column of the acetabulum is feasible from the anatomical basis.Key words: acetabulum；anterior column；lag screw；internal fixation；anatomy近年來(lái)，隨著暴露、復(fù)位及內(nèi)固定技術(shù)的進(jìn)步，越來(lái)越多的學(xué)者選擇單一的髂腹股溝入路或K-L入路（Kocher-Langenbeck）治療復(fù)雜的髖臼骨折。單一的K-L入路治療復(fù)雜的髖臼骨折，對(duì)前柱的骨折只能采用間接的復(fù)位和拉力螺釘固

10、定技術(shù)。由于髖臼前柱獨(dú)特的解剖結(jié)構(gòu)，拉力螺釘有可能穿透髖關(guān)節(jié)或骨皮質(zhì)，損傷血管神經(jīng)等重要組織，因而未被廣泛采用。本研究通過(guò)對(duì)正常成人髖臼標(biāo)本的測(cè)量分析得出準(zhǔn)確可靠的解剖學(xué)數(shù)據(jù)，為后方入路時(shí)前柱拉力螺釘置入提供幫助。1 材料和方法1.1 標(biāo)本的制備取成人尸體12具，其中男7具，女5具。自第3腰椎水平及雙側(cè)大腿中上1/3交界處將尸體橫斷，剝離附著于腰椎、骨盆、股骨干的肌肉、韌帶等軟組織，將雙側(cè)股骨上段去除，仔細(xì)剔除髖關(guān)節(jié)囊及韌帶，得骨盆標(biāo)本12個(gè)，肉眼及X線攝片均排除骨性異常。1.2 髖臼截面的制備前方于髂恥隆起垂直于前柱表面截骨，后方于髖臼中部（髖臼上下切跡連線中點(diǎn)）垂直于后柱表面截骨，兩截骨面

11、在內(nèi)側(cè)四方區(qū)會(huì)合截?cái)囿y臼，雙側(cè)均截?cái)嗪笕∠虑胺桨牍桥?見(jiàn)圖1)。1.3 前柱截面軸心及半徑的確定髖臼前柱截面近似呈三角形。前柱截面前方為髖臼前柱表面，外側(cè)為髖臼軟骨，內(nèi)側(cè)為四邊體。三角形的內(nèi)心即為截面的軸心，軸心到截面三邊的垂直距離相等即截面的半徑，也就是髖臼前柱拉力螺釘?shù)淖畲蟀霃健Ｓ糜螛?biāo)卡尺測(cè)量截面的半徑。1.4 髂骨后外側(cè)前柱入釘點(diǎn)的確定取下前部分骨盆，用直徑2.5 mm的克氏針自髖臼前柱截面的軸心沿前柱的縱軸線順行鉆入，前柱克氏針在同側(cè)恥骨結(jié)節(jié)的下方穿出，然后將髖臼前后柱截面復(fù)位，再將克氏針逆行打入(見(jiàn)圖2、圖3)。前柱克氏針在髂骨后外側(cè)的穿出點(diǎn)即髖臼前柱拉力螺釘?shù)娜脶旤c(diǎn)P，為了精確測(cè)量該點(diǎn)，作一參考線AB，其中A為坐骨大切跡頂點(diǎn)，B為髂前上、下棘切跡，經(jīng) P點(diǎn)向AB作垂線并與AB相交于D點(diǎn)，與髖臼上緣相交于E點(diǎn)，測(cè)量AB、AD、PD及PE的距離(見(jiàn)圖4)。1.5 髖臼前柱軸心方向的測(cè)量將骨盆標(biāo)本俯臥于水平桌面上固定，恥骨聯(lián)合及雙側(cè)髂前上棘著地，測(cè)量前柱克氏針與水平面及骨盆矢狀面的夾角。測(cè)量前柱克氏針與水平面的夾角時(shí)將自制雙面垂直的畫(huà)板一面平放于桌面，移動(dòng)畫(huà)板