经皮逆行髋臼前柱螺钉的应用解剖与临床

目的 应用优化计算机辅助解剖测量技术,为经皮逆行髋臼前柱螺钉内固定术提供解剖学基础.方法 取骨盆CT数据40份,进行精确的三维重建得到骨盆模型.首先为使用单螺钉的内固定方法设计特定的最优化目标函数,并在约束条件下自动计算其最佳经皮逆行螺钉位置.统计分析测量结果,并设计解剖测量参考体系.结果 经皮逆行髋臼前柱螺钉的入钉点在耻骨上支耻骨结节与髂耻隆起中点处的闭孔嵴上,出钉点在髂前上下棘之间切迹与坐骨大切迹连线中点上方,其连线即为髋臼前柱纵轴.该线与弓状线接近平行,其进针方向与出钉点-髂前下棘连线为(42.84±2.61)°,与出钉点-髂结节连线为(31.96±2.58)°.螺钉骨内段长度为(101.12±7.28)mm.结论 优化计算机辅助解剖测量是一种非常有效的测量技术,克服了传统手工实物解剖测量的很多缺点,便于设计解剖测量参考体系和制定临床手术方案.经皮逆行髋臼螺钉技术可用于髋臼前柱骨折的临床治疗.

Anatomy and clinics of the retrograde acetabulum anterior column screw percutaneously

Objective To investigate the optimization technique for computer aided measurement and provide anatomical data for the retrograde acetabulum anterior column screw percutaneously. Methods Forty pelvic model data were collected by CT scan and then reconstructed in 3-D. The optimization objective function for the single screw fixation was set, the optimal placement was accumulated under constraint conditions. The new anatomical reference marks were designed after the statistics were analyzed. Results The percutaneous retrograde anterior column acetabular screws entrance point lies in the superior ramus of pubis, pubic tubercle and the midpoint iliopubic uplift of the obturator crest. The out point is between the anterior superior iliac spine from top to bottom notch and above the midpoint of the greater sciatic notch. The connection of the two points is the longitudinal axis of the anterior column acetabular, which is parallel with the arcuate line. Its direction connected with the anterior inferior iliac spine was (42.84 ± 2.61) ° and with Iliac was (31.96 ± 2.58) °. Length of the screw in bone was (101.12 ± 7.28) mm. Conclusion The automatic optimization technique for computer aided measurement is very efficient and has many advantages over the conventional manual dissection methods, it is convenient to design an anatomical reference landmark system and formulate a surgical plan