不同路径髂骨钉钉道的CT影像学研究

目的：研究髂骨钉的最佳路径,为腰骶骨盆重建手术提供参考依据。方法：2009年2月至8月,选门诊或住院因各种原因进行骨盆CT扫描及三维重建并且无阳性表现的50例患者影像学资料进行研究,男28例,女22例;年龄19～65岁,平均41.2岁。设计4条路径,A、B、C路径均以CLIC点（Chiotic线与后髂嵴的交叉点,位于髂后上棘上方24mm处）为起点,方向分别为髋臼上缘、髂前下棘、髋臼中心;D路径以髂后上棘起点,指向髂前下棘。对每条路径中不同钉道的长度及钉道中两处狭窄点的骨板厚度进行数据分析。结果：A（CLIC点到髋臼上缘）、B（CLIC点到髂前下棘）、D（髂后上棘与髂前下棘）路径钉道长度相当,但A路径髂骨板厚度明显较B、D路径大。A、C（CLIC点到髋臼中心）路径髂骨板厚度无明显差异,但A路径通道长度明显大于C路径。结论：A路径即从CLIC点到髋臼上缘方向的髂骨钉钉道路径最长且髂骨板最厚,能够容纳相对最长最粗的髂骨钉,又能承受的拉力最大,是最理想的髂骨钉钉道。

CT radiographic study of different paths of iliac screw path

Objective: To investigate the best effective and accepted path of iliac screws for lumbar sacral spine and pelvis to provide reference for reconstruction. Methods: From Feb. 2009 to Aug. 2009,radiographic data of 50 patients were selected for various reasons,pelvic CT scanning and three-dimensional reconstruction and no positive performance,included 28 males and 22 females with an average age of 41.2 years old,ranging from 19 to 65 years. Designed four paths,in path A,B,C,CLIC(crossing point of Chiotic line and posterior iliac crest,located 24 mm on the top of posterior superior iliac spine) was the starting point for the path in the direction of the upper edge of the acetabulum,anterior inferior iliac spine,acetabulum center;in path D,the posterior superior iliac spine was starting point to direct anterior inferior iliac spine. The length of the screw channel and two narrow points in the screw channel of the bone plate thickness data of each different path were measured and analyzed. Results: The path A(CLIC point to the upper edge of the acetabulum) and the path B(CLIC point to the AIIS) and the path D(PSIS to AIIS) had correspond length of the screw channel,but the thickness of iliac of path A was thicker than that of path B and D. The iliac thickness of path A(CLIC point to the upper edge of the acetabulum) and the path C (CLIC point to the acetabular center) has no significant difference,but the channel length of path A was significant longer than that of path C. Conclusion: Path A from the CLIC point to the direction of the upper edge of acetabular ilium nail route was the longest path and the iliac bone plate was the most thick,and able to accommodate the relatively longest and most coarse iliac screw,but also bear the greatest tension. It is the best iliac nail route.