经皮骶髂螺钉与后方张力带钢板治疗不稳定骨盆后环骨折脱位的病例对照研究

目的 对比经皮骶髂螺钉和后方张力带钢板治疗不稳定骨盆后方骨折脱位的临床疗效。方法 2019年6月至2021年5月,收治符合纳入标准的骨盆后环骨折脱位患者40例,其中经皮骶髂螺钉组和后方张力带钢板各20例,比较两组基线资料、围手术期资料及临床疗效。结果 两组随访时间无明显统计学差异（P>0.05）。两组性别、年龄、致伤原因、骨折分型、ISS评分等基线资料对比无明显统计学差异（P>0.05）。骶髂螺钉组待术时间、手术时间、住院时间、切口长度、术中出血量等围手术期指标均优于钢板组（P<0.05）,但术中放射次数较多（P<0.05）。而术后Majeed评分和Matta评分两组间无明显统计学差异（P>0.05）。术后骶髂螺钉组发生两例神经损伤,钢板组发生两例术后切口感染,无其他重大手术并发症。结论 骶髂螺钉应用于不稳定骨盆后方骨折脱位患者中,对软组织创伤小,更适合作为骨盆后环骨折脱位的内固定方式。     

腹腔镜辅助经肛全直肠系膜切除术治疗下段直肠癌疗效分析

目的 探讨腹腔镜辅助经肛全直肠系膜切除术治疗下段直肠癌的经验。方法 回顾性分析2017年1月至2020年6月间收治的48例腹腔镜辅助经肛全直肠系膜切除术的患者临床资料（A组）,并与同期186例腹腔镜全直肠系膜切除术进行对比分析（B组）。结果 两组病人之间年龄、性别比例、肿瘤最大横径、术中出血量、收获淋巴结个数、术后并发症、术前Wexner评分、术前肛门最大收缩压、术后Wexner评分、术后肛门最大收缩压的差异无统计学意义（P>0.05）。两组病人之间肿瘤下缘至齿线距离、体质指数、手术时间的差异有统计学意义（P<0.05）。在A组内,男性患者和女性患者之间年龄、肿瘤最大横径、新辅助放化疗比例、术中出血量、收获淋巴结、术后并发症比例的差异无统计学意义（P>0.05）,但肿瘤下缘距齿线距离、BMI、手术时间的差异有统计学意义（P<0.05）。结论 腹腔镜辅助经肛全直肠系膜切除术治疗下段直肠癌是有效的,尤其适合于低位、骨盆狭窄的男性直肠癌患者,但要充分准备,有序开展。     

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。     

髂前下棘的解剖学研究及其在骨盆骨折中的应用

目的对髂前下棘及其体表投影进行应用解剖学研究,为骨盆骨折微创置入外固定钉提供参考依据。方法观察15具尸体30侧骨盆髂前下棘及体表投影,测量髂前下棘横径、矢状径和体表投影,按性别分组进行统计学处理。结果男性髂前下棘矢状径和横径分别为(26.51±2.86)mm和(11.64±1.15)mm;女性分别为(25.46±3.92)mm和(9.20±1.14)mm。男性髂前上棘到髂前下棘体表投影的距离对髂前上棘与耻骨结节间距离的回归系数为0.252;女性为0.262。结论髂前下棘的体表投影点位于髂前上棘与耻骨结节连线的外上1/4处,了解这一特点有助于准确置入骨盆外固定钉。     

微侵袭血肿清除术对高血压脑出血患者术后神经功能恢复及并发症的影响

目的 分析微侵袭血肿清除术对高血压脑出血患者术后神经功能恢复及并发症的影响。方法 选取2017年6月至2020年5月期间我院38例高血压脑出血患者,按照手术方式不同将患者分为微侵袭组（n=12）和大骨瓣组（n=26）。微侵袭组给予微侵袭血肿清除术治疗;大骨瓣组采用基底节区改良翼点入路,骨窗大小约为6 cm×8 cm。比较两组患者临床疗效、手术情况、临床神经功能缺失量表（NDS）评分、日常生活能力量表（ADL）评分以及并发症发生情况。结果 微侵袭组患者总好转率为91.67%,高于大骨瓣组的73.07%,差异无统计学意义（P>0.05）;微侵袭组手术时间、术中出血量明显小于大骨瓣组（P<0.05）,两组血肿清除率、住院时间比较无明显差异（P>0.05）;手术后3个月,两组患者NDS评分均明显低于本组手术前（P<0.05）,ADL评分均明显高于本组手术前（P<0.05）,微侵袭组患者NDS评分明显低于大骨瓣组（P<0.05）,ADL评分明显高于大骨瓣组（P<0.05）;两组患者颅内感染、肺部感染以及再出血并发症总发生率对比无统计学差异（P>0.05）。结论 与传统大骨瓣开颅术相比,微侵袭血肿清除术治疗高血压脑出血更加安全有效,患者术后神经功能恢复更好,并发症更少。     

骶髂关节紊乱在X线片上的表现形式和临床意义

目的:研究骶髂关节紊乱在X线片上的表现形式和临床意义,为推拿手法治疗骶髂关节紊乱提供临床诊断依据。方法:自2009年7月至2011年3月,选取104例骶髂关节紊乱的患者,其中男64例,女40例;年龄18～81岁,平均(45.39±1.30)岁;病程1～144个月,平均(12.64±2.19)个月。拍摄患者的骨盆平片104张,腰椎侧位片97张。在腰椎侧位片测量骶骨的水平角(腰骶角),骨盆平片上测量两侧髂嵴的垂直距离(髂嵴差),髋骨内侧缘与外侧缘之间的距离(髋骨宽),骶嵴连线与垂直轴线的夹角(骶嵴左右偏移度)。结果:两侧髂嵴差的均值为(10.34±0.73)mm,髋骨宽度差的均值为(6.73±1.01)mm;髂嵴差的均值较大(P<0.01),髋骨不等宽出现的频率较高(P<0.01)。腰骶角异常的均值是(7.29±1.86)°,骶嵴左右偏移度的均值是(3.18±0.47)°;腰骶角异常的均值较大(P<0.01),骶嵴左右偏移的频率较高(P<0.01)。结论:骶髂关节紊乱可分为髂骨紊乱和骶骨紊乱,髂骨是旋转移位,可分为前后旋转和内外旋转移位,内外旋转频率高,前后旋转幅度大;骶骨是倾斜紊乱,可分为前后倾斜和左右倾斜移位,左右倾斜频率高,前后倾斜角度大。     

心理干预对腹腔镜胆囊切除术老年患者围术期血流动力学和焦虑的影响

目的 观察术前心理干预对腹腔镜胆囊切除术老年患者围术期血流动力学和焦虑的影响.方法 将腹腔镜胆囊切除术的老年患者随机分为心理干预组和对照组,各20例.对照组给常规术前访视,心理干预组在上述基础上采取综合评估、心理干预措施、寻求家庭支持以及放松疗法.以焦虑自评量表(SAS)评估患者不同时间点的焦虑状态.结果 干预组各时间点心率、血压稳定,差异无统计学意义(P>0.05);而对照组心率、血压T1、T2较T0和T3明显升高(P<0.05);干预组T1、T2心率、血压较对照组明显低(P<0.05).干预组SAS评分各时间点间差异无统计学意义,对照组麻醉诱导前30minSAS评分明显升高(P<0.05),而且高于干预组(P<0.05).结论 腹腔镜胆囊切除术的老年患者在围手术期给予心理干预,不仅可显著减轻患者焦虑,而且使血流动力学趋向稳定.     

胆道镜术后置管灌洗溶石治疗肝内胆管结石

目的 探讨胆道镜术后经置管振荡灌洗溶石治疗肝内胆管结石的疗效.方法 选取25例肝内胆管多发结石需行胆道镜多次取石的患者,其中17例进行胆道镜术后置管灌洗溶石治疗,作为治疗组;8例作为对照组.分别测定两组胆汁中胆红素浓度、两组B超下残余结石最大径变化,统计两组胆道镜平均操作次数.结果 治疗组胆汁中胆红素浓度大于对照组(P<0.01);B超测量治疗组灌洗后残石最大径均值小于对照组(P<0.01);治疗组平均胆道镜操作次数少于对照组(P<0.05).结论 胆道镜术后置管灌洗溶石可提高治疗肝内胆管结石的疗效.     

PCNA与Caspase-3在胆囊癌组织中的表达及其临床意义

目的 探讨增殖细胞核抗原(PCNA)和半胱氨酸天冬氨酸蛋白酶3(Caspase-3)在胆囊癌组织中的表达及临床意义.方法 采用免疫组化检测42例胆囊癌组织和10例慢性胆囊炎组织石蜡切片中PCNA和Caspase-3的表达水平,并分析与临床病理特征之间的关系.结果 (1)PCNA的阳性表达率在胆囊癌及慢性胆囊炎组分别为64.29%和30‰两组间差异有显著性(P<0.05);Caspase-3在胆囊癌及慢性胆囊炎组分别为30.95%和70%,两组间差异有显著性(P<0.05).(2)胆囊癌组织中,PCNA和Caspase-3表达水平在性别、年龄方面差异无统计学意义(P>0.05),但与淋巴结转移、癌组织分化程度及病理TNM分期有关(P<0.05).(3)PCNA和Caspase-3的表达呈负相关(rs=-0.62,P<0.01).结论 PCNA和Caspase-3的表达在胆囊癌组织中呈负相关,且两者表达水平与胆囊癌淋巴结转移、癌组织分化程度及病TNM分期有关,提示PCNA和Caspase-3是反映胆囊癌生物学行为的重要指标.     

髋臼上方骨盆外固定技术相关研究

骨盆外固定术是骨盆损伤患者复苏阶段治疗颇为重要的环节,传统的骨盆外固定架对骨盆前环提供足够的稳定性,但对后环的稳定性不足。髋臼上方外固定的钉道位于髂前下棘至髂后上棘间髋臼上方致密骨质内髂嵴前缘自髂前上棘向下至髋臼边缘,熟悉股外侧皮神经解剖可避免损伤。生物力学研究表明置钉于髋臼上方密质骨中可比传统置钉法获得更佳的骨盆稳定性,外固定针插入髋臼上方4～5 cm深能提供足够稳定性,联合应用骨盆闭孔-出口位、闭孔入口位及髂骨斜位像可确保螺钉安全植入。经髋臼上方通道的外固定针可获得更长的钉-骨界面,并实现对骨盆后环的加压,增加固定可靠性。     

髋臼前柱钢板内固定的解剖学研究

目的研究髋臼前柱钢板内固定技术中螺钉的最佳进钉点、方向和长度,预防发生螺钉穿入关节内的严重并发症。方法取成年男性半骨盆标本20个,分别测量髋臼前、后缘到髂前下棘、髂耻隆起和耻骨结节的距离,确定和制作髋臼前柱系列断面,分别测量各断面上各进钉点的安全进钉角度,将测量数据输入到SPSS10.0软件进行统计学分析。结果髋臼前缘到髂前下棘、髂耻隆起和耻骨结节的距离分别为(25.4±1.4)mm,(11.8±0.7)mm和(37.4±1.5)mm,后缘到髂前下棘和髂耻隆起的距离分别为(15.5±0.9)mm和(29.1±1.6)mm。在各断面距离骨盆界线0.5cm点、1.0cm点和1.5cm点上螺钉的安全进钉角度的最大值分别为(8.2±2.2)°、(14.9±3.4)°和(26.1±4.5)°。结论在前柱髋臼区使用钢板内固定时,可以采用3种方法避免螺钉穿入关节内。第一种方法是使用短螺钉,螺钉方向随意;第二种方法是使用长螺钉紧贴骨盆界线进钉,方向平行于四方区;第三种方法为根据不同的进钉点选择不同的进钉角度和长度。     

不同年龄段髂前下棘的解剖学特点分析

目的比较18~40，41~60，≥61岁不同年龄段髂前下棘形态学解剖参数变化。 方法选择正常半骨盆资料155例，其中男性115例，年龄（48±15）岁，女性40例，年龄（53±14）岁，均无髋臼撞击综合征，通过软件测量髂前下棘的最大长度、宽度、高度以及表面积和体积。 结果41~60岁及≥61岁年龄段男性髂前下棘的最大宽度[（12.0±1.9）mm；（12.0±1.8）mm]、表面积[（444.11±139.24）mm²；（469.03±132.26）mm²]以及体积[（910.19±452.34）mm³；（989.09±442.99）mm³]显著大于女性[宽度：（9.5±1.1）mm，（9.5±1.6）mm；表面积：（328.96±92.64）mm²，（326.26±118.32）mm²；体积：（577.04±259.51）mm³，（482.47±254.34）mm³，均P<0.05）。≥61岁年龄段中，男性髂前下棘的最大高度大于女性[（6.1±1.4）mm VS（4.6±1.4）mm，P=0.007）。不同年龄段之间（18~40岁，41~60岁，≥61岁），男性和女性的解剖学参数均无统计学意义。在三个年龄段中，最常见的髂前下棘分型均是1型（18~40岁，86.05%；41~60岁，71.23%；≥61岁，79%）。年龄与髂前下棘的长度、宽度、高度、体积和表面积均没有相关性（均P>0.05）。 结论髂前下棘的解剖形态相对稳定，与年龄没有显著相关性，但同年龄组不同性别髂前下棘的体积和表面积会有显著差异。此外低位髂前下棘（2型）并不一定导致髋臼撞击综合征的出现。     

Anatomic and radiographic considerations for placement of transiliac screws in lumbopelvic fixations

Lumbopelvic fixation in spinal and pelvic surgery relies on rods or screws as an iliac anchor. Secure placement of screws with maximum diameter and length for the greatest pullout strength requires knowledge of the iliac structure and of intraoperative fluoroscopic landmarks for secure placement. Therefore, the authors evaluated the intrailiac length, inner width, and cortical thickness of three different transiliac screw anchor paths aimed toward the anterior inferior iliac spine and initiated at the iliac tubercle, posterior superior iliac spine, or posterior inferior iliac spine. Measurements were made using two- and three-dimensional computed tomographic reformations in 40 consecutive trauma patients (27 measurements in 21 males, 16 to 75 years old; 28 measurements in 19 females, 16 to 78 years old). In addition, fresh and dry human cadaveric specimens were marked with metal wires at the previously determined optimal screw path to determine fluoroscopic landmarks for easiest and best controlled transiliac screw placement. The posterior superior iliac spine-anterior inferior iliac spine path had the largest bony canal lengths, with 141 mm in male and 129 mm in female patients. Two stereotypic iliac constrictions allowed placement of 8-mm implants in male and 6- to 7-mm implants in female patients. Cortical thickness at that optimal extraarticular path was 5.2 mm in the male and 4.7 mm in the female patients. Transiliac screws can be placed during operation under fluoroscopic control using standard lateral and obturator oblique-outlet views, the latter presenting a stereotypical teardrop figure above the acetabulum.     

髋关节旋转中心相关骨性参数的测量

目的 了解国人正常髋关节周围的骨性参数,探讨其对高位髋中心技术的影响. 方法 挑选CT表现完全正常且病例资料完整的男女各30例的影像资料,采用专用图像软件测量.测量参数:髋臼上方骨质的厚度、颈干角、偏心距、股骨头直径、骨盆高度及骨盆宽度.将年龄、体质量、性别和测量的各项参数值收集整理后进行统计分析. 结果 髋臼上方骨质形态在通过股骨头中心的冠状面上呈倒漏斗形,由远及近逐渐变薄,断面呈扇形,角度逐渐增大,半径逐渐变短.两性均在髋臼上方3 cm明显变薄,平均厚度男性为3.00 cm,女性为2.85 cm.男女两性之间的骨盆高度、骨盆宽度、颈干角、股骨头直径以及髋臼上方2 cm平面的骨质厚度等参数差异有统计学意义(P＜0.05),特别是颈干角,男性平均为121.42°,女性平均为135.42°,相差达14°,男女两性最小值与最大值相差达24.1°. 结论 髋臼上方骨质允许在全髋关节翻修术时垂直上方或上内方3 cm内放置高位髋中心.正常国人髋关节周围骨性参数男女差别较大,基于性别的差异,有必要在建立数据库时进行区别.     

Spino-pelvic- lower extremity balance during walking in elderly patients with spinal kyphosis

Back groundPatients with spinal kyphosis were radiographically evaluated while standing. However, the spino-pelvic alignment during walking is different. This study examined the spino-pelvic-lower extremity alignment during walking by a three-dimensional (3D) motion analysis.MethodsTwenty-six patients with a sagittal vertical axis of ≥4 cm (male: female, 5:21; average age, 66 years) were evaluated. Using a 3D motion capture system, the trunk and pelvic anterior inclination angles, hip and knee joint angles were measured during a 3-min walk. The correlation coefficient between the change of the trunk anterior inclination angle and each parameter at the beginning of walking was calculated, and those parameters were compared with radiographic measurements.ResultsThe patients were divided into two groups according to the change of the trunk anterior inclination angle: the large change group included 14 patients with an increase of ≥5° between the beginning and end of the 3-min walk; the small change group included 12 patients with an increase of <5°. The pelvic anterior inclination angle showed a significant difference between the two groups at the first gait cycles. The pelvic anterior inclination angle and the hip joint angle in the large change group showed a significant difference between the first and last cycles. The correlation coefficient revealed a significant association between the change in the trunk anterior inclination angle and the pelvic anterior inclination angle at the beginning of walking. There were no significant differences between the two groups in any radiographic spino-pelvic parameters.ConclusionsThere were two types of patients with spinal kyphosis: patients with a small pelvic anterior inclination angle at the beginning of walking showed slight progression in their trunk anterior inclination, whereas those with a large pelvic angle showed a large degree of progression in their pelvic and trunk inclination during walking.     

儿童S2髂骨螺钉置钉可行性分析及钉道规划

目的:利用计算机三维重建及模拟置钉技术评估S₂髂骨螺钉在国人儿童应用可行性,且优化测量其钉道参数。方法:选取2018年12月至2020年12月行骨盆CT扫描且年龄5~16岁的儿童骨盆影像学资料83例,排除骨折、畸形、肿瘤等情况,其中男44例,女39例,年龄(10.66±3.52)岁,依据年龄分为4组(A组5~7岁;B组8~10岁;C组11~13岁;D组14~16岁)。将获得的原始CT数据导入Mimics软件中,三维重建骨盆骨性结构,并在三维视图模拟分别以螺钉最大头倾角、最小头倾角置入直径6.5 mm S₂髂骨螺钉。随后在3-Matic软件中分别测量最大头倾角和最小头倾角下螺钉冠状位夹角、矢状位尾倾角、横断位外展角、置钉总长度、骶骨内螺钉长度、髂骨宽度、进钉点距皮肤距离。比较分析不同年龄段儿童S₂髂骨螺钉置钉参数间的差异及性别与左右侧别间差异。结果:83例儿童均可置入直径6.5 mm S₂髂骨螺钉。各置钉参数左右侧别间比较,差异无统计学意义(P>0.05)。5~7岁儿童螺钉冠状位角度小于其他年龄段(P<0.05);但在螺钉矢状位角度上,在螺钉最大头倾角下5~7岁儿童可获得较大角度,但在最小头倾角下较大角度获得年龄组为11~13岁。螺钉横断位角度各年龄组差异无统计学意义(P>0.05)。5~7岁男童在最大头角下的冠状位角度和最小头倾角下的矢状位角度均大于女童(P<0.05);8~10岁女童最小头倾角下的冠状位角度大于男童(P<0.05);其余置钉角度参数男女性别间差异均无统计学意义(P>0.05)。各年龄组间,髂骨最小宽度、最长钉道距离及骶骨内螺钉长度差异随年龄增长,均呈增长趋势(P<0.05)。5~7岁及8~10岁女童皮肤距离均大于男性(P<0.05)。男童在14~16岁髂骨最小宽度宽于同阶段女童(P<0.05)。而5~7岁及11~13岁女童,最长钉道距离长于同阶段男童(P<0.05)。结论:5~16岁儿童骨盆可安全容纳直径6.5 mm S₂髂骨螺钉置入,但是由于儿童骨盆骨性结构处于发育生长时期,需精准评估,规划合理钉道、选择合适螺钉长度。     

健康成人肱骨远端的CT解剖形态学特征

目的探讨健康成人肱骨远端的CT解剖形态学特征及性别差异,为肱骨远端植入物的设计提供参考。方法从医院图像存档与传输系统中选取121例正常肘关节CT图像,于AW4.5工作站中进行重建和测量。通过屈戌轴和肱骨干确定冠状面和水平面,与屈戌轴垂直的面确定为矢状面。于冠状面上测量肱轴角;取四个不同的矢状面测量肱骨小头高度、外侧滑车缘高度、滑车沟高度、内侧滑车缘高度;于水平面上测量肱骨小头宽度、肱骨小头前距、外侧滑车缘前宽、外侧滑车缘后宽、滑车宽度、内侧滑车缘前宽、内侧滑车缘后宽、滑车沟前后距、外侧滑车缘前距、外侧滑车缘后距、内侧滑车缘前距、内侧滑车缘后距、肱骨远端宽度。分析测量参数的性别差异、数据间的相关性及肱轴角与90°的差异。结果男性肱骨小头高度为(21.5±1.3)mm、肱骨小头宽度为(17.5±1.1)mm、肱骨小头前距为(10.8±0.9)mm、滑车宽度为(25.1±2.2)mm、滑车沟高度为(17.3±1.5)mm、滑车沟前后距为(17.5±1.4)mm、外侧滑车缘前宽为(7.7±1.2)mm、外侧滑车缘后宽为(12.5±1.6)mm、内侧滑车缘前宽为(12.4±1.6)mm、内侧滑车缘后宽为(9.8±2.0)mm、外侧滑车缘前距为(10.0±0.8)mm、外侧滑车缘后距为(16.3±1.4)mm、内侧滑车缘前距为(12.9±1.4)mm、内侧滑车缘后距为(13.2±1.4)mm、外侧滑车缘高度为(20.6±1.3)mm、内侧滑车缘高度为(25.0±2.4)mm、肱骨远端宽度为(42.6±2.5)mm,女性分别为(18.7±1.1)mm、(15.3±1.1)mm、(9.5±0.6)mm、(21.7±1.5)mm、(15.4±1.7)mm、(15.6±1.5)mm、(6.8±1.3)mm、(10.7±1.4)mm、(10.6±1.4)mm、(8.5±1.4)mm、(8.9±0.8)mm、(14.5±1.1)mm、(11.4±1.1)mm、(11.5±1.0)mm、(18.1±1.4)mm、(21.6±1.4)mm、(37.0±1.8)mm,男性均大于女性,差异有统计学意义(P<0.05)。肱轴角(男87.4°±3.5°,女87.8°±3.3°)、肱骨小头宽度与肱骨小头高度比(男0.8±0.1,女0.8±0.1)、滑车宽度与肱骨小头宽度比(男1.4±0.2,女1.4±0.1)、内外侧滑车缘高度比(男1.2±0.1,女1.2±0.1)、内侧滑车缘前宽与滑车宽度比(男0.5±0.1,女0.5±0.1)、内侧滑车缘后宽与滑车宽度比(男0.4±0.1,女0.4±0.1)、外侧滑车缘前宽与滑车宽度比(男0.3±0.0,女0.3±0.1)、外侧滑车缘后宽与滑车宽度比(男0.5±0.1,女0.5±0.1)的性别差异无统计学意义(P>0.05)。各项参数除肱轴角外均与肱骨远端宽度呈正相关,随肱骨远端宽度的增大而增大(r值0.335~0.928,P<0.05)。肱轴角(87.6°±3.4°)与90°的差异有统计学意义(t=-7.287,P<0.05)。结论男性肱骨远端尺寸略大于女性,但形状无差异。关节宽度可以作为一个衡量肱骨远端大小的指标,肱骨骨干更偏向于桡侧。     

Screw placement in percutaneous acetabular surgery: gender differences of anatomical landmarks in a cadaveric study

Purpose

Percutaneous reduction and periarticular screw implantation techniques have been successfully introduced in acetabular surgery. The advantages of this less invasive approach are attenuated by higher risks of screw misplacement. Anatomical landmarks are strongly needed to prevent malplacement. This cadaver study was designed to identify reliable anatomical osseous landmarks in the pelvic region for screw placement in acetabular surgery. Gender differences were specifically addressed.

Methods

Twenty-seven embalmed cadaveric hemipelvic specimens (13 male, 14 female) were used. After soft-tissue removal, anterior and posterior column acetabular screw placement was conducted by one orthopaedic trauma surgeon under direct vision. Each column was addressed by antegrade and retrograde screw insertion. Radiographic verification of ideal screw placement was followed by assessment of the distance from the different entry points to adjoining anatomical osseous structures.

Results

For anterior column screw positioning, the posterior superior iliac spine (PSIS), posterior inferior iliac spine (PIIS), iliopectineal eminence and centre of the symphysis were most reliable regarding gender differences. For posterior column screw positioning, the distance to the anterior superior iliac spine (ASIS) and the ischial tuberosity showed the lowest deviation between the different gender specimens. Highest gender differences were seen in relation to the cranial rim of the superior pubic ramus in retrograde anterior column screw positioning (p = 0.002). Most landmarks could be targeted within a 2.5-cm range in all specimens.

Conclusions

The findings emphasise the relevance of osseous landmarks in acetabular surgery. By adhering to easily identifiable structures, screw placement can be safely performed. Significant gender differences must be taken into consideration during preoperative planning.     

Relationship between foot length and the inter anterior superior iliac distance

Reduction of unstable pelvic fracture by external fixator might be over or under corrected as there is no proper estimation from the surgical landmark. Radiographic evaluation after reduction must be carried out and improper reduction is found in a certain number. To find a better guide by normal surgical landmark the study was carried out as a survey research in 600 volunteers aged from 10 to 70 years. Simple caliper and tape were used to measure the height, foot length and inter anterior superior iliac spine distance. In 376/420 male volunteers (89%), the length between right heel and tip of the fourth toe was equal to the inter anterior superior iliac spine distance. In 173/180 female volunteers (96%), the length between right heel and tip of big toe was equal to the inter anterior superior iliac spine distance. The length of the right foot can be used as a reference in reducing unstable fractured pelvis by external fixation. These data were used in the management of 36 patients with unstable fractured pelvis with external fixation for reduction and stabilization. All had good results.     

Age-related change and gender differences in pelvic morphology of healthy children

BackgroundAn increasing number of studies about the hip joint morphology with childhood-specific hip diseases have been reported. But there have been few reports on pelvic morphology of healthy children. The purpose of this study was to assess the pelvic morphology of healthy children in detail and clarify the age-related change and gender difference of it.MethodsWe retrospectively assessed the pelvic morphology of 97 healthy children (3–18 years old) using their pelvic computed tomography (CT) data. Superior iliac angle (SIA), inferior iliac angle (IIA), and ischiopubic angle (IPA) as the parameters of pelvic winging, and acetabular anteversion and anterior acetabular sector angle (AASA), posterior acetabular sector angle (PASA), superior acetabular sector angle (SASA) as the parameters of acetabular coverage, are measured. Pearson's correlation coefficient was used for examining the correlation between the each measurement and the age of cases. Multiple linear regression analysis was performed to investigate the possibility of association of age and sex with each measurement.ResultsIn female, it was found that IIA, AASA, PASA, SASA were significantly correlated with the age of the cases. And in male, SIA, IIA, IPA, AASA, PASA were significantly correlated with the age. Multiple linear regression analysis revealed the significant difference of the distribution between males and females was observed in IIA, IPA, AVcen, PASA, and these measurements were lager for female.ConclusionsIn this study, we revealed the age-related change and gender difference of the pelvic morphology of healthy children, and this could be useful information in evaluating the hip with what appears to be an abnormal acetabular anteversion and acetabular inclination in the patients with childhood specific hip disease. Additionally, it will also help us to make operation plans pertaining to the hip.