髂骨翼内板相对于方形区的倾斜角数字化测量及其临床意义

目的 研究正常成人完整骨盆CT扫描三维重建数字化测量髂骨翼内板相对于方形区的倾斜角度,为临床提高髂骨与髋臼骨折复位质量提供影像解剖学参数支持。方法 回顾性研究。纳入2016年1月—2018年12月解放军中部战区总医院行CT三维重建检查的正常成人完整骨盆数据,其中男60例(120侧)、女40例(80侧),平均年龄42.18岁。将数据以DICOM格式导入Mimics 20.0软件,去除周围软组织、骶骨以及双侧股骨,建立完整双侧独立的三维髋骨模型;将髂骨翼分为前、中、后三区,依据骨盆相关骨性标志标记髂骨翼各分区相对于方形区的倾斜角并利用Mimics软件进行测量。比较同性别左右侧、不同性别间相应倾斜角的差异,以及不同部位倾斜角的差异。结果 男性和女性的前、中、后区倾斜角分别为142.40°±5.62°和142.03°±4.82°,130.78°±5.75°和126.37°±6.17°,101.27°±5.40°和100.46°±5.44°。同性别左、右侧前、中、后区倾斜角差异均无统计学意义(P值均＞0.05)。不同性别间前区与后区倾斜角差异均无统计学意义(P值均＞0.05);男性中区倾斜角大于女性,差异有统计学意义(t=5.166, P＜0.05)。髂骨翼内板相对于方形区的前、中、后三区倾斜角逐渐减小,差异均有统计学意义(P值均＜0.05)。结论 髂骨翼内板相对于方形区的倾斜角在不同性别、不同部位有一定变化,该解剖学参数可以为术中指导髂骨与髋臼骨折解剖复位提供参考依据,在一定程度上从整体角度提高骨盆髋臼骨折的复位质量,并能评价骨折的旋转移位情况,弥补Matta评价标准的不足。

Digital measurement and significance of the angle of inclination of the iliac ala relative to the square region

Objective To obtain the angle of inclination of the normal adult iliac ala relative to the square region by three-dimensional(3D)computed tomography(CT)reconstruction and digital measurement of adult intact pelvis,and to provide anatomical parameter support for clinical improvement of ilium and acetabulum fracture reduction quality.Methods Retrospective study.Complete adult pelvic data of CT three-dimensional reconstruction examinations were collected from General Hospital of Central Theater Command from January 2016 to December 2018.There were 60 males(120 sides),40 females(80 sides),aged for an average 42.18 years old.The data were imported into Mimics 20.0 software in DICOM format,and the surrounding soft tissues,patella,and bilateral femurs were removed to create a complete bilateral independent three-dimensional hip bone model.The iliac wing was divided into three zones.The anterior,middle and posterior tilt angles of the ilium wing were marked according to pelvic-related bone markers and measured by Mimics software.The angle of inclination of the iliac ala relative to the square region were compared between the left and right sides of the same sex and between men and women.Results The angle of inclination of the iliac ala relative to the square region between male and female(mixed left and right)were 142.40°±5.62°and 142.03°±4.82°at the anterior part,while 130.78°±5.75°and 126.37°±6.17°at the middle part,101.27°±5.40°and 100.46°±5.44°at posterior part.There was no significant difference between the left and right inclination angles of the same sex subjects(all P values>0.05).The anterior and posterior angles of inclination of the iliac ala relative to the square region that had no statistical differences(all P values>0.05),the middle inclination angle was greater in men than in women.which was statistically significant(P<0.05).The angle of inclination of the iliac ala relative to the square region gradually decreased from front to back(all P values<0.05).Conclusions The angles of inclination of the iliac ala relative to the square region changes between different genders and different parts.The anatomical parameters can provide reference for the anatomical reduction of the ilium and acetabulum fracture during operation.To a certain extent,the quality of reduction of pelvic acetabular fractures can be improved from an overall perspective,and the rotation displacement of the fracture can be evaluated,compensating the deficiency of Matta's criterion.