常规C型臂X线机下骨盆髋臼骨折置钉技术及影像学评估

目的探讨和总结在常规C型臂X线机下骨盆髋臼术中螺钉位置的影像学评估。方法根据文献资料和笔者骨盆髋臼骨折手术病例，介绍在常规C型臂X线机下髂骨螺钉、耻骨上支螺钉（前柱螺钉）、坐骨螺钉（后柱螺钉）、骶髂关节螺钉技术和术中螺钉位置的影像学评估。结果出口一闭孔斜位能显示髂骨内外板，此影像可用来判断外固定支架髂嵴螺钉固定针植入深度和是否位于髂骨内外板之间；髋臼上缘外固定支架固定针从髂前下棘至髂后上棘的致密骨道，在闭孔-出口位相上，螺钉或固定针应位于泪滴中央、髂骨斜位证实螺钉进入深度和位于坐骨大切迹上方；髂后上棘螺钉可利用出口-闭孔斜位相见螺钉在泪滴征中央，入口-闭孔斜位可证实螺钉在骨皮质中；前柱螺钉位置监测可采用出口-闭孔斜位、入口-髂骨斜位和入口位来完成；后柱螺钉位置和长度通过髂骨斜位来判断；骶髂螺钉固定植人过程中，骶骨侧位结合出口位、入口位判断螺钉的正确位置。结论临床医生应熟悉骨盆正常骨性结构、血管位置、骨折类型、骨折移位情况和术中不同的位相意义。

Intraoperative fluoroscopic evaluation of screw placement during pelvic and aeetabular surgery.

Objective To explore and summarize the intraoperative evaluation of hardware placement with fluoroscopic assistance during pelvic and acetabular surgery. Methods Based upon a literature review and our own clinical practice, differ- ent screw placement techniques including iliac screw or pin, superior pubic ramus screw （anterior column screw）, ischium screw （posterior column screw） and iliosacral screw fixation under fluoroscopic control in pelvic and acetabular surgery were described. Results The obturator-outlet image could display the external fixator pin as it passed between the inner and outer tables of the ilium. The trajectory for pin placement of the supra-acetabular external fixator and posterior PSIS screws was loca- ted in the column of bone that ran from the anteriorly AIIS to the PSIS posteriorly, which appeared as a teardrop under obtura- tor-outlet view. The lilac oblique view was used to demonstrate appropriate depth and confirm the relationship of the pin to the superior greater sciatic notch. Anterior column screw was monitored by using the obturator-outlet and iliac inlet view or inlet view of the pelvis. Frequent radiographic images of the iliac and obturator oblique views were used to guide advancement of the posterior column screw across the fracture. For the iliosacral screw placement, lateral, inlet and outlet views were helpful for the evaluation of correct screw position. Conclusion uring pelvic and acetabular surgery, the surgeon must fully understand pelvic osseous anatomy, the location of neurovascular structures, variation in injury patterns, and be familiar with interpreta- tion and correlation of the intraoperative fluoroscopic imaging.