脊柱骨盆固定中髂骨钉的应用解剖学

目的 探讨脊柱骨盆固定术中髂骨钉入钉点、钉长及直径、植钉方向,为其正确植入提供解剖学依据. 方法 选用35侧成人尸体髋骨标本(左16侧,右19侧,男30侧,女5侧),经髂后上、下棘间切迹上缘至坐骨大切迹顶弧做一直线并延续至髋臼缘,定为基线(a),通过坐骨棘和髂前上棘做一直线(b),该线与a线相交于C点上.经过a线和C点在髂骨后部向上做5°、10°、15°、20°、15°、30°、35°的扇形线,之后经过10°～30° 5个角度做髂骨斜截面.观察各斜截面形态,并从截面上面进行相关数据测量.同时观察髂骨后部内外侧唇、中间线的形态和可辨性.确定髂骨钉入钉点、直径、长度及进钉方向后,以2具尸体标本进行验证. 结果 35°扇形线已到达髂窝,髂骨臀盆面间距明显变窄,5°扇形线紧邻坐骨大切迹弧顶,坐骨大切迹弧顶A点到各截面垂直距离变短明显. f线在各截面最为狭窄. 髂骨后部中间线明显可辨,呈一规则弧形,为后部髂嵴最凸出部,在所选实验标本中均可观察到.进钉点至髋臼顶软骨距离(k)测得值最小为109.38mm. 结论 通过基线(a)、C点及10°～30°之间髂骨外侧板能准确、安全植入髂骨钉;钉长以不超过100mm、直径不超过9mm为宜.

Applied anatomy of the parameters of the iliac screw for lumbopelvic fixation

Objective To explore the entering spot, the length , the diameter and the direction of the iliac screw in the lumbopelvic fixation operations and provide anatomic basis for implanting correctly the iliac screw. Methods A total of 35 side hipbone specimens of native adults were studied.There were 30 side male specimens and 5 side female,16 left sides and 19 right sides.One line from the arc of the notch between posterior superior iliac spine and posterior inferior iliac spine was difined as the baseline(a).It was extended to acetabulum edge.Another line(b) was marked through the ischial spine and anterior superior iliac spine.It was intersected with baseline(a) in C spot. The C spot was located on the surface of ilium body behind the acetabulum and determinated.The fan-shaped lines were described in the posterior part of iliac through the C spot and the baseline.Five oblique sections were obtained through there fan-shaped lines. Various oblique sections were observed and correlation data above the 10°-30° oblique sections were measured.At the same time,the medial lip, lateral lip and intermediate line in the behind part of iliac were observed.After definiting the entering spot, the length, the diameter and the direction of the iliac screw,these data were verificated in 2 native adut cadavers . Results It was found that 35° oblique section arrivals to the iliac fossa and 5° oblique section clings to the arc of the greater sciatic notch. The diameter of the iliac screw based on f line which was the shortest distance between the gluteal surface and pelvic surface. The intermediate line on posterior part of the iliac spine could be distinguished clearly,which was like a regular arc and the most raised part. The minimum distances(K) from entering spots to the cartilage of the acetabulum roof was 109.38mm.  Conclusion Iliac screws can be implanted accurately and safely by the C spot,the baseline and the outer plate in 10°-30° posterior part of the iliac. The most entering spots are located in the points of the fan shaped lines intersecting with the