髋臼后柱钢板螺丝钉内固定技术的解剖学研究

目的：确定后柱各个区域放置螺钉的最佳角度和长度,解决后柱中部区域拧入螺钉易穿入关节的难题.方法：取成年男性尸体标本10具,年龄20～74岁,平均54.5岁.自髋关节处去除双侧股骨,切除L5,自正中矢状面锯开骶骨及耻骨联合,得半骨盆标本20个,排除骨性异常.彻底剔除附着于骨盆的软组织,令标本自然风干备用.确定髋臼上下缘界限和髋臼后柱系列断面,制作髋臼后柱系列断面.在各断面上测量后柱宽、髋臼宽和髋臼后柱宽度百分比,测量各进钉点的螺钉角度和长度,测量数据用SPSS10.0进行统计学分析.结果：平髋臼上1/2断面B、平髋臼1/2断面C、平髋臼下1/2断面D各进钉点的螺钉进钉角度和长度：在平髋臼上1/2断面B上,髋臼后柱外侧缘即髋臼后缘B0分别为41°和44.0 mm;髋臼后柱外1/2即B1分别为66°和42.2 mm;髋臼后柱1/2即B2分别为91°和59.5mm;髋臼后柱内1/2即B3分别为107°和64.0 mm;髋臼后柱内侧缘B4的最大进钉角度和螺钉长度分别为123°和65.5 mm,最小进钉角度和螺钉长度分别为109°和59.0mm.在平髋臼1/2断面C上,髋臼后柱外侧缘即髋臼后缘C0分别为39°和39.0 mm;髋臼后柱外1/2即C1分别为57°和36.0mm;髋臼后柱1/2即C2分别为74°和36.0 mm;髋臼后柱内1/2即C3分别为90°和36.0 mm;髋臼后柱内侧缘C4分别为106°和76.0mm.在平髋臼下1/2断面D上,髋臼后柱外侧缘即髋臼后缘D0分别为42°和35.5 mm;髋臼后柱外1/2即D1分别为61°和33.0 mm;髋臼后柱1/2即D2分别为81 °和32.0 mm;髋臼后柱内1/2即D3分别为100°和31.0 mm;髋臼后柱内侧缘D4分别为120°和74.0 mm.结论：髋臼后柱钢板螺丝钉技术中,在髋臼区的外1/4区、外中1/4区、内中1/4区和在内1/4区,钉后柱角分别为40°～60°、60°～75°、75°～90°、90°～平行于四方区,螺钉长度30 mm.

Anatomy study on the fixation technique of buttress plate in the posterior column of the acetabulum

Objective: To solve the problem of screw penetrating the joint surface easily by determining the angle of inclination and the mean longth screw plated on the posterior column.Methods: Ten specimens of adult male cadavers,aged 20 to 74 years old,averaged 54.5 years old,were collected. After removal of the bilateral femurs from the hip joints,and sawing through the sacral and pubic symphysis in the median sagittal plane,20 semi pelvic specimens were used for this study when the osseous abnormalities were excluded. The specimens were air dried naturelly after the soft tissue attaching to the pelvis had been eliminated. The margin of superior acetabular and inferior acetabular were determined,and the serial cross-sections of the acetabular posterior column were made. The width of posterior column,the width of acetabulum,the width ratio of acetabulum to posterior column,the angle of inclination and the mean length of screw on all entry points were measured. Defined the level parallel to 1/2 section of superior acetabulum was cross-section B;1/2 section of acetabulum was C;1/2 section of inferior acettabulum was D. At the different levels,defined the entry point on the outer edge of posterior column of the acetabulum or the trailing edge of acetabulum was B0,C0 or D0;lateral 1/2 of posterior column of the acetabulum was B1,C1 or D1;1/2 of posterior column of the acetabulum was B2,C2 or D2;medial 1/2 of posterior column of the acetabulum was B3,C3 or D3;the inner edge of posterior column of the acetabulum was B4,C4 or D4.Results: On cross-section B,the angle of inclination and the mean length of screw at B0 was 41°and 44.0 mm;at B1 was 66° and 42.2 mm;at B2 was 91° and 59.5 mm;at B3 was 107° and 64.0 mm;the maximum angle and the mean length at point B4 was 123° and 65.5 mm;the minimum angle and the mean length at point B4 was 109° and 59.0 mm. On cross-section C,the angle and the mean length at point C0 was 39° and 39.0 mm;at C1 was 57° and 36.0 mm;at C2 was 74° and 36.0 mm;at C3 was 90° and 36.0 mm;at C4 was 106° and 76.0 mm. On cross-section D,the angle and the mean length at D0 was 42° and 35.5 mm;at D1 was 61° and 33.0 mm;at D2 was 81° and 32.0 mm;at D3 was 100° and 31.0 mm;at D4 was 120° and 74.0 mm.Conclusion: When using the fixation technique of acetabular posterior column plate,the angles of screw-posterior column are 40° to 60°,60° to 75°,75° to 90° and 90° to the angle of parallel to the square area respectively on the region of outer 1/4,outer-middle 1/4,inner-middle 1/4 and inner 1/4 of the acetabulum region,and the screw length is 30 mm.