骶骨骨折后路横置钢板固定的影像解剖学研究

目的研究后路横置钢板固定骶骨骨折的可行性。方法临床采集60例成人正常骨盆CT数据(男30例,女30例),导入Mimics14.1行三维重建,用MedCAD模拟置钉,观测螺钉位置及毗邻,确定S1～4进钉点。测量钉道长度及其与水平面、冠状面及矢状面的夹角。解剖30侧成人尸体标本,观察进钉点毗邻。2具成人骨盆标本模拟置钉,经X线验证试验结果。结果男性内侧钉道长度S1为(32.78±2.10)mm、S2为(28.54±2.67)mm、S3为(18.54±1.86)mm、S4为(12.58±1.18)mm;女性内侧钉道长度S1为(31.18±2.52)mm、S2为(26.00±2.49)mm、S3为(16.79±2.09)mm、S4为(11.19±1.53)mm;男性外侧钉道长度S1为(35.78±1.88)mm、S2为(29.99±2.48)mm、S3为(22.53±2.21)mm、S4为(13.62±1.58)mm;女性外侧钉道长度S1为(33.03±2.23)mm、S2为(29.34±3.87)mm、S3为(21.00±2.12)mm、S4为(12.72±1.83)mm;验证结果满意。结论后路横置钢板可固定骶骨纵形或斜行骨折,从形态学上具有可行性。

The dorsal transverse reconstruction plate fixation for treating sacral fractures: applied anatomy

Objective To study the feasibility of the dorsal transverse reconstruction plate fixation for treating longitudinal or oblique sacral fractures.Methods CT data of pelvis were collected from 60 healthy adults(30 males and 30 females)and then imported into Mimics14.1 for 3D image reconstruction.MedCAD was used to simulate screw placement.Observation was made on the screw position,adjacent vessels and nerves for determining the S1～4 screw entry points.The length of screw trajectory was measured,as well the intersection angle between the screw trajectory and horizontal plane,coronal plane and sagittal plane,respectively.30 cadaveric specimens were dissected to observe the distribution of the vessels and nerves around the screw entry points.Simulated screw placements were performed on 2 adult pelvic specimens,with the results testing by X-ray.Results The length of medial screw trajectory in males was(32.78±2.10)mm for S1,(28.54±2.67)mm for S2,(18.54±1.86)mm for S3,and(12.58±1.18)mm for S4;that in females was(31.18±2.52)mm,(26.00±2.49)mm,(16.79±2.09)mm,and(11.19±1.53)mm respectively.The length of lateral screw trajectory in males was(35.78±1.88)mm for S1,(29.99±2.48)mm for S2,(22.53±2.21)mm for S3 and(13.62±1.58)mm for S4;that in females was(33.03±2.23)mm,(29.3±3.87)mm,(21.00±2.12)mm,and(12.72±1.83)mm respectively.The test results proved satisfactory.Conclusions The dorsal transverse reconstruction plate is capable of fixing longitudinal or oblique sacral fracture with small trauma,satisfactory reduction and marked sturdiness.