髋臼前柱骨折钢板中内固定的最佳进针点*☆

背景：近年来切开复位内固定成为骨盆骨折和髋臼骨折的一种重要治疗手段，但是在内固定过程中有时会发生螺钉穿入关节内、损伤盆腔内重要血管或神经等严重并发症。目的：测量髋臼前柱钢板内固定技术中螺钉的最佳进钉点、方向和长度。材料：取成年男性半骨盆标本20个，由山东大学医学院解剖学教研室提供。方法：分别测量20个半骨盆标本髋臼前、后缘到髂前下棘、髂耻隆起和耻骨结节的距离，确定和制作髋臼前柱系列断面，并测量各断面上各进钉点的安全进钉角度，将测量数据输入到SPSS 10.0软件进行统计学分析。主要观察指标：髋臼前柱钢板内固定技术中螺钉的最佳进钉点、方向和长度。结果：髋臼前缘到髂前下棘、髂耻隆起和耻骨结节的距离分别为(25.4±1.4)，(11.8±0.7)，(37.4±1.5) mm，后缘到髂前下棘和髂耻隆起的距离分别为(15.5±0.9)，(29.1±1.6) mm。在各断面距离骨盆界线0.5 cm点、1.0 cm点和1.5 cm点上螺钉的安全进钉角度的最大值分别为(8.2±2.2)°，(14.9±3.4)°和(26.1±4.5)°。结论：在前柱髋臼区使用钢板内固定时，可以采用3种方法避免螺钉穿入关节内。第1种方法是使用短螺钉，螺钉方向随意；第2种方法是使用长螺钉(长度5 cm)内紧贴骨盆界线进钉，方向平行于四方区；第3种方法为根据不同的进钉点选择不同的进钉角度和长度。

Best entry point during internal fixation of acetabular anterior column fracture

BACKGROUND: Recently, open reduction and internal fixation has become a common therapy for pelvic and acetabular fractures. However, screw penetration sometimes damages important vessels or nerves in the pelvic cavity during the internal fixation.OBJECTIVE: To explore the best entry points, direction and length of screw in acetabular anterior column plate technique.MATERIALS: Twenty male cadaveric adult semipelvic specimens were provided by the Anatomy Teaching and Research Section of Medical School of Shandong University. METHODS: The distances from anterior acetabular margin, posterior acetabular margin to anterior inferior iliac spine, iliopubic eminence and pubic tubercle were measured, respectively to determine and make serial cross-sections of the acetabular anterior column. In addition, the safe angle of screw entry on all entry points of each cross-section was measured, and all data were put into software SPSS 10.0 for statistics process. MAIN OUTCOME MEASURES: the best entry points, direction and length of screw in acetabular anterior column plate technique.RESULTS: The distance from anterior acetabular margin to anterior inferior iliac spine, iliopubic eminence and pubic tubercle was (25.4±1.4) mm, (11.8±0.7) mm and (37.4±1.5) mm, respectively; the distance from posterior acetabular margin to anterior inferior iliac spine and iliopubic eminence was (15.5±0.9) mm and (29.1±1.6) mm, respectively. On each cross-section, the maximum of the safe entry angle of inclination in 0.5 cm, 1 cm and 1.5 cm entry point lateral to the linea terminalis of pelvis was (8.2±2.2)°, (14.9±3.4)° and (26.1±4.5)°, respectively. CONCLUSION: In internal fixation using plate on acetabular region of anterior column, there are three ways to avoid screw penetrating the joint surface. The first way is to use short screw, and the direction of the screw is not limited; the second way is to use long screw (5 cm) close to the linea terminalis of pelvis, and the direction of the screw is parallel to the quadrilateral plate; the last way is to use different entry angle and length according to different entry points.