摘要
目的应用三维重建技术比较不同性别髋臼后柱内髂坐钢板置钉的安全区和安全角度。方法收集52例成年人（男27例，女25例；年龄为18～74岁，平均47．2岁）正常骨盆的CT扫描数据，重建出骨盆3D模型。对髋臼进行增厚5mm处理，测量放置内髂坐钢板安全区的宽度（d）和闭孔管顶点到坐骨大切迹的垂直距离（W），计算d／w的比值（r）。过髋臼中心、垂直于方形区和坐骨大切迹对装配后的髋骨进行截骨得到截面。男性在大切迹前方1．0、1．5、2．0和2．5cnq处取4点，于截面上分别测量方形区与增厚的髋臼外缘切线所成的角度∠a、∠b和∠c和∠d；女性在大切迹前方1．0、1．5和2．0em处取3点，测量∠a、∠b和∠c比较男、女性之间上述参数的差异。结果男性和女性放置内髂坐钢板安全区的d平均分别为（28．56±2．44）、（24．36±2．47）mm，r平均分别为0．61±0．07、0．54±0．05。男性置钉的安全角度∠a、∠b和∠c和∠d平均分别为88．04°±3．18°、77．81°±3．85°、68．01°±4．11°和56．81°±4．81°；女性∠a、∠b和∠c平均分别为91．29°±4．52°、76．23°±3．82°和62．79°±3．51°男、女性之间d,r∠a和∠c和∠c比较差异均有统计学意义（P〈0．05）。结论以内髂坐钢板固定髋臼后柱骨折时，应考虑性别的差异，根据钢板的位置选择特定的安全角度。
Objective To compare the safe zone and safe angles between males and females for screw placement on the medial iliosciatic plate for acetabular posterior column using 3D reconstruction tech- nique. Methods Normal pelvic CT scans of 52 adults （27 males and 25 females; aged from 18 to 74 years, averaging 47.2 years） were obtained to create pelvic 3D models. After the acetabulum was thickened by 5 ram, the width （d） of the safe zone for placement of the medial iliosciatic plate was measured. After the vertical distance （w） between the vertex of the obturator canal and the greater sciatic notch was measured, the ratio （r） of d/w was calculated. The recombined innominatum model was cut through the center of the ac- etabulum with a plane perpendicular to the quadrilateral plate and the greater sciatic notch. The cross-section was marked as M. In males, 4 points at distances of 1.0 cm, 1.5 cm, 2.0 cm and 2.5 cm anterior to the greater sciatic notch were marked. At the 4 points, the angulations （ ∠ a, ∠ b, ∠ e and ∠d） between the quadrilateral plate and the tangent line of the outer edge of the thickened acetabulum model were measured on the cross-section M. In females, 3 points at distances of 1.0 cm, 1.5 em and 2.0 cm anterior to the greater sciatic notch were marked before ∠ a,∠ b, and ∠ c were measured. The differences in the above parameters were compared between males and females. Results The width （d） of the safe zone for placement of the medial iliosciatic plate was 28.56 ± 2. 44 mm in males and 24.36 ± 2.47 mm in females; the ratio （r） was 0.61 ±0. 07 in males and 0.54 ±0.05 in females. The safe angulations for screw placement in males, La, Lb, Lc and Ld, were 88.04°±3.18°, 77.81°±3.85°, 68.01°±4.11°and56.81°±4.81°whilethose in females, L a, L b and L e, were 91.29° ± 4.52°, 76.23° ± 3.82° and 62. 79° ± 3.51°, respectively.There were statistically significant differences between males and females in values of d, r, ∠ a and ∠ c （ P 〈 0.05 ） . Conclusions In fixation of acetabular posterior column fractures using medial iliosciatic plate, the differences between males and females should be taken into account. Besides, specific sate angles shouhl be chosen according to the position of the plate.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2017年第5期371-376,共6页
Chinese Journal of Orthopaedic Trauma
基金
基金项目：国家自然科学基金（81272008）
广州市科技计划项目（2013J4100104）
南方医科大学科技开发培育计划（KJ20161107）
关键词
髋臼
骨板
骨钉
成像
三维
Acetabulum
Bone plates
Bone nails
hnaging, three-dimensional
