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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 226 -230. doi: 10.3877/cma.j.issn.1674-0785.2022.03.006

临床研究

自髂骨前方植入骶髂螺钉固定的仿真研究
罗俊浩1, 王健1,(), 殷渠东1, 李栋2, 吴永伟1, 马运宏1   
  1. 1. 214062 无锡,苏州大学附属无锡市第九人民医院骨科
    2. 213000 溧阳,南通大学附属溧阳市人民医院放射科
  • 收稿日期:2021-06-21 出版日期:2022-03-15
  • 通信作者: 王健
  • 基金资助:
    2020年度无锡市“太湖人才计划”顶尖医学专家团队项目(Wuxi-THTP-10); 无锡市第九人民医院院士工作站课题(WXJYYSGZZ-202002)

Simulation study of sacroiliac screw fixation by implanting screw from the front of the ilium

Junhao Luo1, Jian Wang1,(), Qudong Yin1, Dong Li2, Yongwei Wu1, Yunhong Ma1   

  1. 1. Orthopaedics Department, Wuxi No. 9 People's Hospital Affiliated to Suzhou University, Wuxi 214062, China
    2. Radiology Department, Liyang People's Hospital Affiliated to Nantong University, Liyang 213000, China
  • Received:2021-06-21 Published:2022-03-15
  • Corresponding author: Jian Wang
引用本文:

罗俊浩, 王健, 殷渠东, 李栋, 吴永伟, 马运宏. 自髂骨前方植入骶髂螺钉固定的仿真研究[J]. 中华临床医师杂志(电子版), 2022, 16(03): 226-230.

Junhao Luo, Jian Wang, Qudong Yin, Dong Li, Yongwei Wu, Yunhong Ma. Simulation study of sacroiliac screw fixation by implanting screw from the front of the ilium[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(03): 226-230.

目的

探讨自髂骨前方植入骶髂螺钉(SIS-FI)固定的解剖可行性和仿真植入效果。

方法

回顾性分析2019年1月至2020年5月无锡市第九人民医院影像科数据库中80例(男、女各40例)成年正常骨盆CT扫描数据资料。利用CT数字重建技术模拟SIS-FI固定,测量螺钉通道解剖参数。以髋臼后上缘2点或10点钟位置向后6 mm处为进针点,以S1上关节突基底与横突水平中位线交点为出针点,利用瞄准器控制下在40具3D打印(1∶1)骨盆模型两侧分别植入直径6.5、7.3 mm和长度均为90 mm螺钉,观察螺钉植入情况。

结果

进针点为距离髋臼后缘水平向后(5.78±1.35)mm、距离髋臼上缘垂直向下(2.48±0.50)mm处;进针方向:向上与S1上终板平行线成角(42.99±5.16)°、向内与躯干纵轴线成角(43.79±2.83)°。通道长度为(102.55±6.15)mm,最小横径为(16.55±1.77)mm,最小纵径为(18.78±1.44)mm。植入螺钉均未穿破钉道,但1例螺钉过长、穿出钉道后部少许。

结论

国人骨盆可植入至少一枚直径6.5~7.3 mm、长度85~95 mm的SIS-FI。利用瞄准器植入SIS-FI的精确度高,但是其临床价值还需进一步研究。

Objective

To investigate the anatomic feasibility and simulation effect of sacroiliac screw implanted from the front of the ilium (SIS-FI).

Methods

Pelvis CT data for 80 healthy adults (40 males and 40 females) collected from Imaging Department database of Wuxi No. 9 People's Hospital from January 2019 to May 2020 were analyzed retrospectively. Anatomic parameters of screw channel were measured by CT digital reconstruction technique to simulate SIS-FI fixation. Under the control of an aiming device, taking 6 mm backward from 2 o'clock or 10 o'clock of the posterior edge of the acetabulum as the entry point, and the base of the superior facet of S1 as the exit point, SIS-FIs with a diameter of 6.5 mm and 7.3 mm respectively, and a length of 90 mm were implanted on the two sides of the 40 3D printed models of the pelvis (1∶1). The implantation of screw was observed.

Results

The entry point was located at the position of (5.78±1.35) mm horizontally backward from the posterior edge of the acetabulum and (2.48±0.50) mm vertically downward from the upper edge of the acetabulum. The upward angle between the central axis of the channel and the line parallel to the superior endplate of S1 was (42.99±5.16)°, and the inward angle between the central axial of the channel and the longitudinal axis of the human trunk was (43.79±2.83)°. The length of the screw channel was (102.55±7.64) mm, the minimum width was (16.55±1.77) mm, and the minimum height was (18.78±1.44) mm. All the implanted screws were located within the channel, but screws in one case were longer and penetrated a little behind the posterior part of the channel.

Conclusions

At least one screw with a diameter of 6.5-7.3 mm and a length of 85-95 mm for SIS-FI can be implanted into the pelvis of Chinese. SIS-FI implanted with the aid of an aiming device has high accuracy. However, its clinical value needs further study.

图1 两种骶髂螺钉通道植入螺钉示意图
图2 螺钉中心轴的定义。其中,A为出针点位置,B点为弓状线与该通道的交点,C为螺钉最佳通过处,D为进针点位置
图3 自髂骨前方植入骶髂螺钉通道解剖参数测量方法。图3a中M1为进针点与髋臼后缘的距离,L为钉道长度,E为内倾角,F为上倾角,W为横径,H为纵径;图3b中M2为进针点与髋臼上缘的距离
图4 利用瞄准器仿真植入螺钉
图5 自髂骨前方植入骶髂螺钉的CT扫描影像。CT扫描显示,植入螺钉均位于钉道内
表1 80例自髂骨前方植入骶髂螺钉通道解剖参数值(
xˉ
±s
1
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