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目的通过对骶髂关节三维重建模型进行解剖参数测量和虚拟骶髂螺钉固定,明确骶髂螺钉的最佳进钉点和安全置钉范围。方法用Mimics软件对50例骨盆CT数据进行三维重建,切割出骨盆三维模型,测量S1椎体解剖参数,在同一骶髂关节多次虚拟置钉,确定螺钉最佳进钉点,计算其安全角度。三维重建骨盆表面软组织,确定髂前上棘顶点N、髂嵴上点M、进钉点P的体表投影点N1、M1、P1,分段测量各投影点之间的长度。结果骶骨Ⅱ区中心螺钉骨面进钉点P到髂前上棘顶点N的距离PN男性为(95.17±5.59)mm,女性为(98.49±7.71)mm;经点P作PN的垂线与髂嵴交于点M,PM长度男性为(58.71±4.33)mm,女性为(54.59±6.01)mm;从髂前上棘顶点N沿髂嵴到点M的长度男性为(129.78±6.25)mm,女性为(130.64±7.79)mm,其中男女间PM长度有显著差异。中心螺钉前、后倾安全范围男性为(10.70±2.00)°,女性为(7.20±1.64)°;头、尾倾安全范围男性为(12.36±2.68)°,女性为(11.27±3.29)°,男性前、后倾安全范围明显大于女性。男女间体表投影点之间的长度仅P1M1有显著差异。结论通过触摸髂前上棘顶点N和髂嵴上的点M,可确定骶骨Ⅱ区骨折固定螺钉的体表进钉点。以S1椎体上表面为横截面,后表面为冠状面,男性螺钉前后倾安全范围约10°,头尾倾安全范围约12°,女性前后倾安全范围约7°,头尾倾安全范围约11°。
OBJECTIVE To determine the best entry point of the sacroiliac screw and the range of safety nail placement by measuring the anatomical parameters of the sacroiliac joint three-dimensional reconstruction model and virtual sacroiliac screw fixation. Methods Fifty pelvic CT data were reconstructed by Mimics software. Three-dimensional model of the pelvis was cut out and anatomical parameters of S1 vertebral body were measured. Multiple virtual nail placement was performed on the same sacroiliac joint to determine the best screw entry point and calculate the safety angle . Three-dimensional reconstruction of soft tissue surface of the pelvis to determine the apex of the anterior superior iliac N, iliac crest M, into the nail point P of the body surface projection points N1, M1, P1, sub-measure the length of each projection point. Results The distance from the screw point P to the vertex N of anterior superior iliac spine in the central sacrum Ⅱ was (95.17 ± 5.59) mm for female and (98.49 ± 7.71) mm for female; The length of PM was (58.71 ± 4.33) mm in females and (54.59 ± 6.01) mm in males. The length of males from the apex of anterior superior iliac spine to the point M was (129.78 ± 6.25) mm, Female (130.64 ± 7.79) mm, male and female between the length of PM significant difference. (10.70 ± 2.00) ° in female and (7.20 ± 1.64) ° in female, and (12.36 ± 2.68) ° in female and (11.27 ± 3.29) ° in female. Men before and after dumping security range significantly larger than women. There was a significant difference in P1M1 length between male and female body surface projection points. Conclusion By touching the apical vertebral anterior superior iliac spine N and the point I on the iliac crest, the sacral fracture fixation screw fixation point can be determined. S1 vertebral body surface as a cross-section, the posterior surface of the coronal plane, men and women before and after the screw safety range of about 10 °, head and tail tilt safety range of about 12 °, women fore and aft safety range of about 7 °, head and tail tilt safety range of about 11 °.