髂骨翼内板相对于方形区的倾斜角数字化测量及其临床意义

doi:10.3760/cma.j.issn.2095-7041.2020.01.003

摘要
图/表
参考文献(24)
相关文章 (15)

全文: PDF (1360 KB) HTML (2 KB)
输出: BibTeX | EndNote (RIS)

摘要目的研究正常成人完整骨盆CT扫描三维重建数字化测量髂骨翼内板相对于方形区的倾斜角度,为临床提高髂骨与髋臼骨折复位质量提供影像解剖学参数支持。方法回顾性研究。纳入2016年1月—2018年12月解放军中部战区总医院行CT三维重建检查的正常成人完整骨盆数据,其中男60例(120侧)、女40例(80侧),平均年龄42.18岁。将数据以DICOM格式导入Mimics 20.0软件,去除周围软组织、骶骨以及双侧股骨,建立完整双侧独立的三维髋骨模型;将髂骨翼分为前、中、后三区,依据骨盆相关骨性标志标记髂骨翼各分区相对于方形区的倾斜角并利用Mimics软件进行测量。比较同性别左右侧、不同性别间相应倾斜角的差异,以及不同部位倾斜角的差异。结果男性和女性的前、中、后区倾斜角分别为142.40°±5.62°和142.03°±4.82°,130.78°±5.75°和126.37°±6.17°,101.27°±5.40°和100.46°±5.44°。同性别左、右侧前、中、后区倾斜角差异均无统计学意义(P值均＞0.05)。不同性别间前区与后区倾斜角差异均无统计学意义(P值均＞0.05);男性中区倾斜角大于女性,差异有统计学意义(t=5.166, P＜0.05)。髂骨翼内板相对于方形区的前、中、后三区倾斜角逐渐减小,差异均有统计学意义(P值均＜0.05)。结论髂骨翼内板相对于方形区的倾斜角在不同性别、不同部位有一定变化,该解剖学参数可以为术中指导髂骨与髋臼骨折解剖复位提供参考依据,在一定程度上从整体角度提高骨盆髋臼骨折的复位质量,并能评价骨折的旋转移位情况,弥补Matta评价标准的不足。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	宋成璟
	尚冉冉
	吴海洋
	蔡贤华

关键词 ：髂骨, 髂骨翼, 成像,三维, 数字解剖

Abstract：Objective To obtain the angle of inclination of the normal adult iliac ala relative to the square region by three-dimensional(3D) computed tomography(CT) reconstruction and digital measurement of adult intact pelvis, and to provide anatomical parameter support for clinical improvement of ilium and acetabulum fracture reduction quality.Methods Retrospective study. Complete adult pelvic data of CT three-dimensional reconstruction examinations were collected from General Hospital of Central Theater Command from January 2016 to December 2018. There were 60 males (120 sides), 40 females (80 sides), aged for an average 42.18 years old.The data were imported into Mimics 20.0 software in DICOM format, and the surrounding soft tissues, patella, and bilateral femurs were removed to create a complete bilateral independent three-dimensional hip bone model. The iliac wing was divided into three zones. The anterior, middle and posterior tilt angles of the ilium wing were marked according to pelvic-related bone markers and measured by Mimics software. The angle of inclination of the iliac ala relative to the square region were compared between the left and right sides of the same sex and between men and women.Results The angle of inclination of the iliac ala relative to the square region between male and female (mixed left and right) were 142.40°±5.62° and 142.03°±4.82° at the anterior part, while 130.78°±5.75°and 126.37°±6.17° at the middle part, 101.27°±5.40° and 100.46°±5.44° at posterior part. There was no significant difference between the left and right inclination angles of the same sex subjects (all P values＞0.05).The anterior and posterior angles of inclination of the iliac ala relative to the square region that had no statistical differences ( all P values＞0.05), the middle inclination angle was greater in men than in women. which was statistically significant (P＜0.05). The angle of inclination of the iliac ala relative to the square region gradually decreased from front to back(all P values＜0.05).Conclusions The angles of inclination of the iliac ala relative to the square region changes between different genders and different parts. The anatomical parameters can provide reference for the anatomical reduction of the ilium and acetabulum fracture during operation. To a certain extent, the quality of reduction of pelvic acetabular fractures can be improved from an overall perspective, and the rotation displacement of the fracture can be evaluated, compensating the deficiency of Matta's criterion.

Key words： Ilium Ala ossis ilium Imaging, three-dimensional Digital-anatomy

收稿日期: 2019-09-19

基金资助:湖北省技术创新专项重大项目(2017ACA099)

通讯作者: 蔡贤华,Email:wgcaixh@163.com

引用本文:

宋成璟, 尚冉冉, 吴海洋, 蔡贤华. 髂骨翼内板相对于方形区的倾斜角数字化测量及其临床意义[J]. 中华解剖与临床杂志, 2020, 25(1): 14-19.
Song Chengjing, Shang Ranran, Wu Haiyang,Cai Xianhua. Digital measurement and significance of the angle of inclination of the iliac ala relative to the square region. Chinese Journal of Anatomy and Clinics, 2020, 25(1): 14-19.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.issn.2095-7041.2020.01.003 或 http://www.cjac.com.cn/CN/Y2020/V25/I1/14

[1]	Matta JM. Indications for anterior fixation of pelvic fractures[J]. Clin Orthop Relat Res, 1996(329): 88-96. DOI:10.1097/00003086-199608000-00011.
[2]	陈晓丰, 蔡贤华, 陈家, 等. 髋臼方形区倾斜角的数字化测量研究及其意义[J]. 中国矫形外科杂志, 2018, 26(8): 746-750. DOI:10.3977/j.issn.1005-8478.2018.08.16. Chen XF, Cai XH, Chen J, et al. Digital measurement of the inclination of acetabular medial wall and its significance[J]. Orthopedic Journal of China, 2018, 26(8): 746-750. DOI:10.3977/j.issn.1005-8478.2018.08.16.
[3]	王正坤. 动力化前路方形区钛板螺钉系统治疗髋臼方形区骨折安全置钉的数字化测量研究[D]. 广州: 南方医科大学, 2016.Wang ZK. Digital measurement research on safe screw insertion in the treatment of acetabular fractures involving the quadrilateral plate dynamic anterior plate-screw system for quadrilateral area (DAPSQ) [D]. Guangzhou: Southern Medical University, 2016.
[4]	Abrassart S, Stern R, Peter R. Morbidity associated with isolated iliac wing fractures[J]. J Trauma, 2009, 66(1): 200-203. DOI:10.1097/TA.0b013e31814695ba.
[5]	Ragnarsson B, Mjöberg B. Arthrosis after surgically treated acetabular fractures. A retrospective study of 60 cases[J]. Acta Orthop Scand, 1992, 63(5): 511-514. DOI:10.3109/17453679209154725.
[6]	高延军, 梁庆威, 杨军. 髋臼骨折的手术治疗[J]. 中国骨与关节损伤杂志, 2007, 22(5): 395-396. DOI:10.3969/j.issn.1672-9935.2007.05.016.Gao YJ, Liang QW, Yang J. Surgical treatment of acetabular fractures[J]. Chin J Bone Joint Injury, 2007, 22(5): 395-396. DOI: 10.3969/j.issn.1672-9935.2007.05.016.
[7]	陈小雷, 王文俊, 钱炳根, 等. 手术治疗髋臼骨折17例[J]. 解剖与临床, 2006, 11(6): 399-401. DOI:10.3969/j.issn.1671-7163.2006.06.012. Chen XL, Wang WJ, Qian BG, et al. Surgical treatment of 17 cases with acetabular fractures[J]. Anatomy and Clinics, 2006, 11(6): 399-401. DOI:10.3969/j.issn.1671-7163.2006.06.012.
[8]	蔡贤华, 陈庄洪, 徐永年, 等. 有移位髋臼骨折开放复位策略分析[J]. 中国矫形外科杂志, 2007, 15(20): 1543-1545. DOI:10.3969/j.issn.1005-8478.2007.20.008. Cai XH, Chen ZH, Xu YN, et al. Study on the strategy of open reduction for different displaced acetabular fractures[J]. Orthopedic Journal of China, 2007,15(20):1543-1545. DOI: 10.3969/j.issn.1005-8478.2007.20.008.
[9]	陆俭军, 谭海涛, 陆声榆, 等. 3D打印技术辅助手术治疗髋臼双柱骨折的临床疗效分析[J]. 广西医科大学学报, 2017, 34(1): 28-32. DOI:10.16190/j.cnki.45-1211/r.2017.01.007. Lu JJ, Tan HT, Lu SY, et al. The effects of 3D printing technology guided double-column acetabular fracture surgery[J]. Journal of Guangxi Medical University, 2017, 34(1): 28-32. DOI: 10.16190/j.cnki.45-1211/r.2017.01.007.
[10]	李涛, 陈卓夫, 龚辉, 等. 3D打印技术在复杂髋臼骨折术中的初步临床应用[J]. 中国骨与关节损伤杂志, 2016, 31(4): 387-388. DOI:10.7531/j.issn.1672-9935.2016.04.015. Li T, Chen ZF, Gong H, et al. Preliminary clinical application of 3D printing technology in complex acetabular fractures[J]. Chinese Journal of Bone and Joint Injury, 2016, 31(4): 387-388. DOI:10.7531/j.issn.1672-9935.2016.04.015.
[11]	任光金. 国人髋骨指数[J]. 沂水医专学报, 1983(2): 129-130.Ren GJ. Chinese hip index[J]. Journal of Yishui Medical College, 1983(2): 129-130.
[12]	孙文琢. 国人髋骨的测量[J]. 人类学学报, 1988(1): 94.Sun WZ. Measurement of Chinese hip bone[J]. Acta Anthropologica Sinica, 1988(1): 94.
[13]	沈宗起. 国人髋骨的测量及观察[J]. 解剖学通报, 1990(1): 82.Shen ZQ. Measurement and observation of Chinese hip bone[J]. Chinese Journal of Anatomy, 1990(1): 82.
[14]	王先泉, 张伟, 孙水, 等. 骨盆的地形图[J]. 中国临床解剖学杂志, 2006, 24(5): 485-488. DOI:10.3969/j.issn.1001-165X.2006.05.003.Wang XQ, Zhang W, Sun S, et al. Topographic map of the pelvis[J]. Chinese Journal of Clinical Anatomy, 2006, 24(5): 485-488. DOI:10.3969/j.issn.1001-165X.2006.05.003.
[15]	舒莉. 髋臼前柱螺钉内固定的数字化三维重建与测量[D]. 乌鲁木齐: 新疆医科大学, 2010.Shu L. The Measurement of the lag screw internal fixation in the anterior column of the acetabulum by three-dimensional reconstruction of CT[D]. Urumqi: Xinjiang Medical University, 2010.
[16]	赵雪. 髋臼中柱壁的解剖学测量及三维有限元分析[D]. 上海: 第二军医大学, 2014.Zhao X. Anatomic measurement of the wall of acetabular middle column and three-dimensional finite element analysis[D]. Shanghai: The Second Military Medical University, 2014.
[17]	孙永建, 孔圳, 左睿, 等. 髋臼前柱解剖学测量及解剖锁定钢板的设计[J]. 中国矫形外科杂志, 2017, 25(22): 2069-2073. DOI:10.3977/j.issn.1005-8478.2017.22.12. Sun YJ, Kong Z, Zuo R, et al. Anatomical measurements and design of anatomical locking plate for acetabular anterior column[J]. Orthopedic Journal of China, 2017, 25(22): 2069-2073. DOI:10.3977/j.issn.1005-8478.2017.22.12.
[18]	王剑, 云文科, 李格当, 等. 数字化测量正常成人男女性髋臼前柱解剖学参数的临床意义[J]. 中国组织工程研究, 2018, 22(11): 1713-1718. DOI:10.3969/j.issn.2095-4344.0168. Wang J, Yun WK, Li GD, et al. Clinical significance of anatomic parameters of acetabular anterior column of normal male and female adults by digital measurement[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(11): 1713-1718. DOI:10.3969/j.issn.2095-4344.0168.
[19]	徐应朋, 蔡贤华, 陈岩召, 等. 正常成人髂嵴水平面偏转角度的数字化测量及临床意义[J]. 华南国防医学杂志, 2019, 33(4): 243-246. DOI:10.13730/j.issn.1009-2595.2019.04.005. Xu YP, Cai XH, Chen YZ, et al. Digital measurement and clinical significance of normal adult iliac crest plane deflection angle of normal adult[J]. Military Medical Journal of South China, 2019, 33(4): 243-246. DOI:10.13730/j.issn.1009-2595.2019.04.005.
[20]	Wilson LA, Ives R, Humphrey LT. Quantification of 3D curvature in the iliac crest: ontogeny and implications for sex determination in juveniles[J]. Am J Phys Anthropol, 2017, 162(2): 255-266. DOI:10.1002/ajpa.23114.
[21]	Demir M, Atay E, Güneri B, et al. Morphometric measurements of the hip bone in turkish adult population[J]. Kobe J Med Sci, 2018, 64(4): E149-E156.
[22]	刘曦明, 曾文波. 3D打印技术在骨盆髋臼骨折手术治疗中的研究进展[J]. 创伤外科杂志, 2018, 20(1): 1-5. DOI:10.3969/j.issn.1009-4237.2018.01.001. Liu XM, Zeng WB. Research progression of 3D printing technique in surgical treatment of pelvic and acetabular fractures[J]. Journal of Traumatic Surgery, 2018, 20(1): 1-5. DOI:10.3969/j.issn.1009-4237.2018.01.001.
[23]	吴超,邓佳燕,谭伦,等.3D打印技术辅助不稳定性骨盆骨折手术疗效分析[J].中国修复重建外科杂志, 2019, 33(4): 455-461.Wu C, Deng JY,Tan L, et al. Effectiveness analysis of three-dimensional printing assisted surgery for unstable pelvic fracture[J]. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(4): 455-461.
[24]	Hung CC, Li YT, Chou YC, et al. Conventional plate fixation method versus pre-operative virtual simulation and three-dimensional printing-assisted contoured plate fixation method in the treatment of anterior pelvic ring fracture[J]. Int Orthop, 2019, 43(2): 425-431. DOI:10.1007/s00264-018-3963-2.