摘要目的 探讨不同节段骶骨置入骶髂关节横行螺钉的可能性.方法 回顾性收集2016年9月至2017年10月在河北医科大学第三医院接受骨盆CT扫描的80例患者的CT原始数据(层厚≤1.0 mm).采用Mimics软件重建骨盆三维模型.根据S1节段是否可横行置入骶髂螺钉,将入组资料分为骶骨正常组(n=55)和骶骨变异组(n=25).在3-Matic软件中模拟S1、S2横行骶髂螺钉置入过程.分析骶骨正常组和骶骨变异组骶骨可置入S2横行骶髂螺钉的最大直径及长度有无区别.测量骶骨变异组骨盆CT资料,得出沿S1椎弓根置入骶髂螺钉时螺钉的最佳倾斜角度及长度.评估S3节段置入横行骶髂螺钉的可行性.计量资料的比较采用t检验或秩和检验进行分析;计数资料的比较采用χ2检验进行分析.结果 骶骨变异组S1最大横行骨通道直径为(4.9±1.6)mm,骶骨正常组为(13.6±3.6)mm,两组差异有统计学意义(t=-15.07,P=0.00);骶骨变异组S2最大横行骨通道直径为(13.8±3.0)mm,骶骨正常组为(12.4±2.2)mm,两组差异有统计学意义(t=2.11,P=0.04).骶骨变异组和骶骨正常组S2可通过横行骶髂螺钉的长度分别为(137.1±8.8)mm和(136.2±7.9)mm,差异无统计学意义(t=0.47,P=0.64).骶骨变异组S1椎体前缘高度为(23.1±4.0)mm,高于骶骨正常组的(14.1±4.2)mm(t=9.01,P=0.00).骶骨变异组的S1S2夹角为10.9°(3.8°,17.6°),大于骶骨正常组的2.0°(1.0°,2.0°)(Z=-4.03,P=0.00).骶骨变异组S1斜型骶髂螺钉的头倾角度为(35.6± 6.2)°,前倾角度为(37.2±4.4)°,可置入的螺钉长度为(90.2±4.7)mm.骶骨变异组的S3横行骶髂螺钉置入率为48.0%,骶骨正常组的S3横行螺钉的置入率为9.1%.结论 S1前缘高和S1S2夹角较大的患者通常存在骶骨变异,骶骨变异的骨盆后环损伤患者可考虑置入S1椎弓根斜行骶髂螺钉.S3横行骶髂螺钉应谨慎置入,尤其是对于骶骨无变异的患者.

abstractsObjective To evaluate the possibility of transverse sacroiliac screw placement in different segments of the sacrum. Methods Data of 80 pelvic CT scans(slice thickness ≤1.0 mm) archived in CT department of the Third Hospital of Hebei Medical University from September 2016 to October 2017 were retrospectively collected. Mimics software was used to rebuild the pelvis three-dimensional model. According to whether the sacral 1(S1)segment could place the transverse sacroiliac screws or not,all the sacrums were divided into normal group(n=55)and dysmorphic group(n=25). Simulation the S1,sacral 2(S2)transverse sacroiliac screw placement in 3-Matic software. Analysis whether there was any difference in maximum diameter and length of S2transverse sacroiliac screw between the normal group and the dysmorphic group. The pelvic CT data of the dysmorphic group were measured,and the optimal tilt angle and length of the oblique S1screw were obtained. The feasibility of transverse sacroiliac screw insertion in sacral 3(S3)segment was evaluated.t-test,rank sum test,and χ2 test was used to analyze data,respectively.Results In the dysmorphic group,the largest diameter of the S1transverse screw was(4.9±1.6)mm,and the normal group was(13.6 ± 3.6)mm(t=-15.07,P=0.00). In the dysmorphic group,the largest diameter of S2transverse screw was(13.8 ± 3.0)mm,and was(12.4 ± 2.2)mm in the normal group(t=2.11,P=0.04). There was no significant difference in the length of S2transverse sacroiliac screw between the two groups(t=0.47,P=0.64). In the dysmorphic group,the anterior vertebral height of S1was(23.1± 4.0)mm,which was significantly higher than that of the normal group((14.1 ± 4.2)mm)(t=9.01,P=0.00). The angle of S1S2in the dysmorphic group was 10.9°(3.8°,17.6°),which was significantly larger than that of the normal group(2.0°(1.0°,2.0°)(Z=-4.03,P=0.00). In the dysmorphic group,the incline angle of the oblique S1sacroiliac screw was(35.6±6.2)°,the anteversion angle was(37.2±4.4)°, and the mean screw length was(90.2 ± 4.7)mm. In the dysmorphic group,the placement rate of S3 transverse sacroiliac screw was 48.0%,and that of the normal sacral group was 9.1%. Conclusions There is often dysmorphic in the sacrum in patients with large S1anterior vertebral height and S1S2angle. Sacral dysmorphic patients with posterior pelvic ring injury may be treated with S1pedicle oblique sacroiliac screws. S3transverse sacroiliac screws should be carefully placed,especially for the absence of sacral dysmorphic in patients.