Department of Orthopaedic Surgery, Washington University School of Medicine, 1 Barnes Hospital Plaza, Suite 11300, St. Louis, MO 63110, USA.
J Bone Joint Surg Am. 2010 Aug 18;92(10):1947-53. doi: 10.2106/JBJS.I.01580.
Musculoskeletal plain radiographic imaging protocols are typically predicated on orthogonal views of the bone or joint being evaluated. Pelvic injury has been evaluated with 45 degrees inlet and 45 degrees outlet radiographs. While these views are perpendicular to each other, they may not be in the best plane to evaluate pelvic injury because of variable lumbopelvic anatomy. We hypothesized that inlet and outlet radiographic views optimized to examine the clinically relevant osseous landmarks vary substantially from routine 45 degrees inlet and outlet views.
Sixty-eight consecutive patients without pelvic ring disruption who had undergone routine axial pelvic computed tomography scans were retrospectively identified. The optimal inlet and outlet angles required to profile the clinically relevant pelvic anatomy were quantified for each patient with use of sagittal computed tomography reconstructions.
The optimal inlet angle to profile the anterior body of S1 required an average caudal tilt of 21 degrees . The average outlet angle (cephalad tilt) perpendicular to the body of S1 was 63 degrees and perpendicular to S2 was 57 degrees . The optimal angles were the same for male and female patients and for patients with normal and dysmorphic pelves and were independent of patient age.
Screening inlet and screening outlet radiographs made at 25 degrees and 60 degrees , respectively, are recommended to provide accurate profiles of the clinically relevant posterior osseous pelvic anatomy.
肌肉骨骼的普通 X 光影像学检查方案通常基于待评估的骨骼或关节的正交视图。骨盆损伤的评估采用 45 度入口和 45 度出口 X 光片。虽然这些视图彼此垂直，但由于腰骶骨盆解剖结构的差异，它们可能不在评估骨盆损伤的最佳平面上。我们假设，为检查临床相关的骨性标志而优化的入口和出口 X 光视图与常规的 45 度入口和出口 X 光视图有很大的不同。
回顾性地确定了 68 例没有骨盆环破裂且接受过常规轴向骨盆 CT 扫描的连续患者。使用矢状 CT 重建，对每位患者进行量化，以确定检查临床相关骨盆解剖结构所需的最佳入口和出口角度。
为了对 S1 的前体进行成像，最佳入口角度需要平均向下倾斜 21 度。与 S1 体部垂直的平均出口角度（头倾）为 63 度，与 S2 垂直的角度为 57 度。最佳角度对男性和女性患者、正常和畸形骨盆患者以及与患者年龄无关的患者均相同。
建议分别使用 25 度和 60 度的筛查入口和筛查出口 X 光片，以提供临床相关的后部骨性骨盆解剖结构的准确图像。
