Michelitsch Christian, Nguyen-Kim Thi Dan Linh, Jentzsch Thorsten, Simmen Hans-Peter, Werner Clément M L
Department of Surgery, Division of Trauma Surgery, University Hospital, Zurich, Switzerland.
Department of Diagnostic and Interventional Radiology, University Hospital, Zurich, Switzerland.
Arch Orthop Trauma Surg. 2016 Dec;136(12):1673-1681. doi: 10.1007/s00402-016-2568-8. Epub 2016 Sep 14.
Typical stabilisation of pelvic open book injuries consists of plate fixation of the symphysis. No previous literature has been published about the evaluation of screw placement and their trajectory with four oblique 4.5 mm screws using a four-hole plate in symphysis diastasis. The aim of this study was to define insertion points and angles of trajectory for crossed screw placement regardless of any plate design based on an analysis of three-dimensional computed tomography data sets.
One hundred human pelvic CT data sets were collected. Unilateral and bilateral placements of crossed 4.5 mm screws were simulated. Primary outcome measure was successful simulated screw placement without cortical breach. Secondary outcome measures included the anatomical measurements of the screw positions.
Simulated screw placement of two oblique screws on each side of the pubic symphysis without cortical breach was achieved in all (100 %) cases. There were a total of 400 screw simulations. Medial screws were longer, lateral screws had higher coronal angles, and the distance between both screws was higher on the right side (p < 0.001 each). The lengths of the right lateral, right medial, left lateral, and left medial screws were 44.9, 65.8, 45.4, and 67.4 mm, respectively. The sagittal angles to the dorsal surface area of the pubic rami were 10.5°, 11.1°, 9.0°, and 11.0°. The coronal angles to the vertical axis of the symphysis measured 39.5°, 16.0°, 33.8°, and 16.8°. The distances between these screws and the medial edge of the pubic crest were 33.5, 8.6, 29.5, and 7.3 mm. Furthermore, certain sex- and side-related differences were noted.
This series provides results about the feasibility and a detailed anatomical description of crossed screw placement. This is of special interest in pelvic surgery for choosing the entry points, safe screw channel parameters, and trajectories.
骨盆开书样损伤的典型固定方法是耻骨联合钢板固定。此前尚无关于使用四孔钢板置入4枚4.5毫米斜向螺钉时螺钉置入位置及其轨迹评估的相关文献发表。本研究的目的是通过分析三维计算机断层扫描数据集，确定交叉螺钉置入的进针点和轨迹角度，而不考虑任何钢板设计。
收集100例人体骨盆CT数据集。模拟单侧和双侧交叉4.5毫米螺钉置入。主要观察指标是模拟螺钉成功置入且无皮质骨穿破。次要观察指标包括螺钉位置的解剖学测量。
所有（100%）病例均成功模拟在耻骨联合两侧各置入2枚斜向螺钉且无皮质骨穿破。共进行了400次螺钉模拟。内侧螺钉更长，外侧螺钉的冠状角更大，右侧两枚螺钉之间的距离更大（每项p<0.001）。右侧外侧、右侧内侧、左侧外侧和左侧内侧螺钉的长度分别为44.9、65.8、45.4和67.4毫米。与耻骨支背侧表面区域的矢状角分别为10.5°、11.1°、9.0°和11.0°。与耻骨联合垂直轴的冠状角分别为39.5°、16.0°、33.8°和16.8°。这些螺钉与耻骨嵴内侧边缘的距离分别为33.5、8.6、29.5和7.3毫米。此外，还发现了一些性别和侧别相关的差异。
本系列研究提供了交叉螺钉置入的可行性结果及详细的解剖学描述。这对于骨盆手术中选择进针点、安全的螺钉置入位置和轨迹具有特殊意义。
