The School of Medicine, Nankai University, Tianjin, P.R. China.
Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China.
BMC Musculoskelet Disord. 2022 Mar 26;23(1):293. doi: 10.1186/s12891-022-05256-2.
Percutaneous screw placement, especially the insertion of LC2 screws, is technically demanding. Although the traditional LC2 bony canal spans the anterior inferior iliac spine (AIIS) to the posterior superior iliac spines (PSIS), a high perforation rate has been reported.
The aim of this research was to design a revised bony canal, measure the canal width and length and guide the insertion of LC2 screws for pelvic fractures.
The plane tool in the Mimics analysis menu was used to draw a midplane connecting the midpoint between the anterior inferior spine and the PSIS upper flat region with pelvic CT data. The minimum widths of the upper, middle, lower surfaces of the tunnel and perforation rate were measured and compared. The ideal screw length was also measured along the longitudinal axis running through the midpoint of the midplane.
The minimum widths of the upper, middle and lower surfaces of the revised canal were 3.63 mm, 7.7 mm, and 11.93 mm, respectively, in males and 5.97 mm, 9.93 mm, and 12.45 mm, respectively, in females. Significant differences were observed among the upper, middle and lower surfaces of the revised canal in male patients (P < 0.001). In female subjects, the upper canal surface was significantly different from the middle and lower canal surfaces (P < 0.001). The perforation rate was significantly decreased especially in females pelvic. The channel length passing through the midpoint of the narrowest position of the pelvis was 130.85 ± 8.02 mm in males and 124.30 ± 7.71 mm in females and was significantly different for male and female pelvises (P = 0.004).
The LC2 screw should be inserted along the intersection line of the AIIS lateral wall and the iliac body. The screw should be inserted under the line between the midpoint of the AIIS and the PSIS upper flat region to ensure accuracy of placement. LC2 screws can be more easily inserted in males than in females, and the rate of cortical perforation can be significantly decreased under the guidance of the newly proposed canal.
经皮螺钉固定术，尤其是 LC2 螺钉的插入，技术要求较高。虽然传统的 LC2 骨道从前下髂棘（AIIS）延伸到后上髂棘（PSIS），但报道的穿孔率较高。
本研究旨在设计一个修正的骨道，测量骨道的宽度和长度，并指导骨盆骨折 LC2 螺钉的插入。
使用 Mimics 分析菜单中的平面工具，以骨盆 CT 数据连接前下棘中点与 PSIS 上平面区域的中点，绘制一个中平面。测量并比较隧道和穿孔的上、中、下表面的最小宽度和穿孔率。还沿着穿过中平面中点的纵轴测量理想螺钉的长度。
男性修正骨道上、中、下表面的最小宽度分别为 3.63mm、7.7mm 和 11.93mm，女性分别为 5.97mm、9.93mm 和 12.45mm。男性患者修正骨道的上、中、下表面之间存在显著差异（P<0.001）。女性受试者中，上骨道表面与中、下骨道表面有显著差异（P<0.001）。特别是女性骨盆的穿孔率显著降低。穿过骨盆最窄处中点的通道长度在男性为 130.85±8.02mm，在女性为 124.30±7.71mm，男性和女性骨盆之间存在显著差异（P=0.004）。
LC2 螺钉应沿着 AIIS 外侧壁和髂骨体的交点线插入。螺钉应插入到 AIIS 中点和 PSIS 上平面区域中点之间的线下方，以确保放置的准确性。LC2 螺钉在男性中比在女性中更容易插入，在新提出的骨道的引导下，皮质穿孔率可显著降低。
