Safe zone for transacetabular screw fixation using a Kerboull cross-plate: A CT-scan templating prospective study.
Safe zone for transacetabular screw fixation using a Kerboull cross-plate: A CT-scan templating prospective study.
复制标题
使用 Kerboull 交叉板进行髋臼螺钉固定的安全区：CT 扫描模板前瞻性研究。
DOI：
10.1016/j.otsr.2016.09.017
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Tsuchiya H.
中科院分区：
文献类型：
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作者：
Ohmori T;Kabata T;Kajino Y;Hasegawa K;Inoue D;Tsuchiya H.
背景：植入Kerboull髋臼加固交叉钢板（Kerboull钢板）有损伤血管结构和盆腔器官的风险。据我们所知，目前还没有研究评估与这种特殊设计相关的解剖评估。因此，我们进行了一项前瞻性研究，以回答以下四个问题：1)钢板与髂血管之间的最小距离和角度是多少？2)钢板与髂骨内皮质之间的距离是多少？3)与髂骨内表面的肌肉组织的比例是多少？4) Kerboull钢板经髋臼螺钉固定的安全范围是什么？假设固定螺钉的安全区域将通过狭窄的插入角度范围来确定。材料与方法基于ct的三维模板前瞻性研究。对18例安装Kerboull钢板的患者进行了模拟。原始Kerboull板（Stryker, Mahwah， NJ， USA）相对于x轴呈45°外展角放置（对准a），调色板垂直放置于x轴（对准B）。我们测量了从钢板中心到髂骨皮质内表面的距离，到血管的最短距离和现有血管的角度，以及髂骨内表面肌肉的比例。结果随着螺钉置入角度的增加，与血管结构的最短距离增加，A为85.8±12.1 mm， B为111.4±12.0 mm。螺钉后向置入时，与内皮质的距离进一步增加。当置入角度≥40°时，大多数情况下，螺钉在进入骨盆前先穿过肌肉。然而，当前后角（AP角）≤- 10°时，直接将螺钉插入骶髂关节的风险增加。经髋臼螺钉的安全置入角度≥40°，AP角在0°至- 10°之间（轻微后向）。证据水平：IV级前瞻性诊断研究。
BackgroundImplantation of Kerboull acetabular reinforcement cross-plates (Kerboull plate) carries a risk for injury to vascular structures and pelvic organs. To our knowledge, there is no study assessing anatomical assessment related to this risk with this specific design. Therefore, we performed a prospective study to answer the following four questions: 1) What is the minimum distance and angle between the plate and iliac vessels? 2) What is the distance between the plate and the inner cortex of the ilium? 3) What is the ratio of views with muscle tissue present on the inner surface of the ilium? 4) What are the boundaries of the safe zone for transacetabular screw fixation for a Kerboull plate?HypothesisA safe zone for fixation screws would be defined by a narrow range of insertion angles.Materials and methodsThis is a CT-based 3D templating prospective study. Simulations were performed for 18 patients fitted with a Kerboull plate. An original Kerboull plate (Stryker, Mahwah, NJ, USA) was placed at a 45° abduction angle relative to the X-axis (alignment A) and the palette was placed vertically to the X-axis (alignment B). We measured the distance from the centre of the plate to the inner surface of the cortex of the ilium, the shortest distance to vessels and the angle of existing vessels, and the ratio of muscles on the inner surface of the ilium.ResultsThe shortest distance to the vascular structures increased with increasing angle of insertion of the fixation screws, 85.8 ± 12.1 mm for A and 111.4 ± 12.0 mm for B at 45°. The distance to the inner cortex was further increased for screws inserted in posterior direction. At insertion angles ≥ 40°, the screws passed through muscle before invading the pelvis in most cases. However, at anterior-posterior angle (AP angles) ≤ −10°, the risk of direct insertion of screws into the sacroiliac joint increased.DiscussionThe safe zone for transacetabular screws would be insertion at an angle ≥ 40°, with an AP angle between 0° and −10° (slight posterior direction).Level of evidenceLevel IV prospective diagnostic study.