中文摘要：

目的探讨经骶髂关节横向S1椎体螺钉固定安全钉道的确定及其在骶骨纵形骨折治疗中的应用.方法对50 名健康成年志愿者进行腹部连续螺旋CT扫描、三维表面重建、标准骶骨矢状位多层剖分等,以确定最优钉道.将数字化分析结果应用于2012 年8 月至2013 年8 月内蒙古医科大学附属医院收治的18 例骶骨纵形骨折患者,术中经骶骨矢状位图像投影确定横向置钉钉道后,采取经骶髂关节横向S1椎体螺钉固定治疗.结果矢状位X线片检查显示S1椎体安全区投影呈卵圆形,投影的长短轴连线交点为S1椎体最优横向钉道,钉道平均长度（135 ± 8）mm,虚拟置入直径7.3 mm的拉力螺钉后骶髂关节螺钉位置及长度满意.术后X线片及CT平扫断层图像显示患者骶髂关节螺钉位置及长度均满意,平均长度（115 ± 4）mm,平均手术时间（30 ± 5）min.术后随访12～24 个月,平均随访时间（16 ± 3）个月,未见神经血管损伤、骶髂关节螺钉松动及断裂等并发症.结论通过术中骶骨矢状位图像投影确定横向置钉钉道,可提高经皮横向骶髂关节螺钉固定治疗骶骨纵形骨折的手术安全性,同时简化手术过程.

英文摘要：

Objective To investigate the determination of safe pathway of screw insertion for S1 transverse sacroiliac screw fixation, and to explore their application values in the treatment of longitudinal fracture of the sacrum. Methods Fifty healthy adult volunteers received abdominal continuous spiral CT scanning, 3D surface reconstruction, standard sacral sagittal multi-layer triangulation, and then an optimal screw channel was generated. The digital analysis results were subsequently applied in 18 patients with sacral longitudinal fracture, who were treated by S1 transverse sacroiliac screw fixation from August 2012 to August 2013 in the Affiliated Hospital of Inner Mongolia Medical University, which the screw insertion pathway was determined by intraoperative CT sagittal image projection on sacrum. Results Sagittal projection of X-ray on S1 vertebral body displayed the safety area was oval, and the intersection of long and short axial lines of projection for S1 vertebrae was the optimal screw channel. The average length of the channel was (135 ± 8) mm. Lag screw (7.3 mm diameter) insertion was simulated, and the position and length of the sacroiliac screw showed well. Postoperative X-ray and CT scan images also confirmed that the screw insertion position and length were well satisfied, with the average length of screw was (115 ± 4) mm, the average operation time was (30 ± 5) min. All patients were followed up for 12 to 24 months, with the average of (16 ± 3) months. No nerve or vascular injury, sacroiliac screw loosening or breakage had occurred. Conclusion For sacral longitudinal fracture, determination of safe pathway of screw insertion for S1 percutaneous transverse iliosacral screw fixation by intraoperative CT sagittal image projection on sacrum may provide surgical safety and simplified operation process.