体表骨盆标志与骶2骶髂螺钉钉道关系的研究

Study on the relationship between pelvic landmarks on the body surface and S2AI screw path

中文关键词:  S2AI螺钉  骨盆体表标志  髂前上棘  大转子

英文关键词:S2AI screw  Pelvic body surface landmarks  Anterior superior iliac spine  Greater trochanter

中文摘要:

  【摘要】　目的：观察不同性别、体质指数人群体表骨盆标志与骶2骶髂螺钉（S2 alar-iliac screws，S2AI）置钉轨迹的关系。方法：回顾性分析2022年2月~2024年2月在西南医科大学附属医院行骨盆CT扫描的150例患者，收集患者年龄、性别、体重、身高等基本人口学资料；CT重建骨盆模型，在模型上模拟钉道，延长钉道与皮肤相交，所有安全的钉道与体表交点构成安全区域，测量体表髂前上棘（anterior superior iliac spine，ASIS）、髂前下棘（anterior inferior iliac spine，AIIS）、大转子（greater trochanter，GT）到体表安全区域的最短距离；在体表分别测量ASIS与GT的连线长度、连线与安全区域相交的长度、连线上ASIS到安全区域距离、连线上GT到安全区域距离。根据不同性别、BMI[低体重（BMI＜18.50kg/m2），正常（18.50kg/m2≤BMI＜24.00kg/m2），超重（24.00kg/m2≤BMI＜28.00kg/m2），肥胖（BMI≥28.00kg/m2）]进行分组比较比较。结果：男性组ASIS、AIIS、GT到安全区域的最短距离分别为19.87±3.66mm、33.66±3.33mm、39.53±3.56mm；女性组分别为19.31±3.41mm、33.23±3.45mm、38.74±3.23mm；两组间无统计学意义（P＞0.05）。在不同BMI分组中，低体重组ASIS、AIIS、GT到安全区域的最短距离分别为14.03±1.64mm、26.79±1.15mm、43.68±1.32mm；正常组为17.67±2.36mm、31.73±1.77mm、41.18±2.43mm；超重组为21.85±1.37mm、35.78±1.76mm、36.80±1.68mm；肥胖组为25.66±0.84mm、38.75±0.88mm、36.80±1.68mm。四组间比较有统计学差异（P＜0.05），组间进行两两比较均有统计学差异（P＜0.05）。ASIS与GT的连线长度、连线与安全区域相交的长度、连线上ASIS到安全区域长度、连线上GT到安全区域长度男性组分别为129.43±6.42mm、30.72±5.27mm、33.61±8.82mm、69.14±11.46mm，女性组分别为109.83±8.99mm、32.32±4.94mm、35.77±11.26mm、43.75±7.62mm，两组间有统计学差异（P＜0.05）；在不同BMI分组中，低体重组测量结果为119.40±12.21mm、30.72±3.83mm、25.42±7.75mm、65.64±14.79mm，正常组测量结果为122.98±10.91mm、30.29±4.29mm、35.01±10.22mm、60.58±13.43mm，超重组测量结果为117.52±13.70mm、32.12±6.27mm、36.92±8.27mm、51.42±18.38mm，肥胖组测量结果为120.52±13.95mm、35.65±3.29mm、29.58±11.67mm、60.93±15.13mm。ASIS与GT连线长度在不同组之间比较无统计学差异（P＞0.05），连线与安全区域相交的长度、连线上ASIS到安全区域距离、连线上GT到安全区域距离在不同组间比较有统计学意义（P＜0.05）。结论：所有S2AI螺钉安全的钉道与体表交点构成安全区域且髂前上棘、大转子连线经过该安全区域，该连线可作为辅助置入S2AI螺钉的标志。

英文摘要:

  【Abstract】 Objectives: To investigate the relationship between pelvic landmarks on body surface and the trajectory of S2 alar-iliac(S2AI) screws in populations of different genders and body mass indexes. Methods: A retrospective analysis was conducted on 150 patients who underwent pelvic CT scans in the Affiliated Hospital of Southwest Medical University between February 2022 and February 2024. Basic demographic data including age, gender, weight, and height were collected. Pelvic models were reconstructed by CT, and screw trajectories were simulated on the models. The screw trajectories were extended to intersect with the skin surface, and the intersection points of the safe trajectories with skin formed a safety zone on the body surface. The shortest distances from the anterior superior iliac spine(ASIS), anterior inferior iliac spine(AIIS), and greater trochanter(GT) to the safe zone were measured. The length of the line connecting ASIS and GT on the surface, length of such line intersecting with the safety zone, length from ASIS to the safety zone along such line, length from GT to the safety zone along such line were measured. Group comparisons were performed based on gender and BMI[underweight group(BMI<18.50kg/m2), normal group(18.50kg/m2≤BMI<24.00kg/m2), overweight group(24.00kg/m2≤BMI<28.00kg/m2), obese group(BMI≥28.00kg/m2)]. Results: In males, the shortest distances from ASIS, AIIS, and GT to the safe zone were 19.87±3.66mm, 33.66±3.33mm, and 39.53±3.56mm, respectively; In females, they were 19.31±3.41mm, 33.23±3.45mm, and 38.74±3.23mm, respectively. No statistically significant differences were observed between gender groups(P＞0.05). The shortest distance from ASIS, AIIS, GT to safety zone was 14.03±1.64mm, 26.79±1.15mm, 43.68±1.32mm in the underweight group,17.67±2.36mm, 31.73±1.77mm, 41.18±2.43mm in the normal group, 21.85±1.37mm, 35.78±1.76mm, 36.80±1.68mm in the overweight group, and 25.66±0.84mm, 38.75±0.88mm, and 36.80±1.68mm in the obese group, respectively. Intergroup comparisons between the four groups were statistically significant(P＜0.05), and pairwise comparisons within groups were statistically significant(P<0.05). In males, the length of the line connecting ASIS and GT was 129.43±6.42mm, the length of the line intersecting with safety zone was 30.72±5.27mm, the length from ASIS to safety zone along the line was 33.61±8.82mm, and the length from GT to safety zone along the line was 69.14±11.46mm; In females, such lengths were 109.83±8.99mm, 32.32±4.94mm, 35.77±11.26mm, and 43.75±7.62mm, respectively, with significant differences between the two gender groups(P<0.05); In the underweight group, such distances were 119.40±12.21mm, 30.72±3.83mm, 25.42±7.75mm, and 65.64±14.79mm; In the normal weight group, they were 122.98±10.91mm, 30.29±4.29mm, 35.01±10.22mm, and 60.58±13.43mm; In the overweight group, they were 117.52±13.70mm, 32.12±6.27mm, 36.92±8.27mm, and 51.42±18.38mm; In the obese group, they were 120.52±13.95mm, 35.65±3.29mm, 29.58±11.67mm, and 60.93±15.13mm. The length of the line connecting ASIS and GT showed no statistically significant difference between weight subgroups(P>0.05). However, the length of the line intersecting with the safety zone, the length from ASIS to the safety zone along the line, and the length from GT to the safety zone along the line exhibited statistically significant differences between subgroups(P<0.05). Conclusions: All the S2AI screw safety channels targets a specific area on the body surface, and the line connecting the anterior superior iliac spine and greater trochanter(GT) passes through this safety zone, which can serve as an auxiliary landmark for placing the S2AI screw.