| Background and purpose:Normal human containing five lumbar vertebrae, the basic structure of the lumbar spine can be divided into two parts, part of the vertebral body, as part of the annex vertebrae, vertebral generally larger, internal edge of the lamina is formed arcuate, generally by the vertebral foramen and the trailing edge of the arch formed around the plate-like level spinous process extends to the rear, a larger gap adjacent spinous processes, for clinical lumbar puncture foramen is connected up and down, can be formed containing vertebral nerve and spinal cord pipe, annulus and nucleus of two parts, the intermediate disc for moisture-rich nucleus, the nucleus is an elastic protein, its shape was jelly, nucleus surrounded by the annulus, play a fixed the role of the nucleus, annulus put more vertebrae are connected, the disc is an important part of the connection of the spinal canal. Pelvis consists of the left hip and right hip, sacrum, coccyx and connected in the middle of the bone. Boundary is a belt line, the sacral promontory, pubic hair, pubic tubercle, the arcuate line and the upper edge of the pubic symphysis constitution. Left hip and right hip, sacrum, coccyx and pelvic ligaments link from pelvis. Pelvis by a slash into large and small pelvis pelvis, pelvis to slash more parts, also known as the false pelvis, iliac fossa Go bone cavity portion of the abdominal cavity. Small pelvis into the following sections slash, also known as the true pelvis, pelvic cavity is small pelvis upper and lower mouth. These characteristics of the lumbar spine can lead to pelvic pelvis and lumbar easy destructive angle at both sides of the lower edge of the pubic joint branch formed called pubic pubic angle, female angle is large, approximately 90～100°, a relatively small angle male Some, about 70～75°. Upright body, pelvis catchy plane tilted forward, the female is slightly larger than the inclination of men. Female pelvis is the fetus out of the birth canal delivery, so there is a clear difference between male and female pelvis. Lumbosacral part of a special anatomical features of this part of the tumor, senile osteoporosis and degenerative diseases and tuberculosis, so that the parts can be structural changes occur, the clinical need of the lesions cleared, reset its parts, and finally the use of certain surgical internal fixation. This part of the study is still under development, is immature segment of fixed lumbar pelvic problem is still more difficult problem. To solve this problem clinicians using iliac screw fixation for lumbar pelvic implementation. This study selected in January 2013 to January 2016 in our hospital lumbar pelvic fixed 56 patients as research subjects. Some basic and clinical data collection study in order to be able to make better use of the pelvis and lumbar iliac screw fixation method has feasibility and safety, and its study and research.Methods:In January 2013-January 2016 period,50 cases of patients with lumbar pelvic ectopic lesion treated as an object of study were randomly selected in our hospital. Female 25 patients in the study, male 25 patients, aged between 41 to 80 years, mean age (61.2±15.3) years, duration of 1 to 11 years, mean disease duration (6.1±1.5) years. Step specific research methods (1) Questionnaire design, survey generally include the patient’s age, gender, family background, specific signs of treatment, diagnosis, treatment results and post-discharge condition, it could also be based on the specific circumstances of the patient’s design a set of questionnaires. (2) Used a self-administered questionnaire collected during the treatment of patients in treatment, the basic vital signs were recorded before surgery and after surgery. (3) Admissions to surgery, the whole process consists essentially of a physician to operate discharge telephone follow-up every three each month, a year of follow-up, to be able to better analyze the efficacy of iliac screw fixation of the pelvis and lumbar clinical treatment, research process more smoothly. Before surgery, the patient scans and three-dimensional reconstruction of spiral CT in order to be able to more easily determine the cut-off point, usually cutting site for the sacral, sacral plane 2, iliac screw entry points could be labeled as A point, select point A location iliac distal section, a starting point for the cut point at a position at this point to do section direction generally be divided into three directions, respectively, above the greater sciatic notch, anterior superior iliac spine, anterior superior iliac spine this study could be analyzed research and data on the various surgery cut road directions. Pelvis around data analyzed includes several measurement data:mainly S1 and S2 and measure around the pelvis, S1 arch width, arch height of S1; could occur on the rear side iliac wing after hip line and the shape of the observation and analysis; S1 and S1 vertebrae frontal cortex contralateral to determine the specific measure the distance between the starting point; measuring a specific distance from the starting point S1 pedicle surgery centers; sacroiliac screw direction of the needle and the ilium after the outer wing to measure the angular relationship; measuring angled relationship under the sciatic notch and the iliac spine, respectively needle points. Measured values S2 are:First implant of iliac screw channel diameter closely measurement; S2 pedicle height measurement values; S2 pedicle width measured values; S2 pedicle central location and surgical cut point distance measurement; measuring the distance S2 vertebral middle position with the surgical needle points; angled measuring the relationship between the direction of the sacroiliac screw needle and posterolateral iliac wing; in the greater sciatic notch and the iliac spine, respectively and angled measuring the relationship between the needle points. Iliac screw into the front of the patient’s vital signs were measured in order to reach a better clinical efficacy. In the postoperative follow-up of patients tracked for a deep understanding of the use of iliac screw fixation of the pelvis and lumbar effect.Results:Surgery on the sacrum and the sacral lamina 12 plane was cut on the second hole on the rear edge of the sacrum connection with the cutting plane of the distal end of the iliac wing holding at the same level, iliac wing cutting plane iliac screws as a starting point, marking the letters a, may be developed in three different directions implantable screw connections on the upper edge of the distal end of the second sacral foramen according to the starting point a point on the path, the path before①iliac spine on markers the AD path.②iliac spine before the path marked AC path.③ large sciatic notch above the path of AB. These three different paths implanted in iliac screw diameter of 7mm or more. These screw channel investigation of the screw channel parameters using statistical methods normality test, and are in line with normal distribution. Screw channel parameters used sex and no significant difference. The three paths opened a certain regularity, AB path, AC and AD path paths tunnel cavity curvature is increased gradually, the trend is over by the "I" shape to the "S" shape, this transitional form no doubt, it is to increase the difficulty of iliac screw implanted to increase the operation cost, increase the risk of surgery. Iliac screw of choice, including specific length, shape and hardness to be accurate choice. In the Select iliac screw length on specific requirements, different gender iliac screw length also have some differences, the choice of iliac screw length:the general scope of male patients:AC path selected iliac screw length:124.5±30.22mm; AB path selected iliac screw length:113.5±28.02mm; AD path selected iliac screw length:71.5± 11.89mm; the general scope of female patients:AC path selected iliac screw length: 117.5±28.22mm; AB path selected iliac screw length:102.5±25.11mm; AD path selected iliac screw length:69.5±17.63mm, statistically significant (P> 0.05); the final statistics showed that male ilium no significant difference nail nail screw channel angle end to a female patient with iliac screw spiral channel Spiketail to declination. Significant (P> 0.05) statistically. Men iliac screw spiral path outward angle also with nails female patients iliac screw spiral channel nail outward declination no significant differences. Significant (P> 0.05) statistically. Social declination of choice for men and women are different, such as the general scope of male patients at 25.3±6.2 degrees, the general scope of female patients at 25.4±6.3 degrees, (P> 0.05). Within the selected range, the inside of the starting point bias, if the increase in outward angle, through a narrow canal area, relatively easy to increase the length of the iliac nail.Conclusion:In the choice of iliac screw also be requested, the pelvis iliac screw fixation has also been requested, through the sacroiliac joint S1 pedicle iliac screw length requirements may be set for 75mm, through this part of the screw entry point is the point sciatic notch from the top of 40mm, after the front from the iliac spine of 25mm.1 on the sacrum, sacral lamina rear 2 plane, the position of the posterior superior iliac spine and the upper level of the second sacral foramen connection between the upper edge, in this position to give iliac screw implant surgery the benefits of this position is to undergo surgery to increase the length of the fixed stage after sacral area, where it should point to three different directions is the sciatic notch, and iliac spine on the front under the direction of the anterior superior iliac spine. The general scope of male patients:AC path nail length:124.5±30.22mm; AB nail path length:113.5±28.02mm; AD path length nails:71.5±11.89mm; the general scope of female patients:AC path nail length:117.5±28.22mm; AB nail path length:M:: between 25.3±6.2 degrees 102.5±25.11mm;:; nail path length AD general scope outward angle 69.5±17.63mm, statistically significant (P> 0.05) female:between 25.4±6.3 degrees, (P>0.05). The method of operation of position, surgery choice, the choice of iliac screw fixation in the lumbar spine pelvis are ideal path. Reduce the risk of surgery, reduce the recurrence rate after surgery, greatly reducing the suffering of patients and reduce the cost of surgery patients. Fixed plays a larger role in the treatment of lumbar pelvis. It should be widely used in clinical research and treatment. |
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