| Objcetive:Based on the surgical method of mandible reconstruction with free iliac bone flap in stomatology and a case of reconstruction of Achilles tendon and calcaneus defect with free sartorius iliac composite tissue flap,the morphology of ilium near the starting point of sartorius and the morphology of calcaneus tuberosity were studied on CT three-dimensional imaging to provide morphological support for the rationality of the operation and the size of bone flap cut during the operation.Materials and methods:The CT of normal calcaneus and pelvis in Lequn Hospital of The First Bethune Hospital of Jilin University from January 2020 to January 2023 were collected.According to the inclusion and exclusion criteria,51 patients and 78 calcaneus CT data were obtained,including 31 males,20 females,38 on the left and 39 on the right.The average age was 41.48 ±14.56 years(18-66 years).There were51 pelvic CT data,including 51 left and right iliac bones of 28 males and23 females.The demographic characteristic indexes such as age,sex and side of each examiner were extracted.Importing CT into the Philips Intellispace Potral program,three-dimensional images were generated,useing the measuring tools of the program to measure.SPSS26.0(Chicago,IL,USA)software was used for statistical analysis.The measurement method of anterior superior iliac spine: the anterior superior iliac spine was set as point A,the lowest point between anterior superior iliac spine and anterior inferior iliac spine was point B,the thickest iliac tubercle,the midpoint of iliac crest was point C,and the thickest midpoint between anterior superior iliac spine and iliac tubercle was point D.The area surrounded by the four points serves as the maximum range of bone removal in this operation.Measure the distance between AB,the thickness of point C and the thickness of point D.The measurement method of calcaneal tuberosity: the highest point of posterior view of calcaneus was E,the lowest point was F,the most prominent point of medial view was G,the most prominent point of lateral view of calcaneus was H,and the highest point of posterior articular surface of calcaneus was I.the length of the widest GH,the highest EF line and the length of EI from the highest point of posterior articular surface to the highest point of calcaneal tuberosity were measured.Result:The parameter measurement method based on free sartorius iliac bone flap for repairing Achilles tendon and calcaneal defects has good credibility and repeatability.The lowest distance from ASIS to ASIS and AIIS was AB,the distance from AC to iliac tubercle was 59.74 ±8.53,the thickness of iliac tubercle C was 18.09 ±3.06 mm,ASIS,and the thickness of midpoint of iliac tubercle line D was 13.99 ±2.28,8.9022.10 mm.The length of the highest EF of calcaneal tuberosity was 25.47 ±2.67(18.2-33.3)mm,and the width of GH of calcaneal tuberosity was 25.47±2.67(18.2-33.3)mm,and the distance from the highest point of the posterior articular surface of the calcaneus to the highest point of the calcaneal tubercle was 31.07 ±3.22(22.2-40.1)mm.The morphological parameters showed gender differences but no side differences.The width of the tuberosity of the calcaneus was correlated with the maximum,and the lowest distance from ASIS to ASIS and AIIS was correlated with the thickness of the iliac crest.The thickness of the widest part of calcaneal tuberosity was different from that of iliac tubercle(P<0.05),and the thickness of the widest part of calcaneal tuberosity was different from that of ASIS and the midpoint of the connecting line of iliac tubercle(P<0.05).The length from anterior superior iliac spine to the lowest point between anterior superior iliac spine and anterior inferior iliac spine was different from the height of calcaneal tubercle(P < 0.05),but there was little difference between the length from anterior superior iliac spine to iliac tubercle and the length from the highest point of posterior articular surface to the highest calcaneal tuberosity(P <0.05),which could meet the needs of recipient area.Conclusion:In the surgical scheme of repairing Achilles tendon and calcaneal defects with sartorius muscle iliac bone flap,the free iliac bone can meet the requirements of length and height for reconstruction for reconstruction of lateral view of calcaneus,but can not meet the requirement of width,so additional management is needed for the iliac bone.The morphological parameters showed gender differences but no side differences.This study provides a new idea for the treatment of tubercle defect of calcaneus. |
