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The Study of Method to Inspect the Position of Lag Screw Implanted into the Anterior Acetabular Column by X-ray

Author: SunJianTing
Tutor: WangPengCheng
School: Hebei Medical University
Course: Surgery
Keywords: The anterior column of the acetabulum Lag screws C-arm X-ray Tangential
CLC: R687.3
Type: Master's thesis
Year: 2010
Downloads: 24
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Abstract

Objective: To compare the two sets of C-arm X-ray position (acetabular obturator oblique pelvic outlet bit group and acetabular anterior column tangential group) the detection lag screw piercing the sensitivity of the acetabular anterior column, discover a simple and economic precise intraoperative monitoring methods, to improve the security acetabular front pillar screw implant. MATERIALS AND METHODS: Step 1: Preparation of specimens: 10 formaldehyde corrosion adult male cadavers by Hebei Medical University, Department of Anatomy. All specimens were recognized by the naked eye and x-rays, no deformity, osteoporosis and other abnormalities. Removal of the soft tissue around the acetabular anterior column, save only the bone structure. Step 2: determine the experimental application of a variety of C-arm fluoroscopy position angle. Step 3: specimen removal femur fixed in the prone position on the operating table, the C-arm X-ray fluoroscopy assisted drill into Kirschner: Adjust the perspective and Kirschner at an angle, see Kirschner wire tip in the anterior column axial center of the image, which shows the entrance point to choose the right. C-arm X-ray acetabular anterior column tangential perspective, gradually penetrate into the Kirschner wire with an electric drill, Kirschner In addition, the front side of the surface, see Kirschner in the acetabular anterior column acetabular anterior column , then the direction into the nail and Kirschner wire in the correct position, otherwise it should be adjusted Kirschner wire into the direction. Step 4: Preparation of experimental models: in the pelvis specimens acetabular anterior column select the three points, three points for A, B, C, A point: iliopubic bump that acetabular anterior wall at the thinnest point B suprapubic branched minimum perimeter at the point A, point B between C. Due to acetabular anterior column outer side of the structure is the most complex, divided into proximal portion - acetabular articular surface and the distal portion - pubic support part projection and determined by three points A, B, C D, E F between three plus drill three Kirschner. Then use the drill to drill into the Kirschner wire at every point, vertical inward, the first three planes, piercing the surface of 1mm. Talus cortical surface 1mm cut Kirschner. Application vernier caliper Kirschner wire piercing length. Step Five: packet judge: divided into consists of two groups: Group A-line acetabular anterior column side, front side of the outer tangential position, Group B line obturator oblique pelvic outlet bit. The evaluation results based on the packet: Invite three orthopedic physician experienced group 3 into the Division 2 years residency experience group. 2 groups of physicians to judge the experimental data collected to draw perspective image Kirschner wire piercing the the acetabular anterior surface of the column positive rate: Kirschner wire piercing the front pillar surface according to the judgment of the perspective image is positive, there is no wear out negative. 2 medical personnel involved in the evaluation Kirschner I do not know the actual location. 4 weeks after the three measurements in order to evaluate the two groups consistency of evaluation results, the judge re-collected image data to judge. Calculation of the sensitivity of each method. Statistical analysis: application SPSS16.0 the (statistical products and services solutions) the two pools C-arm X-ray perspective the position detection Kirschner whether piercing the acetabular anterior surface of the column, the positive rate do pairing X2 (chi-square) test statistical analysis. Results: Group A (anterior column acetabular side - front - the side of the outer tangential) and Group B (pelvic outlet bit - obturator oblique) monitoring Kirschner wire piercing the sensitivity of the acetabular anterior column three planar surfaces . Two pools inspection experience group and the sensitivity of the inexperienced group: acetabular anterior column side: Group A 100.0%, 100.0%, Group B: 71.7%, 70.0% acetabular anterior column front surface: Group A 93.3%, 95.0%, Group B: 56.7%, 53.3% acetabular anterior column outer side acetabular articular face: Group A: 86.7%, 90.0% Group B: 86.7%, 40.0% acetabular anterior column of the outer surface of the pubic branch minutes: Group A: 80.0%, 83.3% Group B: 50.0%, 51.7% by statistical analysis found that: (1) monitoring Kirschner piercing acetabular anterior column the surface sensitivity C-arm X-ray monitoring acetabular column side, there are significant differences between the two sets of inspection methods (P lt; 0.01, the matching tables X2 test), relatively poor sensitivity of Group B, the anterior column acetabular side, in front of the side of the outer tangential the sensitivity of the group is much higher than the the the obturator oblique pelvic outlet bit group; ② acetabular anterior column on the outer side of the pubic branch of the time-sharing, Group B sensitivity worst acetabular anterior column side, in front of , the outer surface of tangential group sensitivity is much higher than the the obturator oblique pelvic outlet bit group; (3) for the front of the acetabular anterior column screw piercing the sensitivity of the monitoring, significantly higher than Group A Group B, two sets of inspection methods there was an obvious difference (P lt; 0.01, matching tables X2 test). Conclusion: The acetabular anterior column side, front side of the outer tangential group monitoring screw piercing acetabular anterior column sensitivity is much higher than the acetabular obturator oblique pelvic outlet bit group, intraoperative C-arm X ray acetabular anterior column side, front side of the outer tangential surgery can accurately determine whether the screw piercing the advantages of acetabular anterior column acetabular anterior column lag screw of intraoperative monitoring can be used as the first choice of the security Methods.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery
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