Digital analysis and optimization of the modified LC-Ⅱ screw fixation path

doi:10.3877/cma.j.issn.2096-0263.2023.03.001

Abstract

Abstract:

Objective

Using digital medical software, the modified LC-Ⅱ screw optimal path has been designed for parallel analysis and measurement to improve the safety and accuracy of nail placement.

Methods

We collected CT data from 40 adult normal pelvic patients from the Third Affiliated Hospital of Southern Medical University between January 2021 and December 2022. They were 20 men and 20 women, aged 20 to 65 years old (mean 45.6 years). First, the Mimics19.0 software was used to reconstruct the pelvic model to determine the optimal nail path and measure its diameter and length, then the 3-Matic13. 0 software was used to measure the vertical distance Dv1 and the horizontal distance Dh1 of the central axis of the modified LC-Ⅱ screw between the anterior iliac skin junction and the anterior superior iliac spine, the included angles between the central axis of the modified LC-Ⅱ screw and the coronal, sagittal and horizontal planes, ∠α、∠β、∠γ, and the angles of ∠LPM and ∠LPM' between the central axis of the modified LC-Ⅱ screw and the midline of the pelvis under the condition of the pelvis in the upright position and the entry position were measured and compared between sexes and sides.

Results

In 40 pelvic cases, the entire modified LC-Ⅱ screw path could be planned in both lateral screw placement areas.Based on the three-dimensional digital pelvic model, the bony entry points of the modified LC-Ⅱ screws were located at the superior border of the acetabulum and at the outer and posterior sides of the anterior inferior iliac spine. The maximum channel diameter of the modified LC-Ⅱ was (12.33±1.04) mm for male and (10.33±0.9) mm for female. The maximum channel length was (95.37±6.6)mm for male and (92.51±5.59)mm for female. The angle of ∠β between the modified LC-Ⅱ screw and the median sagittal plane was (33.04±4.04)° for male and (35.18±2.84)° for female (P<0.05). The angle between the axis of the screw and the horizontal plane of the pelvis is ∠γ, which is (35.97±4.70)° for males and (39.83±6.16) for females (P<0.05), the angle of ∠LPM' between the axis of the screw and the median line of the pelvis is (35.09±2.85)° for males and (33.35±3.14) for females (P<0.05).

Conclusions

Digital medicine is an ideal tool to study the anatomy of the modified LC-Ⅱ screw bone channels. As measured by digital medical software, the modified LC-Ⅱ channels exist and are safe. Our digital measurement provides a theoretical basis for the clinical application of the modified LC-Ⅱ screws.

Key words: Pelvic fracture, Fracture fixation, Digital medicine, Natomy

Jingqi Deng, Tao Li, Zhenhua Zhu, Jiacheng Li, Sheqiang Chen, Jiajun Mo, Yilan Liao, Peiyi Liu, Shicai Fan. Digital analysis and optimization of the modified LC-Ⅱ screw fixation path[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(03): 129-137.

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Figures/Tables 7

References 24

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参数	总体	男性	女性	t值	P值
最大直径（mm）	11.33±1.39	12.33±1.04	10.33±0.90	-8.964	<0.001
最大长度（mm）	93.94±6.25	95.37±6.60	92.51±5.59	-2.039	0.045
∠α（°）	33.19±5.69	34.24±5.06	32.15±6.14	-1.622	0.109
∠β（°）	34.11±3.63	35.18±2.84	33.04±4.04	-2.669	0.009
∠γ（°）	37.90±5.78	35.97±4.70	39.83±6.16	3.072	0.003
AI（mm）	25.37±5.08	23.85±3.76	26.89±5.78	2.714	0.008
AS（mm）	52.49±5.35	51.94±4.92	53.04±5.77	0.886	0.378
AC（mm）	14.16±2.54	13.72±1.72	14.60±3.12	1.518	0.133
AN（mm）	55.88±6.11	59.58±3.57	52.18±5.89	-6.628	<0.001
∠LPM（°）	43.27±4.84	42.89±3.15	43.64±6.10	0.673	0.503
∠LPM’（°）	34.22±3.11	35.09±2.85	33.35±3.14	-2.531	0.013
Dv1（mm）	74.27±15.25	70.54±12.52	78.01±16.92	2.188	0.032
Dh1（mm）	24.47±14.12	21.94±10.93	27.00±16.48	1.578	0.119

参数	总体	男性	女性	t值	P值
最大直径（mm）	11.33±1.39	12.33±1.04	10.33±0.90	-8.964	<0.001
最大长度（mm）	93.94±6.25	95.37±6.60	92.51±5.59	-2.039	0.045
∠α（°）	33.19±5.69	34.24±5.06	32.15±6.14	-1.622	0.109
∠β（°）	34.11±3.63	35.18±2.84	33.04±4.04	-2.669	0.009
∠γ（°）	37.90±5.78	35.97±4.70	39.83±6.16	3.072	0.003
AI（mm）	25.37±5.08	23.85±3.76	26.89±5.78	2.714	0.008
AS（mm）	52.49±5.35	51.94±4.92	53.04±5.77	0.886	0.378
AC（mm）	14.16±2.54	13.72±1.72	14.60±3.12	1.518	0.133
AN（mm）	55.88±6.11	59.58±3.57	52.18±5.89	-6.628	<0.001
∠LPM（°）	43.27±4.84	42.89±3.15	43.64±6.10	0.673	0.503
∠LPM’（°）	34.22±3.11	35.09±2.85	33.35±3.14	-2.531	0.013
Dv1（mm）	74.27±15.25	70.54±12.52	78.01±16.92	2.188	0.032
Dh1（mm）	24.47±14.12	21.94±10.93	27.00±16.48	1.578	0.119

参数	男性（n=20）		t值	P值	女性（n=20）		t值	P值
参数	左侧	右侧	t值	P值	左侧	右侧	t值	P值
最大直径（mm）	12.33±0.93	12.34±1.17	-0.031	0.976	10.29±0.95	10.38±0.86	-0.302	0.764
最大长度（mm）	94.64±6.92	96.11±6.37	-0.68	0.501	91.62±5.01	93.40±6.13	-0.982	0.333
∠α（°）	33.63±5.17	34.85±5.00	-0.741	0.464	31.54±6.29	32.75±6.10	-0.603	0.550
∠β（°）	35.04±3.14	35.31±2.58	-0.291	0.773	34.11±4.01	31.96±3.89	1.682	0.101
∠γ（°）	36.68±4.44	35.25±4.97	0.937	0.355	39.49±6.21	40.17±6.26	-0.334	0.740
AI（mm）	24.08±3.64	23.62±3.96	0.37	0.714	27.54±5.61	26.24±6.03	0.689	0.495
AS（mm）	52.65±5.11	51.24±4.76	0.886	0.382	53.12±5.92	52.95±5.77	0.089	0.930
AC（mm）	13.75±1.78	13.69±1.71	0.097	0.923	15.3±3.53	13.90±2.56	1.394	0.172
AN（mm）	58.72±4.19	60.45±2.66	-1.518	0.138	50.78±4.51	53.58±6.84	-1.49	0.145
∠LPM（°）	42.22±2.59	43.57±3.56	-1.34	0.189	43.87±5.55	43.42±6.76	0.224	0.824
∠LPM’（°）	34.55±2.99	35.64±2.67	-1.184	0.244	33.52±3.28	33.17±3.08	0.338	0.737
Dv1（mm）	73.05±13.53	68.0±11.22	1.244	0.222	79.06±18.53	76.96±15.58	0.379	0.707
Dh1（mm）	23.16±12.03	20.72±9.88	0.683	0.499	31.29±18.33	22.72±13.55	1.639	0.110

参数	男性（n=20）		t值	P值	女性（n=20）		t值	P值
参数	左侧	右侧	t值	P值	左侧	右侧	t值	P值
最大直径（mm）	12.33±0.93	12.34±1.17	-0.031	0.976	10.29±0.95	10.38±0.86	-0.302	0.764
最大长度（mm）	94.64±6.92	96.11±6.37	-0.68	0.501	91.62±5.01	93.40±6.13	-0.982	0.333
∠α（°）	33.63±5.17	34.85±5.00	-0.741	0.464	31.54±6.29	32.75±6.10	-0.603	0.550
∠β（°）	35.04±3.14	35.31±2.58	-0.291	0.773	34.11±4.01	31.96±3.89	1.682	0.101
∠γ（°）	36.68±4.44	35.25±4.97	0.937	0.355	39.49±6.21	40.17±6.26	-0.334	0.740
AI（mm）	24.08±3.64	23.62±3.96	0.37	0.714	27.54±5.61	26.24±6.03	0.689	0.495
AS（mm）	52.65±5.11	51.24±4.76	0.886	0.382	53.12±5.92	52.95±5.77	0.089	0.930
AC（mm）	13.75±1.78	13.69±1.71	0.097	0.923	15.3±3.53	13.90±2.56	1.394	0.172
AN（mm）	58.72±4.19	60.45±2.66	-1.518	0.138	50.78±4.51	53.58±6.84	-1.49	0.145
∠LPM（°）	42.22±2.59	43.57±3.56	-1.34	0.189	43.87±5.55	43.42±6.76	0.224	0.824
∠LPM’（°）	34.55±2.99	35.64±2.67	-1.184	0.244	33.52±3.28	33.17±3.08	0.338	0.737
Dv1（mm）	73.05±13.53	68.0±11.22	1.244	0.222	79.06±18.53	76.96±15.58	0.379	0.707
Dh1（mm）	23.16±12.03	20.72±9.88	0.683	0.499	31.29±18.33	22.72±13.55	1.639	0.110

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