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Master Thesis

Modélisation et évaluation clinico-radiologique des vissages antérogrades de la colonne postérieure de l’acetabulum

Abstract : Introduction - The aim of this study was to model the volume of the posterior column containing all trajectories for the insertion of an APCS. This modeling will be a theoretical model in order to establish a standardization and recommendations for APCS insertion. Material and method - The freeware 3D Slicer version 4.10.2 was used to perform the segmentation of CT-scans (millimeter thickness) of 34 patients (24 men and 10 women) by thresholding and growth of regions as well as the volume of the trajectories of the APCS (Vp). Morphological data collected included the length of Vp, its anteroposterior and medio-lateral diameters, identification of an entry point and angulation in the frontal and sagittal planes. Statistical analysis was performed by Student's t test using JASP software version 0.10.2. Results - The mean length of Vp was 139.8 mm in men and 133.2 mm in women (p=0.042). The minimum anteroposterior diameter was 7.2 mm and 7 mm for the medio-lateral diameter. This narrow area was located 4.7 mm before the upper edge of the ischial spine and 1 mm after. The surface area of the "safe zone" measured on average 392.5 mm2 in male and 278.3 mm2 in female (p=0.002). The entry point of the APCS located in the center of the "safe zone” was not different between female and male (p <0.05). The mean angulation in the frontal plane was 124.9° in male, 123.1° in female (p=0.47) and 56.1° in male and 58.8° in female in the sagittal plane (p=0.22). Thus, fracture located before the ischial spine, located in the "safe zone" and with a significant verticality should alert the surgeon to the risk of failure of the APCS fixation. Conclusion - The APCS screwing is theoretically possible without danger by a single 3.5 mm cortical screw, regardless of the patient's sex, by checking validity criteria on the preoperative scanner during the analysis of the fracture lines.
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Master Thesis
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Submitted on : Wednesday, October 28, 2020 - 11:56:25 AM
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Guillaume Cavalié. Modélisation et évaluation clinico-radiologique des vissages antérogrades de la colonne postérieure de l’acetabulum. Médecine humaine et pathologie. 2020. ⟨dumas-02981925⟩



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