计算机辅助影像导航经皮螺钉内固定治疗髋臼骨折的实验研究  

Percutaneous screw fixation in treatment of fractures of acetabular columns using computer-assisted imaging navigation system： experiment with cadaver model

作　　者：王军强[1] 吴伟坚[2] 邓宁[2] 赵春鹏[1] 苏永刚[1] 吴新宝[1] 王满宜[1] 梁国穗[2] 

机构地区：[1]北京积水潭医院创伤骨科,100035 [2]香港中文大学矫形外科及创伤学系香港威尔士亲王医院骨科

出　　处：《中华医学杂志》2008年第27期1900-1904,共5页National Medical Journal of China

基　　金：北京市科委科技计划重大资助项目（H060720050230）、北京市科技新星资助项目（2005818）

摘　　要：目的确定标准的术中透视图像，作为计算机辅助影像导航经皮螺钉内固定治疗髋臼前、后柱骨折的注册图像。方法选取干燥尸体骨盆4具、模型骨盆4具作为骨折模型。直视徒手将2．5mm导针置人髋臼前、后柱（双侧）；双侧前柱导针分别采用逆行及顺行置人，后柱导针采用逆行植入；目视确认导针位置满意后，将骨盆固定于影像导航手术模拟操作模块，应用C形臂X线透视机，针对髋臼结构的前、后、外、内4个虚拟平面的垂直方向进行多角度连续动态透视，选择并确认能够清楚显示导针与前后柱、髋臼关节面的透视影像，作为导航手术的注册图像，记录此时C形臂X线透视机与骨盆、手术床的相对空间位置。依此注册图像，在导航手术系统辅助下，应用6.5mm的钛中空螺钉进行髋臼前、后柱螺钉置入。每个骨折模型，每侧进行1次操作，共16次。目测螺钉位置、分别记录为获取标准注册图像C形臂摆放时间、透视时间、手术操作时间（导航系统建立，软件界面操作及螺钉植入操作的总时间）。结果所有螺钉置入位置满意，未进关节；前柱螺钉置入需要闭孔斜位（Judet-Letournel斜位）、闭孔入口位、闭孔斜出口位、骨盆正位像；后柱螺钉置入需要髂骨斜位、闭孔斜位、骨盆入口位、闭孔斜出口位像；为获取前柱、后柁标准沣册罔像摆放C形臂X线透视机的时间平均分别为9．5、7．3min，前柱、后柱每枚螺钉置入术中透视时间平均分别为2．9、1．7S，前柱、后柱每枚螺钉置入操作时间平均分别为11．7、9．2min。结论导航注册图像不同与传统的Judet-Letournel影像，如何正确获取标准的术中透视注册图像，是确保安全、准确实施影像导航辅助经皮螺钉内固定手术的关键。Objective To establish a new imaging protocol to acquire the most appropriate fluoro- images for fluom-navigated percutaneous fixation of acetabular fracture and to evaluate the safety and efficiency of the procedures, Methods Guide needles were inserted into the bilateral anterior and posterior columns of the acetabula of 4 dry human cadaver pelvic skeletons and 4 plastic pelvic models. Then the pelvis skeletons were fixed to imaging guided surgery mimic operation modules, Dynamic fluoroscopy was conducted with C-arm X-ray machine vertically on the 4 virtual planes of the acetabulum, inner, outer, anterior, and posterior from multiple angles. The fluoroscopic images clearly showing the guide needles, anterior and posterior columns, and acetabulum were selected as registration images, and the relative space positions between the C-arm X-ray fluoroscope and pelvis and operation table. Guided by the navigation system, totally 16 titanium hollow screws were inserted into bilateral anterior and posterior columns of acetabula of the 4 pelvis skeletons. The screw positions were estimated by visual method. The time needed to position the C-arm so as to obtain the standard registration image, time needed for fluoroscopy, and operation time, including establishment of navigation system, software interface operation, and screw insertion, were recorded. Results All the screws were inserted to the satisfying positions： placed within the desired bony corridor of the column and none of then were inserted into the joint. While inserting the screw into the anterior column fluoroscopy should be conducted with obturated oblique view, obturated inlet view, obturated oblique outlet view, or pelvic AP view. While inserting the screw into the posterior column fluoroscopy should be conducted with iliac-oblique view, obturated oblique view, pelvic inlet view, or obturated oblique outlet view. The total surgical time required for screw insertion was 11.7 min for anterior column, and was 9. 2 min for posterior column. 9. 5 and 7.3 minut

关 键 词：髋臼 骨折 治疗 计算机辅助 

分 类 号：R686[医药卫生—骨科学]