透视导航引导下骨盆骨折的微创治疗  

MINIMAL INVASIVE FIXATION FOR PELVIC FRACTURE WITH FLUOROSCOPY-BASED NAVIGATION

作　　者：曾智敏 罗从风[1] 胡承方[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中国修复重建外科杂志》2009年第11期1302-1305,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨透视导航引导下骨盆骨折微创治疗的安全性及临床疗效。方法2007年4月-2008年6月,对22例骨盆骨折患者行闭合复位,透视导航引导下经皮螺钉微创内固定治疗。男13例,女9例;年龄21～65岁。致伤原因:交通事故伤17例,高处坠落伤5例。骨折按AO分型:A2.2型2例,A2.3型2例,B1.2型7例,B2.2型3例,B3.3型1例,C1.2型2例,C1.3型3例,C2.3型2例。伤后至入院时间为4h～3d,平均1.2d。入院后行胫骨结节骨牵引3～13d后手术。结果术中共植入空心螺钉42枚,平均每枚植入时间为20.4min。除1枚空心螺钉因采集图像时出现较大偏差需取出重植,其余均一次性准确植入,成功率为97.6%。术后切口均Ⅰ期愈合,无内固定失败。22例均获随访,随访时间7～21个月,平均14.5个月。末次随访X线片示骨折愈合,螺钉植入位置满意。根据Majeed骨盆功能评分标准,优18例,良4例,优良率为100%。结论透视导航引导下行骨盆骨折微创内固定,可有效重建骨盆环的稳定性,提高手术精确度,缩短手术时间,降低手术对患者的损伤,减少术后并发症的发生,有利于患者功能康复。Objective To evaluate the security and effectiveness of minimal invasive fixation with Iluoroscopybased navigation in the management of pelvic fractures. Methods From April 2007 to June 2008, 22 patients with pelvic fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system after closed reduction. There were 13 males and 9 females, aged 21-65 years old. Fractures were caused by traffic accident in 17 cases, and falling from height in 5 cases. According to AO classification, there were 2 cases of A2.2 type, 2 cases of A2.3 type, 7 cases of B1.2 type, 3 cases of B2.2 type, 1 case of B3.3 type, 2 cases of C1.2 type, 3 cases of C1.3 type, and 2 cases of C2.3 type. The interval from injury to hospitalization was 4 hours to 3 days （mean 1.2 days）. After 3-13 days of skeletal traction through tibial tubercle, the operation was performed. Results Totally 42 screws were inserted. The average time for operation was 20.4 minutes per screw. Forty-one screws were inserted correctly with a successful insertion rate of 97.6%, only 1 hollow screw was reinserted for deviation. No incision problem and implant failure occurred. All 22 patients were followed up 7 to 21 months with an average of 14.5 months. At last follow-up, fracture union was achieved in all patients with satisfactory screw fixation. According to Majeed functional scoring, the results were excellent in 18 cases and good in 4 cases, with an excellent and good rate of 100%. Conclusion The minimal invasive fixation with fluoroscopy-based navigation makes the surgery for the pelvic fracture more precise and time-saving, and improves clinical results without an increasing rate of complications.

关 键 词：骨盆骨折 微创技术 计算机辅助技术 经皮内固定 

分 类 号：R687.3[医药卫生—骨科学] R683.3[医药卫生—外科学]