三维“C”型臂透视导航下治疗髋臼骨折  

Minimal invasive fixation for acetabular fracture with 3D fiuoro-images navigation

作　　者：罗从风[1] 张巍[1] 胡承方[1] 孙辉[1] 高洪[1] 曾炳芳[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华骨科杂志》2011年第11期1255-1260,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨术中使用三维“C”型臂透视导航下髋臼骨折微创治疗的安全性及临床疗效。方法2008年8月至2010年12月，对20例无明显移位的髋臼骨折患者采用三维“C”型臂透视导航下经皮微创螺钉内固定治疗，男9例，女11例；年龄26-54岁，平均（37．1±1.2）岁。致伤原因：交通伤15例，高处坠落伤5例。骨折按AO分型：A1．1型2例，A2．2型3例，A2．3型4例，A3．2型2例，A3．3型2例，B1．1型2例，B2．2型2例，B3．1型1例，C2．1型1例，C2．3型1例。结果伤后至入院时间为2-46h，平均（8．6-0．2）h。入院后行骨牵引3-14d后手术。术中共置入空心钉46枚，平均每枚置入时间为（22．6±1．2）min。除1枚空心钉因术中采集图像时出现较大偏差需重新置入外，其余均一次性准确置入，成功率为97．8％。置入后术中使用三维“C”型臂进行透视成像验证所有螺钉均未进入关节间隙，与术后CT扫描验证结果一致，符合率100％。术后切口均一期愈合，无内固定失败。20例患者均获得随访，随访时间12-28个月，平均（22．8±1．7）个月。末次随访X线片示骨折愈合，螺钉置入位置满意。结论术中三维透视成像导航下对无明显移位髋臼骨折进行经皮微创内固定，可有效重建髋臼关节面的平整性，提高螺钉置入的精确度，减少切口长度与出血量，降低手术对患者的损害，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 3D fluoro-images navigation in the management of acetabular fractures. Methods From August 2008 to December 2010, 20 patients with acetabular fractures were treated with percutaneous screw fixation under the guidance of 3D fluoro-images based on navigation system after closed reduction. There were 9 males and ll females, aged 26-54 years old （mean, 37.1±1.2 years）. Fractures were caused by traffic accident in 15 cases, and falling from height in 5 cases. According to AO classification, there were 2 cases of Al.1 type, 3 cases of A2.2 type, 4 cases of A2.3 type, 2 cases of A3.2 type, 2 cases of A3.3 type, 2 cases of BI.1 type, 2 cases of B2.2 type, 1 case of B3.1 type, 1 case of C2.1 type, 1 case of C2.3 type. The interval from injury to hospitalization was 2-46 h （mean, 8.6±0.2 h）. After 3-14 days of skeletal traction through tibial tubercle, the operation was performed. Results Totally 46 screws were fixed. The average time for surgery was （22.6 ±1.2） rain per screw. Forty-five screws were placed correctly with a successful rate of 97.8%, only one screw was reinserted for deviation. All the screws were checked by the 3D fluoro-images that they were not in the joint space after fixation. The result was same with CT scan. No incision problem and implant failure oc- curred. All 20 patients were followed up 12 to 28 months with an average of （22.8±1.7） months. At last follow-up, fracture union was achieved in all patients with satisfactory screw fixation. Conclusion The minimal invasive fixation with 3D fluoro-images navigation makes the surgery for the nondisplaced acetabular fracture more precise and time-saving, minimize the surgery injury, and improves clinical results without an increasing rate of complications.

关 键 词：髋臼 骨折 外科手术 计算机辅助 

分 类 号：R687.3[医药卫生—骨科学]