利用骨盆模型在三维透视导航下行骨盆骨折手术的研究  

Navigation based on three-dimensional fluoroscopy used for screwing in models of pelvic fracture

作　　者：胡承方[1] 罗从风[1] 张巍[1] 冯大明[1] 朱奕[1] 杨光[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：《中华创伤骨科杂志》2012年第5期415-419,共5页Chinese Journal of Orthopaedic Trauma

基　　金：上海市科委引导项目（074119612）

摘　　要：目的与二维透视导航相比，在骨盆模型上验证三维透视导航在骨盆骨折螺钉置入术中的应用价值，为其在临床的应用提供参考。方法取24个人工骨盆模型，采用三维透视导航（三维透视导航组）与二维透视导航（二维透视导航组）在骨盆模型的耻骨支、坐骨支及骶髂关节分别置入空心钉。所有模型按1～24的顺序标号，其中单号的左侧和双号的打侧使用三维透视导航，其余使用二维透视导航。比较两组之间的设备注册时间、狱取图像时间、置入螺钉时间、手术总时间及置入螺钉长度等。结果二维透视导航组和二维透视导航组手术总时间平均分别为（34．8±2．9）、（29．8±4．5）min，差异有统计学意义（t=-7．776，P=0．000）；其中设备注册时间平均分别为（1．4±0．3）、（1．5±0．3）min，置入螺钉时间平均分别为（15．9±2．0）、（16．4±2．5）min，两组比较差异均无统计学意义（P〉0．05）：获取图像时间平均分别为（13．0±1．8）、（8．8±1．0）min，差异有统计学意义（t=17．482．P=0．000）。两组置入螺钉长度平均分别为（94．9±7．8）、（87．8±11．3）mm，差异有统计学意义（t=4．431，P=0．000）。二维透视导航组有2例螺钉末端顶破皮质。结论与二维透视导航相比，三维透视导航下行骨盆骨折螺钉固定术，可以提高手术精确度，降低术后并发症的发生率，并能安全准确地置入尽可能长的螺钉。Objective To evaluate the navigation based on 3D fluoroscopy used for screwing in models of pelvis fracture. Methods The cannulated screws were inserted into the bilateral pubic branches, ischiadie rami and sacroiliac joints in 24 numbered models of pelvic fracture respectively under the 3D and 2D fluoroscopy navigation. The 3D fluoroscopy navigation was used at the left side in the odd-numbered models and the right side in the even-numbered models while the 2D fluoruscopy navigation was used in the others. The calibration time. image receipt time, screw insertion time, total operative time and screw length were compared between the 2 groups and between diffcrent locations within the 3D group as well. Results The total operative time under 3D navigation （34.8 ±2.9 minutes） was significantly longer than that under 2D navigation （29.8 ±4.5 minutes） （ t = -7. 776, P =0. 000）. There were no significant differences belween the 2 groups in calibration time （ 1. 4± 0.3 minutes versus 1.5 ±0. 3 minales） or in screw insertion time （ 15.9 ±2.0 minutes versus 16. 4±2.5 minutes） （ P 〉 0. 05）. There were significant differences between the 2 groups in images receipt time （13.0±1.8 minutes versus 8.8 ± 1.0 minutes） （t=17.482, P=0.000） and in screw length （94.9±7.8 mm versus 87.8±11.3 mm） （t= - 4. 431, P = 0. 000） . Two screws in the 2D navigation group penetrated the cortex. Conclusions 3D fluoroscopy navigation used for serewing in the treatment of pelvis fractures ean improve accuracy of screw insertion and reduce postoperative complieations. In partic, ular, 3D technique can insert a screw safely, accurately and as long as appropriate.

关 键 词：骨盆 骨折 骨折固定术 骨钉 成像 三维 

分 类 号：R687.3[医药卫生—骨科学]