普通X线透视与ISO—C^3D计算机辅助导航下骶髂螺钉治疗骨盆后环骨折的对比研究  

Comparison of conventional X-ray fluoroscopy and ISO-C^3D navigation for placement of sacroiliac screws in treatment of posterior pelvic ring fractures

作　　者：何吉亮[1] 周东生[1] 李庆虎[1] 杨永良[1] 穆卫东[1] 王永会[1] 

机构地区：[1]山东大学附属省立医院创伤骨科,济南250021

出　　处：《中华创伤杂志》2013年第8期723-728,共6页Chinese Journal of Trauma

摘　　要：目的比较ISO—C^3D计算机辅助导航与普通C形臂X线机透视下经皮骶髂螺钉治疗骨盆后环损伤的效果。方法回顾性分析2006年6月-2012年1月采用经皮骶髂螺钉微创治疗骨盆后环损伤患者65例，其中男37例，女28例；年龄18～63岁，平均35．9岁。根据骨盆骨折Tile分型：B1型10例，B2型15例，B3型9例，C1型18例，C2型13例。根据术中透视方式的不同，将患者分为ISO—C^3D计算机辅助导航组（A组，35例），C形臂X线机透视组（B组，30例）。记录术中透视时间、每枚螺钉置人时间、骨折复位满意率、骨折愈合时间及术后功能优良率等方面的结果。结果65例患者共置入空心螺钉80枚，A组平均透视时间及置入每枚螺钉平均耗时均低于B组（P〈0．01）。两组骨折复位满意程度的差异无统计学意义。所有患者无感染、血管神经损伤等并发症发生。65例患者均获得随访，时间6～24个月（平均12．7个月），术后6个月两组功能恢复差异无统计学意义。两组骨折均愈合，无延迟愈合或不愈合。结论计算机辅助导航手术与普通X线透视比较，减少了术者X线暴露时间，提高了骶髂螺钉置入准确率。Objective To compare the effect of iSO-C^3D navigation and conventional C-arm fluo- roscopy in iliosacral screws insertion for treatment of posterior pelvic ring injuries. Methods Sixty-five patients with posterior pelvic ring injuries managed by minimally invasive pereutaneous iliosacral screws from June 2006 to January 2012 were reviewed. There were 37 males and 28 females, at age range of 18- 63 years （ mean 35.9 years）. Pelvic fracture classification based on Tile system was type B1 in 10 cases, type B2 in 15, type B3 in nine, type C1 in 18 and type C2 in 13. Patients were divided into ISO-C3D nav- igation group （ Group A, n = 35 ） and C-arm fluoroscopy group （ Group B, n = 30） according to the difference in intraoperative fluoroscopy methods, Intraoperative fluoroscopy time, time cost in inserting a screw, patient satisfaction rate for bone reduction, bone union time and excellent-good rate of postopera- tive function were recorded. Results Eighty eannulated screws were inserted for the 65 patients. Average fluoroseopy time and time cost in inserting a screw were shorter in Group A than in Group B （ P 〈 0. 01 ） , but there was no statistical difference between the two groups in patient satisfaction rate for bone reduction. No patient presented with infection, vascular nerve injury or other complications. Follow-up was 6-24 months （ mean 12.7 months ） for all the patients. Functional recovery showed no statistical difference between the two groups at postoperative 6 months. All fractures were healed and no delayed union or nonunion happened. Conclusion As compared with conventional C-arm fluoroscopy, comput- er-navigated surgery can reduce fluoroscopy time and improve screw insertion accuracy.

关 键 词：骨盆 骨折固定术 内 外科手术 微创性 图像处理 计算机辅助 

分 类 号：R687.3[医药卫生—骨科学]