ISO-C^(3D)计算机辅助导航技术经皮微创内固定治疗髋臼骨折  

Minimally invasive percutaneous fixation based on ISO-C^(3D) computerized navigational system for fracture of the acetabulum

作　　者：马玉鹏[1] 周东生[1] 李连欣[1] 穆卫东[1] 何吉亮[1] 李庆虎[1] 

机构地区：[1]山东大学附属省立医院创伤骨科,山东省济南市250021

出　　处：《中国组织工程研究》2013年第52期9023-9028,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:文献报道采用X射线透视下经皮空心螺钉治疗骨盆髋臼骨折,但其内固定时间长,且患者与医生的放射暴露量大。目的:评价ISO-C3D计算机辅助导航微创技术在髋臼骨折治疗中的应用效果。方法:采用计算机辅助导航下经皮微创内固定治疗骨盆髋臼骨折31例,患者伤后至内固定时间为4-13 d。所有患者随访满1年。结果与结论:患者内固定治疗中除1例伴有骶髂关节损伤行切开复位内固定患者出血量约300 mL,其余患者平均出血量18 mL。内固定中共置入螺钉42枚,髋臼前柱骨折螺钉24枚,后柱螺钉18枚,所有螺钉均一次性准确置入。平均内固定时间59 min,平均透视时间为39 s。31例患者治疗后1周疼痛明显减轻,均无感染、血管神经损伤、内固定物断裂等并发症发生。至随访结束,摄X射线片示骨折愈合,无螺钉断裂及松动,根据Matta临床评分标准,优23例,良8例,优良率100%。内固定后髋关节功能根据Majeed评分系统:优22例,良6例,可3例,优良率90%。提示ISO-C3D计算机辅助导航技术经皮微创内固定治疗可实现坚强内固定,且治疗中创伤小,内固定后并发症较少。BACKGROUND：Percutaneous hol ow screw under X-Ray fluoroscopy has been shown to treat fracture of acetabulum of the pelvis, but the time of internal fixation was long, and the amount of radiation exposure to the patients and physicians was large. OBJECTIVE：To test the application of the ISO-C3D METHODS：Thirty-one patients with fracture of the acetabulum were treated with percutaneous hol ow screw under a fluoroscopy-based ISO-C computerized navigational system for fracture of acetabulum. 3D computerized navigational system. The interval from injury to operation was 4 to 13 days. Al patients were fol owed up for one year. RESULTS AND CONCLUSION：The average bleeding volume during operation was only 18 mL, except that the bleeding volume of only one patient, who suffered from the sacroiliacjoint injury and received open reduction and internal fixation, was up to 300 mL. The total number of screws used in the operation was 42, among which 24 were screws for acetabular anterior column fracture and 18 for posterior column fracture. Al screws were implanted once precisely. The average time of internal fixation was 59 minutes, and the mean time for fluoroscopy was 39 seconds. The 31 patients were pain-free one week after the operation and no complication （infection, vascular nerve injury or implant breakage） was noted post-operatively. When the fol ow-up ended, radiography revealed fracture union with satisfactory screw fixation （no screw breakage or loosening）. According to Matta functional scoring, results were excellent in 23 cases, good in 8 cases, with an excellent and good rate of 100%. According to Majeed functional scoring, the results were excellent in 22 cases, good in 6 cases and average in 3 cases, with an excellent and good rate of 90%. These results indicated that ISO-C3D computerized navigational system can supply stable internal fixation without an increase of complication.

关 键 词：骨关节植入物 数字化骨科 骨盆骨折 计算机辅助导航 经皮内固定 微创手术 髋臼骨折 

分 类 号：R318[医药卫生—生物医学工程]