三维图像导航与C型臂X线机透视下经皮螺钉内固定治疗骶髂关节复合体损伤的比较研究  

Three-dimensional images navigation versus C-arm fluoroscopy for guiding percutaneous screw placement in treatment of sacroiliac complex injury

作　　者：王小阵 汪国栋[1] 孟乘飞[1] 王锋[1] 刘曦明[1] 蔡贤华[1] 

机构地区：[1]广州军区武汉总医院骨科,武汉430070 [2]湖北中医药大学,武汉430071

出　　处：《中国矫形外科杂志》2017年第12期1062-1066,共5页Orthopedic Journal of China

基　　金：湖北省自然科学基金项目(编号:2014CFC1052);湖北省卫生计生西医类一般项目(编号:WJ2015MB119)

摘　　要：[目的]比较三维图像导航与C型臂X线机透视下经皮置入骶髂关节螺钉治疗骶髂关节复合体损伤的疗效。[方法]回顾性分析2010年6月~2016年5月采用经皮螺钉内固定治疗的47例骶髂关节复合体损伤患者的病例资料,根据辅助置钉的方式不同分为导航组(30例)和透视组(17例)。记录并比较两组术中置入每枚螺钉X线暴露时间、置入时间、螺钉的长度、脱位或骨折复位满意程度、损伤愈合时间及术后功能优良率。[结果]47例患者共置入55枚螺钉,导航组与透视组平均X线暴露时间、每枚螺钉平均置入时间及置入螺钉的长度,两组间比较差异具有统计学意义(P<0.05)。术后复查X线片,根据Matta评分标准评定,两组患者复位满意程度差异无统计学意义(P>0.05)。术后6个月根据Majeed疗效评定标准进行功能评估,两组功能恢复差异无统计学意义(P>0.05)。[结论]三维图像导航下置钉具有精确、安全等特点,与C型臂X线机透视相比,减少了透视时间,提高了置钉优良率,是治疗骶髂关节复合体损伤的一种有效方法。[Objective] To compare the efficacy of three-dimensional images navigation with C-aim fluoroscopy for guid- ing percutaneous placement of sacroiliac joint screws in treatment of sacroiliac complex injury. [MethodsJ From June 2010 to May 2016, 47 patients with sacroiliac complex injury were treated with percutaneous screws fixation technique. They were as- signed into the navigation group and fluoroscopy group. In the navigation group （n=30 cases）, the eannulated screws were in- serted with assistance of three-dimensional images navigation, while in the fluoroscopy groups （n=17 cases）, the operations were assisted by C-arm X-ray fluoroscopy. Intraoperative average screw X-ray exposure time, average screw fixation time, average length of screw, the reduction degree of dislocation or fracture, healing time and satisfactory rate were recorded amt compared between the two groups. [Results] All patients received 7-24 months follow-up with an average of 13.6 months. A total of 55 cannulated screws were inserted in 47 patients. Average X-ray exposure time and average screw fixation time of navi- gation group were less than that of the fluoroscopy group, the differences were statistically significant （P 〈 0.05） . The aver- age length of screw also showed significant difference between two groups （P 〈 0.05） . No statistically significant difference was found in reduction according to the Matta criteria on assessment of X-ray flint （P 〉 0.05） , additionally, no statistically significant difference at 6 month postoperatively was noted either based on Majeed function assessment between the two groups （P〉 0.05） . [Conclusions] Compared with C-arm fluoroseopy technique, three-dimensional images navigation techniquedoes reduce the time of X-ray exposure, improve of the screw placement. Therefore, it is one of the methods for treatment of sacroiliac complex injury.

关 键 词：骶髂关节复合体 损伤 三维图像 计算机辅助 微创性 X线透视 

分 类 号：R687.3[医药卫生—骨科学]