双C型臂X线机引导逆行经皮耻骨上支螺钉置入技术治疗骨盆骨折  

Retrograde percutaneous superior pubic ramus screw fixation guided by double C-arms in the treatment of pelvic fractures

作　　者：黄晨 任亚明 谢美明 徐伟 邓少林 廖冬发 HUANG Chen;REN Ya-ming;XIE Mei-ming;XU Wei;DENG Shao-lin;LIAO Dong-fa(Department of Orthopedics,General Hospital of Western Theater Command,Chengdu,Sichuan,610083,China)

机构地区：[1]西部战区总医院骨科,成都610083

出　　处：《中国骨与关节杂志》2022年第9期690-695,共6页Chinese Journal of Bone and Joint

基　　金：军委后勤保障部面上项目(19BJZ11)。

摘　　要：目的探讨双C型臂X线机引导逆行经皮耻骨上支螺钉置入技术治疗骨盆骨折的可行性、有效性及安全性。方法回顾性分析我院2018年8月至2020年12月采用逆行经皮耻骨上支螺钉置入技术治疗的21例骨盆骨折患者资料,按术中透视是否使用双C型臂X线机分成两组,双C型臂X线机组9例,男7例、女2例;单C型臂X线机组12例,男9例、女3例。记录术中每枚逆行耻骨上支螺钉置入所需透视的次数及手术时间,术后通过骨盆X线片及CT扫描评估螺钉位置的准确性,应用Matta标准评价骨盆骨折复位质量,末次随访时采用Majeed评分评价患者骨折术后功能。结果所有患者均按术前计划顺利完成经皮螺钉固定,双C型臂X线机组共计置入10枚耻骨上支螺钉,置入1枚螺钉所需的手术时间平均为(21.11±6.97)min,所需透视次数(一次透视双C型臂X线机同时曝光)平均为(10.44±3.50)次;单C型臂X线机组共计置入15枚耻骨上支螺钉,置入1枚螺钉所需的手术时间平均为(31.92±9.70)min,所需透视次数平均为(37.08±8.78)次。术后CT平扫提示25枚螺钉均完全位于骨皮质内,采用Matta标准评价骨盆复位质量,两组间骨折复位优良率差异无统计学意义(P>0.05),21例患者术后获得6~12个月随访,所有患者骨折均愈合,无断钉、无骨折再移位。末次随访时Majeed功能评分两组间患者功能优良率差异无统计学意义(P>0.05)。结论双C型臂X线机引导逆行经皮耻骨上支螺钉置入技术术中不需要调节C型臂X线机,每次透视成像恒定,具有高效、安全、可靠的优点。Objective To investigate the feasibility,effectiveness and safety of double C-arms guided retrograde percutaneous superior pubic ramus screw fixation in the treatment of pelvic fractures.Methods We retrospectively reviewed 21 patients with pelvic ring fracture.All were treated with retrograde percutaneous superior pubic ramus screw fixation in our hospital from August 2018 to December 2020.Patients were divided into two groups according to whether to use double C-arms in intraoperative fluoroscopy,including 9 cases in double C-arms group(7 males and 2 females)and 12 cases in single C-arm group(9 males and 3 females).Fluoroscope frequency and operation time required for each retrograde superior pubic ramus screw were recorded.Postoperative pelvic X-ray and CT scan were used to evaluate the accuracy of screw position;the quality of reduction of pelvic fractures was evaluated by Matta standard;at the last follow-up,the Majeed functional score was used to evaluate postoperative function of the patients.Results All patients successfully completed percutaneous screw fixation according to the preoperative plan.In the double C-arms group,10 superior pubic ramus screws were inserted;the average operation time required for one screw was(21.11±6.97)minutes;the average fluoroscope frequency(two C-arms exposed at the same time)was(10.44±3.50).In the single C-arm group,15 superior pubic ramus screws were inserted;the average operation time required for one screw was(31.92±9.70)minutes;the average fluoroscope frequency was(37.08±8.78).Postoperative CT scan revealed that all the 25 screws were completely located in the intraosseous pathway;the quality of pelvic reduction was evaluated by Matta standard;the rate of excellent and good reduction did not differ significantly between the two groups(P>0.05).All patients were followed up for 6-12 months,and all the fractures were healed without screw breakage or loss of reduction.At the last follow-up,Majeed function score showed no statistical significance between the two groups(P

关 键 词：骨盆 X线 骨钉 骨折固定术 内 

分 类 号：R683.3[医药卫生—骨科学]