非透视下三维可视化技术与二维透视在不稳定型骨盆骨折复位中的应用效果比较  

Effectiveness of three-dimensional visible technique without fluoroscopy versus two-dimensional fluoroscopy in reduction of unstable pelvic fractures

作　　者：李嘉琦 陈华[2,3] 张伟 齐红哲 朱正国 常祖豪 祁麟[1,2] 周烽 刘昊扬 唐佩福 LI Jiaqi;CHEN Hua;ZHANG Wei;QI Hongzhe;ZHU Zhengguo;CHANG Zuhao;QI Lin;ZHOU Feng;LIU Haoyang;TANG Peifu(Chinese PLA General Medical School,Beijing,100853,P.R.China;Department of Orthopaedic Trauma,Chinese PLA General Hospital,Beijing,100048,P.R.China;National Clinical Research Center for Orthopaedics&Sports Rehabilitation in China,Beijing,100048,P.R.China;AI Sports Engineering Lab,School of Sports Engineering,Beijing Sport University,Beijing,100084,P.R.China;Chinese PLA Strategic Support Force Characteristic Medical Center,Beijing,100101,P.R.China)

机构地区：[1]中国人民解放军医学院,北京100853 [2]中国人民解放军总医院骨科医学部,北京100048 [3]国家骨科与运动康复临床医学研究中心,北京100048 [4]北京体育大学体育工程学院人工智能体育工程实验室,北京100084 [5]中国人民解放军战略支援部队特色医学中心,北京100101

出　　处：《中国修复重建外科杂志》2023年第2期129-135,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：军队医学科技青年培育计划(拔尖)项目(21QNPY131);军队后勤科技成果扩试项目(145BHQ0003074X);科技创新2030-新一代人工智能重大项目(2021ZD0140410);国家重点研发计划项目(2016YFE0126200)。

摘　　要：目的 比较采用非透视下三维可视化技术与二维透视下不稳定型骨盆骨折复位质量差异。方法 回顾分析2021年6月—2022年9月在3家医学中心采用骨盆解锁闭合复位装置治疗的40例不稳定型骨盆骨折患者临床资料,根据术中辅助复位方式不同分为试验组(n=20)和对照组(n=20)。试验组采用非透视下三维可视化技术辅助复位,对照组采用二维透视下复位。两组患者性别、年龄、损伤机制、骨折Tile分型、创伤严重程度(ISS)评分以及受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05)。记录并比较两组患者术后即刻骨盆骨折复位质量(根据Matta复位标准进行评估)、手术时间、术中出血量、骨折复位时间、术中透视次数和系统可用性量表(SUS)评分差异。结果 两组均顺利完成手术。术后即刻影像学检查示试验组骨折复位质量达优19例(95%),高于对照组13例(65%),差异有统计学意义(χ^(2)=3.906,P=0.048)。两组手术时间和术中出血量比较,差异均无统计学意义(P>0.05);试验组骨折复位时间、术中透视次数低于对照组,SUS评分高于对照组,差异均有统计学意义(P<0.05)。结论 与二维透视相比,非透视下三维可视化技术辅助骨盆解锁闭合复位装置治疗不稳定型骨盆骨折,可在不延长手术时间情况下显著提高不稳定型骨盆骨折复位质量,对于减少患者及医疗工作者的医源性放射损伤具有一定价值。Objective To compare the reduction qualities of three-dimensional visible technique without fluoroscopy and two-dimensional fluoroscopy for unstable pelvic fractures during operations. Methods The clinical data of 40 patients with unstable pelvic fractures, who met the selection criteria in three clinical centers between June 2021and September 2022, were retrospectively analyzed. According to the reduction methods, the patients were divided into two groups. Twenty patients in trial group were treated with unlocking closed reduction system combined with threedimensional visible technique without fluoroscopy;20 patients in control group with unlocking closed reduction system under two-dimensional fluoroscopy. There was no significant difference in the gender, age, injury mechanism, Tile type of fracture, Injury Severity Score(ISS), and the time between injury to operation between the two groups(P>0.05). The qualities of fracture reduction according to the Matta criteria, operative time, intraoperative blood loss, fracture reduction time, times of fluoroscopy, and System Usability Scale(SUS) score were recorded and compared. Results All operations were successfully completed in both groups. According to the Matta criteria, the qualities of fracture reduction were rated as excellent in 19 patients(95%) in trial group, which was better than that in the control group(13 cases, 65%), with a significant difference(χ^(2)=3.906, P=0.048). The operative time and intraoperative blood loss had no significant differences between the two groups(P>0.05). The fracture reduction time and times of fluoroscopy were significantly less in trial group than in control group(P<0.05), and SUS score in trial group was significantly higher in trial group than in control group(P<0.05). Conclusion Compared to using unlocking closed reduction system under two-dimensional fluoroscopy,three-dimensional visible technique without fluoroscopy can significantly improve the reduction quality of unstable pelvic fractures without prolonging the operat

关 键 词：骨盆骨折 不稳定型骨折 闭合复位 三维可视化技术 

分 类 号：R687.3[医药卫生—骨科学]