计算机导航系统辅助骶髂贯穿螺钉植入治疗骨盆后环损伤的早期临床研究  

Early effectiveness of computer navigation system-assisted transiliac-transsacral screws placement for posterior pelvic ring injuries

作　　者：曹文豪 朱正国 齐红哲 汤俊君 张伟 李嘉琦 李双成 王中鹤 李昌达 周锋 刘昊扬 陈华 唐佩福 CAO Wenhao;ZHU Zhengguo;QI Hongzhe;TANG Junjun;ZHANG Wei;LI Jiaqi;LI Shuangcheng;WANG Zhonghe;LI Changda;ZHOU Feng;LIU Haoyang;CHEN Hua;TANG Peifu(Chinese PLA General Hospital Medical School,Beijing,100853,P.R.China;Department of Orthopaedic Trauma,the Fourth Medical Center,Chinese PLA General Hospital,Beijing,100048,P.R.China;Department of Orthopaedics,Aerospace Center Hospital,Beijing,100049,P.R.China;Chinese PLA Strategic Support Force Medical Center,Beijing,100101,P.R.China;AI Sports Engineering Lab,School of Sports Engineering,Beijing Sport University,Beijing,100084,P.R.China;National Clinical Research Center for Orthopaedics&Sports Rehabilitation in China,Beijing,100048,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第四医学中心骨科医学部,北京100048 [3]航天中心医院骨科,北京100049 [4]中国人民解放军战略支援部队特色医学中心,北京100101 [5]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 [6]国家骨科与运动康复临床医学研究中心,北京100048

出　　处：《中国修复重建外科杂志》2023年第9期1049-1054,共6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);科技创新2030-新一代人工智能重大项目(2021ZD0140410)。

摘　　要：目的探讨使用增强现实导航辅助系统HoloSight(以下简称“计算机导航系统”)辅助植入骶髂贯穿螺钉治疗骨盆后环损伤的早期临床疗效。方法回顾性分析2022年6月—2023年6月采用骶髂贯穿螺钉固定治疗的41例骨盆后环损伤患者临床资料,根据辅助植钉方式不同分为导航组(18例,采用计算机导航系统辅助植钉)和徒手组(23例,采用C臂X线机透视引导植钉)。两组患者性别、年龄、身体质量指数、致伤原因、骨盆骨折Tile分型、受伤至手术时间及术中应用骨盆解锁闭合复位技术例数等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较两组患者每枚螺钉的植钉时间、透视次数、导针调整次数及并发症发生情况等;术后2 d内CT扫描骶髂贯穿螺钉位置,根据Gras标准对螺钉位置进行分类。结果两组患者均顺利完成手术。导航组每枚螺钉的植钉时间、透视次数及导针调整次数均少于徒手组,差异有统计学意义(P<0.05)。徒手组有2例患者术后出现切口感染,经积极换药后切口Ⅰ期愈合;导航组术中及术后早期未发生螺钉相关并发症;两组并发症发生率(8.7%vs.0)比较差异无统计学意义(P=0.495)。根据Gras标准,导航组的螺钉位置优于徒手组,差异有统计学意义(P<0.05)。结论与传统徒手方法相比,计算机导航系统辅助植入骶髂贯穿螺钉治疗骨盆后环损伤在提高植钉精准度、减少放射损害和植钉时间方面具有优势。Objective To investigate the early effectiveness of transiliac-transsacral screws internal fixation assisted by augmented reality navigation system HoloSight(hereinafter referred to as“computer navigation system”)in the treatment of posterior pelvic ring injuries.Methods A retrospective analysis was made in the 41 patients with posterior pelvic ring injuries who had been treated surgically with transiliac-transsacral screws between June 2022 and June 2023.The patients were divided into navigation group(18 cases,using computer navigation system to assist screw implantation)and freehand group(23 cases,using C-arm X-ray fluoroscopy to guide screw implantation)according to the different methods of transiliac-transsacral screws placement.There was no significant difference in gender,age,body mass index,causes of injuries,Tile classification of pelvic fracture,days from injury to operation,usage of unlocking closed reduction technique between the two groups(P>0.05).The time of screw implantation,the fluoroscopy times,the guide wire adjustment times of each screw,and the incidence of complications were recorded and compared between the two groups.The position of the transiliac-transsacral screw was scanned by CT within 2 days after operation,and the position of the screw was classified according to Gras standard.Results The operation was successfully completed in both groups.The time of screw implantation,the fluoroscopy times,and the guide wire adjustment times of each screw in the navigation group were significantly less than those in the freehand group(P<0.05).There were 2 cases of incision infection in the freehand group,and the incision healed by first intention after active dressing change;there was no screw-related complication in the navigation group during operation and early period after operation;the difference in incidence of complications between the two groups(8.7%vs.0)was not significant(P=0.495).According to the Gras standard,the screw position of the navigation group was significantly better than th

关 键 词：骨盆骨折 透视导航 骶髂贯穿螺钉 微创治疗 

分 类 号：R687.3[医药卫生—骨科学]