术前CT模拟指导下行经皮微创螺钉内固定术治疗骶骨骨折的置钉准确度及安全性评估  

Nailing accuracy and safety of CT simulation-guided percutaneous minimally invasive screw internal fixation before surgery in the treatment of sacral fractures

作　　者：林有志 任璐 鄂正康 王宸 齐宝军 陈龙飞 赵金廷 Lin Youzhi;Ren Lu;E Zhengkang;Wang Chen;Qi Baojun;Chen Longfei;Zhao Jinting(Department of Orthopedics,Kaifeng Central Hospital,Kaifeng,Henan 475000,China;The Second Department of Ophthalmology,Kaifeng Eye Disease Hospital,Kaifeng,Henan 475000,China)

机构地区：[1]开封市中心医院骨科一病区,河南开封475000 [2]开封市眼病医院眼二科,河南开封475000

出　　处：《创伤外科杂志》2023年第10期773-780,共8页Journal of Traumatic Surgery

基　　金：开封市科技发展计划项目(1603012)。

摘　　要：目的探究CT模拟指导下行经皮微创螺钉内固定术治疗骶骨骨折的置钉准确度及安全性,并基于多准则决策进行效益-风险评价。方法回顾性分析2019年2月—2022年3月开封市中心医院骨科收治骶骨骨折患者84例,根据术前是否进行CT模拟指导分为分为术前CT模拟指导经皮微创螺钉内固定术为CT模拟组(49例)和经皮微创螺钉内固定术为对照组(35例)。CT模拟组男性27例,女性22例;年龄23~80岁,平均49.6岁;对照组男性19例,女性16例;年龄25~79岁,平均50.3岁。高处坠落伤29例,挤压伤9例,道路交通伤44例,其他2例。比较两组患者手术相关指标以及术后不良事件发生率;建立术前CT模拟指导下行经皮微创螺钉内固定术治疗骶骨骨折的多准则决策模型,并对两组效益值、风险值及决策模型的稳定性进行评价。结果CT模拟组手术时长、术中透视时间、术中出血量、骨愈合时间、住院时间、术中每枚螺钉置入时间与对照组相比较明显减少[(77.3±13.9)min vs.(90.3±12.1)min、(6.2±0.8)s vs.(7.1±0.9)s、(86.2±9.0)mL vs.(97.3±8.9)mL、(3.2±0.5)个月vs.(3.5±0.6)个月、(9.6±2.5)d vs.(13.3±2.6)d、(15.4±2.8)min vs.(20.0±3.6)min,P<0.05];CT模拟组的螺钉位置与术前规划符合率、螺钉长度与术前规划符合率、Matta评分优良率、Majeed功能评分、Gibbons评分明显优于对照组[(100%,49/49)vs.(82.9%,29/35)、(100%,49/49)vs.(85.7%,30/35)、(91.8%,45/49)vs.(74.2%,26/35)、(86.7±10.0)分vs.(79.7±9.8)分、(1.1±0.6)分vs.(2.9±0.3)分,P<0.05];CT模拟组不良事件发生率(10.2%,5/49)显著低于对照组(37.1%,13/35),P<0.05;效益指标中对患者病情影响最大的是螺钉位置与术前规划符合率和螺钉长度与术前规划符合率,风险指标影响较大是螺钉切出骨皮质和固定松动、脱出;CT模拟组和对照组治疗骶骨骨折效益值分别为80和67,风险值分别为70和53,综合效益和风险值发现CT模拟组治疗法的效益-风险值Objective Methods A retrospective analysis was conducted on 84 patients with sacral fractures admitted to the Department of Orthopedics,Kaifeng Central Hospital from Feb.2019 to Mar.2022.All the patients received percutaneous minimally invasive screw internal fixation.Based on whether CT simulation was performed before surgery or not,patients were divided into CT simulation group(n=49)or control group(n=35).In the CT simulation group,there were 27 males and 22 females aged 23-80 years,mean 49.6 years;in the control group there were 19 males and 16 females aged 25-79 years,mean 50.3 years.For the whole study group,the causes of injuries included falls from height in 29 cases,crush injuries in 9 cases,road traffic accidents in 44 cases,and others in 2 cases.Surgery-related indicators and the incidence of adverse events were collected and a multi-criterion decision-making model for the treatment of sacral fractures by percutaneous minimally invasive screw internal fixation under the guidance of preoperative CT simulation was established to evaluate the benefit value,risk value and stability of the decision-making model.Results Compared with the control group,the CT simulation group revealed much shorter operation time(min,77.3±13.9 vs.90.3±12.1)and intraoperative fluoroscopy durations(s,6.2±0.8 vs.7.1±0.9),less intraoperative blood loss(mL,86.2±9.0 vs.97.3±8.9),quicker bone healing(months,3.2±0.5 vs.3.5±0.6),shorter hospital stay(d,9.6±2.5 vs.13.3±2.6)and quicker intraoperative placement of each screw(min,15.4±2.8 vs.20.0±3.6),all P<0.05.Moreover,the coincidence rates of screw location[100%(49/49)vs.82.9%(29/35)]and screw length[100%(49/49)vs.85.7%(30/35)]with the preoperative planning,good and excellent rate by Matta score[(91.8%(45/49)vs.74.2%(26/35)],Majeed function score(86.7±10.0 vs.79.7±9.8)and Gibbons score(1.1±0.6 vs.2.9±0.3)of the CT simulation group were significantly higher than those of the control group(all P<0.05),and the incidence of adverse events was much lower[10.2%(5/49)vs.37.1%(13

关 键 词：骶骨骨折 经皮微创螺钉内固定术 CT模拟 置钉准确度 安全性 

分 类 号：R687.3[医药卫生—骨科学]