O臂导航与C臂导航辅助下经皮加长骶髂螺钉内固定治疗DenisⅡ区骶骨骨折疗效比较  

O-arm navigation versus C-arm navigation for guiding percutaneous long sacroiliac screws placement in treatment of Denis type Ⅱ sacral fractures

作　　者：周唯[1] 汪国栋 裴璇 方志勋 陈煜 包苏要拉吐 陈嘉楠 刘曦明 ZHOU Wei;WANG Guodong;PEI Xuan;FANG Zhixun;CHEN Yu;BAO Suyaolatu;CHEN Jianan;LIU Ximing(Department of Spine Surgery,Wuhan Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine(Affiliated Hospital of Wuhan Sports University),Wuhan Hubei,430081,P.R.China;Department of Orthopedics,General Hospital of Central Theater Command of Chinese PLA,Wuhan Hubei,430070,P.R.China;College of Acupuncture and Orthopedics,Hubei University of Chinese Medicine,Wuhan Hubei,430065,P.R.China)

机构地区：[1]武汉中西医结合骨科医院(武汉体育学院附属医院)脊柱外科,武汉430081 [2]中国人民解放军中部战区总医院骨科,武汉430070 [3]湖北中医药大学针灸骨伤学院,武汉430065

出　　处：《中国修复重建外科杂志》2024年第1期28-34,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：卫勤保障能力创新与生成专项(20WQ034);2021年度湖北省卫生健康委员会首届转化医学项目(WJ2021ZH0010)。

摘　　要：目的比较O臂导航与C臂导航辅助下经皮加长骶髂螺钉内固定治疗DenisⅡ区骶骨骨折的疗效。方法采用回顾性研究分析2021年4月—2022年10月收治的46例DenisⅡ区骶骨骨折患者临床资料。其中,19例采用O臂导航系统(O臂导航组)、27例采用C臂导航系统(C臂导航组)辅助下经皮植入加长骶髂螺钉。两组患者性别、年龄、致伤原因、骨盆骨折Tile分型、合并伤发生情况以及受伤至手术时间比较,差异均无统计学意义(P>0.05)。记录并比较两组导航辅助系统准备时间、每枚骶髂螺钉植入时间及X线透视时间、螺钉位置准确性、骨折复位质量及愈合时间,观察术后并发症发生情况。末次随访时,采用Majeed评分标准评定骨盆功能。结果两组手术均顺利完成,术后切口均Ⅰ期愈合。与C臂导航组相比,O臂导航组术中导航辅助系统准备时间、每枚螺钉植入时间与X线透视时间均缩短(P<0.05),且螺钉位置准确性及骨盆复位质量差异无统计学意义(P>0.05)。两组螺钉植入时均未出现神经、血管损伤。所有患者均获随访,随访时间6~21个月,平均12.0个月。影像学复查示,两组骨折均达骨性愈合,骨折愈合时间组间差异无统计学意义(P>0.05);随访期间无螺钉松动退出、断裂以及骨折复位丢失等并发症发生。末次随访时,两组骨盆功能Majeed评分比较差异均无统计学意义(P>0.05)。结论与C臂导航辅助植钉相比,O臂导航辅助下经皮加长骶髂螺钉内固定治疗DenisⅡ区骶骨骨折可明显缩短术中准备时间、螺钉植入时间以及X线透视时间,能提高操作精度,导航图像更清晰。Objective To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis typeⅡsacral fractures.Methods A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022.Among them,19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation(O-arm navigation group),and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation(Carm navigation group).There was no significant difference in gender,age,causes of injuries,Tile classification of pelvic fractures,combined injury,the interval from injury to operation between the two groups(P>0.05).The intraoperative preparation time,the placement time of each screw,the fluoroscopy time of each screw during placement,screw position accuracy,the quality of fracture reduction,and fracture healing time were recorded and compared,postoperative complications were observed.Pelvic function was evaluated by Majeed score at last follow-up.Results All operations were completed successfully,and all incisions healed by first intention.Compared to the C-arm navigation group,the Oarm navigation group had shorter intraoperative preparation time,placement time of each screw,and fluoroscopy time,with significant differences(P<0.05).There was no significant difference in screw position accuracy and the quality of fracture reduction(P>0.05).There was no nerve or vascular injury during screw placed in the two groups.All patients in both groups were followed up,with the follow-up time of 6-21 months(mean,12.0 months).Imaging re-examination showed that both groups achieved bony healing,and there was no significant difference in fracture healing time between the two groups(P>0.05).During follow-up,there was no postoperative complications,such as screw loosening and breaking or loss of fracture reduction.At last follow-up,there was no significant difference in pelvic function be

关 键 词：骶骨骨折 C臂导航系统 O臂导航系统 骶髂螺钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]