透视影像导航经皮螺钉内固定治疗不稳定骨盆骨折的初步报告

目的 探讨透视导航下经皮螺钉内固定治疗不稳定骨盆骨折的适应证及方法 ,初步评估手术效果. 方法 2006年8月至2008年9月收治16例骨盆骨折患者,根据Tile分型:B2型2例,B3型3例;C2型8例(2例合并髋臼骨折),C3型3例(1例合并髋臼骨折).透视导航经皮骶髂螺钉内固定14例26枚螺钉,耻骨支螺钉9例15枚螺钉,耻骨联合螺钉4例4枚螺钉,髋臼前柱螺钉2例2枚螺钉.术后根据影像资料评估螺钉位置及骨折愈合情况,分别记录骶髂螺钉、耻骨支螺钉、耻骨联合螺钉、髋臼前柱螺钉的平均每枚螺钉置入时间、术中透视时间. 结果 11例患者术后获平均(119.6±2.3)d(63～527 d)随访.骨折愈合时间平均为(67.7±9.7)d.3例患者术后有轻微会阴区及下肢麻木症状,无其他螺钉置入的相关并发症发生.术后X线片及CT确认所有螺钉位置均满意.平均每枚骶髂螺钉、耻骨支螺钉、耻骨联合螺钉、髋臼前柱螺钉的置入时间和术中透视时间分别为(26.39±6.23)、(0.57±0.03)min,(18.20±1.59)、(0.61±0.13)min,(13.70±2.13)、(0.33±0.06)min,(19.40±0.79)、(0.63±0.02)min.结论 不稳定骨盆骨折中的骶髂关节脱位或者骶骨骨折、耻骨支骨折、耻骨联合分离是术中透视影像导航下经皮螺钉固定治疗的适应证,导航下经皮螺钉固定治疗不稳定骨盆骨折具有微创、精确、安全的优点.

Percutaneous screwing for unstable pelvic fractures with fluoroscopy-bused computerized navigation

Objective To discuss operative indications and clinical outcomes of the fluo-roscopy-based computerized navigational system for unstable pelvic fractures. Methods From August 2006 to September 2008, 16 patients with unstable pelvic fractures were treated with pereutaneous screwing under a fluoroscopy-based computer navigation system. According to Tile classification, 2 cases were type B2,3 type B3, 8 type C2, and 3 type C3. Navigated pereutaneons screwing included 26 sacroiliac screws in 14 eases, 15 superior ramus medullary screws in 9 cases, 4 pubic symphysis screws in 4 cases, and 2 anterior column screws in 2 cases. Accuracy of screw placement was verified by radiography and CT scan. Mean time of percutaneous screw implantation and intra-operative fluoroscopic time were recorded for each type to evaluate the procedure. Results Eleven patients were followed up for 119.6 ± 2.3 d. The mean time of bone healing was 67.7 ± 9.7 d. All screws were placed accurately without perforating the cortex. Expect a little numbness in the lower extremities in 3 patients, no eomplication was noted postoperatively. The mean time of navigated screw implantation was 26. 39 ± 6. 23 min for sacroiliac screw, 18.20 ± 1.59 min for superior ramus medullary screw, 13.70 ± 2.13 min for pubic symphysis screw implantation, and 19.40 ± 0.79 min for an-terior column screw. The mean time of intra-operative fluoroscopy was 0. 57 ± 0. 03 min for sacroiliac screw,0.61±0.13 min for superior ramus medullary screw, 0.33±0.06 min for pubic symphysis screw, and 0.63 ± 0.02 min for anterior column screw. Conclusions Percutaneous sacroiliac screwing, superior ramus medullary screwing, pubic symphysis screwing can be performed with assistance of fluoroscopy-based computerized navigation for the treatment of unstable peivie fractures. Though the indications for this procedure are limited, we think it should be applied due to its advantages of less radiation, higher accuracy and greater reliability.