术中三维图像导航下的经皮骶髂关节螺钉固定

目的 探讨术中三维图像导航下经皮骶髂关节螺钉固定术的使用技术.方法 16例骶骨骨折安装定位标记后三维C臂机扫描,获取骨盆三维图像,输出到导航设备后自动进行注册.根据导航探针的指示做皮肤小切口,运用导航电钻经皮钻孔后空心螺钉固定骶髂关节.术毕三维扫描r解内固定情况,术后CT扫描评价螺钉位置.结果 所有16例手术20枚螺钉均顺利植入,无术中及术后并发症,所有螺钉均固定至骶1椎体.手术时间平均80 min,术中放射时间平均1.13 min.4例进行了双侧骶髂关节螺钉固定,所需手术时间及术中透视时间较长.术毕三维扫描及术后CT扫描显示所有骨折或脱位复位后位置满意,螺钉的位置均满意.结论 术中三维图像导航下的骶髂关节螺钉固定术是可行的.虽然有术中图像质量相对CT较差、手术时间相对较长、需要导航设备等缺点,但相对于传统透视下的方法,它能减少手术中的放射量、提高手术的准确性,是一有效的临床新技术.

Navigated percutaneous placement of iliosacral screws using intra-operative three-dimensional imaging

Objective To investigate the effect of a new technique of navigated percutaneous placement of iliosacral screws using intra-operative three-dimensional (3D) imaging. Methods Sixteen patients with hip fracture were placed in supine position. After the reference marker was fixed on the iliac crest,a 3-D C-arm navigation system was used intra-operatively to obtain 3D images that were transferred to the navigation system by an automatic. Registration process to calculate the length of screw and direction to insert it. A navigated pointer defined the entry point,while navigated percutaneous drilling was done accordingly with a navigated drillbit in combination with a navigated drill sleeve under permanent dynamic control on the navigation screen without further intra-operative fluoroscopic imaging. A control intra-operative 3D scan was used to observe the position of the screws,while for didactic reasons another postoperative CT scan was done. Results Twenty screws were successfully inserted into the first sacral vertebral bodies of the 16 patients. No additional intra-operative and postoperative complications occurred. The average operation time was 80 minutes and the average intra-operative radiation time was 1.13 minutes. Four patients underwent bilateral iliosacral fixation with longer operation time (152 minutes) and radiation time (1.56 minutes). The post-operative 3D scanning showed good results. No screws penetrated into the sacral canal or foramen. The reduction of fracture or dislocation and the position of iliosacral screws were all judged satisfactory. Conclusion Compared with the conventional fluoroscopy method,navigated percutaneous placement of iliosacral screws under intra-operative 3D imaging reduces the radiation time and improves the accuracy. It is feasible and useful though there are some disadvantages such as the inferior image quality compared to CT scan,prolonged operation time and higher overall cost.