三维导航与普通透视下微创治疗髋臼骨折的比较研究

目的 比较Iso-C 三维计算机导航辅助下与普通C型臂X线机透视下经皮空心螺钉微创治疗髋臼骨折的效果.方法 回顾性分析2005年6月至2010年12月采用经皮空心螺钉微创治疗的37例髋臼骨折患者资料男23例,女14例,年龄18 ～56岁,平均35.8岁.所有患者均为闭合性髋臼骨折,按照AO分型:A2型9例,A3型18例...     

三维"C"型臂透视导航下治疗髋臼骨折

 目的 探讨术中使用三维野C冶型臂透视导航下髋臼骨折微创治疗的安全性及临床疗效。 方法 2008年 8月至 2010年 12月, 对 20例无明显移位的髋臼骨折患者采用三维野C冶型臂透视导航 下经皮微创螺钉内固定治疗, 男 9例, 女 11例;年龄 26~54岁, 平均(37.1±1.2)岁。致伤原因: 交通伤 15 例, 高处坠落伤 5例。骨折按 AO分型: A1.1型 2例, A2.2型 3例, A2.3型 4例, A3.2型 2例, A3.3型 2例, B1.1型 2例, B2.2型 2例, B3.1型 1例,C2.1型 1例, C2.3型 1例。结果 伤后至入: 时间为 2~46h, 平均(8.6±0.2) h。入: 后行骨牵引 3~14d后手术。术中共置入空心钉 46枚, 平均每枚置入时间 为(22.6±1.2) min。除 1枚空心钉因术中采集图像时出现较大偏差需重新置入外, 其余均一次性准确置 入, 成功率为 97.8%。置入后术中使用三维野C冶型臂进行透视成像验证所有螺钉均未进入关节间隙, 与 术后 CT扫描验证结果一致, 符合率 100%。术后切口均一期愈合, 无内固定失败。 20例患者均获得随 访, 随访时间 12~28个月, 平均(22.8±1.7)个月。末次随访 X线片示骨折愈合, 螺钉置入位置满意。结论 术中三维透视成像导航下对无明显移位髋臼骨折进行经皮微创内固定, 可有效重建髋臼关节面的平整 性, 提高螺钉置入的精确度, 减少切口长度与出血量, 降低手术对患者的损害, 减少术后并发症的发生, 有利于患者功能康复。     

计算机导航辅助下髋臼骨折的微创治疗

目的 探讨计算机导航辅助下对髋臼骨折采用经皮或有限切开复位微创治疗的疗效.方法 2006年6月至2009年10月对17例髋臼骨折患者根据骨折类型和患者一般情况采取闭合或有限切开复位,髋臼前后柱螺钉固定.其中男12例,女5例;年龄19～66岁,平均45.6岁.所有固定柱的空心螺钉均在导航系统指导下置入.术后第2天开始下肢功能锻炼.计算平均置入1枚髋臼前后柱螺钉所需时间、透视次数及新鲜髋臼骨折手术出血量. 结果 本组患者共置入29枚螺钉,平均置入1枚螺钉所需时间为34min,透视次数为29次.新鲜骨折中示切开复位患者出血量低于50 mL,有限切开复位患者出血量平均为350 mL.所有患者术后随访6～60个月,平均30个月.按照Matta功能评分平均为16.1分,优良率为82.4％.按照Matta放射评分优良率为941％.无神经、血管损伤并发症发生. 结论 计算机导航辅助下对髋臼骨折实施闭合复位或者有限切开复位,空心螺钉固定的微创治疗,疗效满意,同时大大减少手术相关并发症.     

3D打印导航模板辅助微创置钉在骨盆骨折合并髋臼骨折内固定术中应用的效果分析

目的 观察3D打印个性化导航模板辅助微创置钉在骨盆骨折合并髋臼骨折内固定术中应用的可行性与效果。方法 回顾性分析自2018-02—2020-03采用手术治疗的93例骨盆骨折合并髋臼骨折,其中45例术中采用3D打印个性化导航模板辅助微创置钉（3D打印组）,48例术中在C型臂X线机透视辅助下徒手置钉（常规组）。比较两组手术时间、术中出血量、导针穿刺次数、术中X线透视次数,术后定期随访观察骨折愈合情况、髋关节功能恢复情况以及并发症发生情况。结果 93例均获得随访,随访时间平均26.8(11～36)个月。所有患者骨折均愈合,未出现感染、骨折延迟愈合、骨折不愈合、内固定失效等并发症。与常规组比较,3D打印组手术时间更短,术中出血量更少,导针穿刺次数、术中X线透视次数也更少,而且末次随访时髋关节功能更优,差异有统计学意义（P<0.05）。结论 与常规C型臂X线机透视辅助徒手置钉比较,3D打印个性化导航模板辅助微创置钉应用于骨盆骨折合并髋臼骨折手术中安全、有效,有助于减少导针穿刺次数与X线透视次数,进而缩短手术时间,同时可明显减少手术创伤,促进患者髋关节功能恢复。     

髋臼骨折术后疗效相关影响因素分析

目的 通过分析髋臼骨折手术治疗患者资料,探讨影响髋臼骨折术后髋关节功能恢复的相关因素.方法 回顾分析2004年9月-2009年6月收治并获随访的82例髋臼骨折患者临床资料.男65例,女17例:年龄26～72岁,平均38岁.致伤原因:交通事故伤62例,压砸伤13例,高处坠落伤7例.其中70例受伤至入院时间为30 min～...     

三维导航下骶髂螺钉固定治疗骨盆后环不稳

目的探讨三维计算机辅助导航技术在骶髂螺钉微创固定中的应用及技术要点。方法回顾性分析2015年3月至2015年12月采用闭合复位、计算机辅助导航下微创行骶髂螺钉内固定手术,10例患者获得随访,其中男6例,女4例;年龄26~58岁,平均41岁;交通事故伤4例,重物压伤3例,高处坠落伤2例,楼道摔伤1例。均伴有其他脏器损伤或其他部位骨折。均采用闭合复位,计算机辅助三维导航下空心钉内固定。结果 10例患者皮肤切口长1~2cm,术后骨盆X线片及三维CT示骨折均获良好复位,螺钉植入位置精确。术后切口均I期愈合,无感染及内固定失败发生,无神经、血管及其他脏器损伤等并发症发生。结论三维导航系统用于骶髂螺钉固定,创伤小、术中失血少、并发症发生率低,手术更加微创精准。     

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.     

计算机辅助导航髋关节周围骨折及骨盆前后环骨折微创固定

目的探讨计算机辅助导航技术在髋关节周围骨折及骨盆前后环骨折微创固定中的应用及技术要点。方法回顾分析2010年5月-2011年5月采用闭合复位、计算机辅助导航微创固定治疗髋关节周围骨折及骨盆前后环骨折,且随访达2年以上的39例患者临床资料。其中男21例,女18例;年龄15~64岁,平均36岁;交通事故伤23例,重物压伤6例,高处坠落伤10例。髋臼骨折6例,股骨颈骨折6例,骶髂关节骨折脱位18例,耻骨联合分离及耻骨支骨折15例。均采用闭合复位或小切口撬拔复位,计算机辅助导航下空心钉内固定。结果术中共植入空心螺钉89枚,其中髋臼8枚,股骨颈18枚,骶髂关节33枚,耻骨联合及耻骨支30枚。每枚螺钉植入时间11~38 min,平均20 min;术中出血10~50 m L,平均20 m L。术后骨盆X线片及三维CT示骨折均获良好复位,螺钉无错误植入。术后切口均I期愈合,无感染及内固定失败发生,无神经、血管及其他脏器损伤等并发症发生。39例患者均获随访,随访时间27~33个月,平均29.6个月。患者于术后6~12周,平均8周开始完全负重行走;末次随访时患者平地步行、单足站立、下蹲等功能恢复良好,均回归正常生活及工作。结论计算机辅助导航微创固定治疗髋关节周围骨折及骨盆前后环骨折具有创伤小、术中失血少、并发症发生率低、术后无需输血、无需使用抗生素、患者恢复快等优点,是治疗髋关节周围骨折及骨盆前后环骨折的一种较好方法。     

CT三维重建在髋臼骨折中的应用

髋臼是形状不规则骨,其某些骨折形式,骨折块在常规髋臼X片上不能得到良好的显示,影响了髋臼骨折的诊断和治疗方案的设计。自1996年,我们给11例髋骨折和髋臼相关骨折病人施行了CT三维重建,结果满意,介绍如下: 一般资料:全部病人均为男性,年龄11～42岁,平均26岁,车祸伤9例,砸轧伤1例,高处坠落伤1例,病情稳定后,均行CT检查,并作三维成像处理,7例手术,4例非手术,效果良好。 成像方法:以髋臼为中心,扫描40层,每层3mm,扫     

重建钢板结合ATMFS治疗复杂髋臼骨折

近年来,随着对髋臼骨折的分类、手术入路、内固定方式的深入研究,特别是重建钢板及记忆合金髋臼三维内固定系统(ATMFS)越来越多地应用于临床,手术治愈率不断提高,通过切开复位治疗有移位复杂髋臼骨折已成为共识,我科自2003年6月至2005年12月对Letournel分类复杂髋臼骨折施行切开复位重建钢板结合ATMFS内固定治疗,疗效满意,现报道如下。临床资料一、一般资料本组12例,其中男10例,女2例。年龄22～56岁,平均35岁。受伤原因:车祸伤8例,坠落伤3例,重物击伤1例。按Letournel分类均为复杂性髋臼骨折,按Letourel-Judet分型:后柱伴后壁骨折2例,…     

3DX线透视影像导航治疗关节内和近关节骨折--早期经验报告

目的利用术中获得的3D透视影像导航关节内和近关节骨折的复位与固定。方法根据标准X线片和3DCT扫描重建图像,进行术前骨折分析。用Stryker导航系统导航胫骨平台骨折、胫骨远端关节内和近关节骨折的复位和固定。结果共治疗了11例胫骨平台骨折、5例Pilon骨折和1例股骨髁部骨折。所有骨折均可经小切口中空螺钉固定主要骨折块。结论联合应用术中3D透视影像和CT的导航系统有助于减少微创技术固定关节内骨折时的X线暴露,其准确性可接受。     

Verletzungen des Azetabulums

Anatomic reduction of the articular surface is essential in the definitive therapy of acetabular injuries. The required surgical approaches with extensive and deep exposure of the adjacent soft tissue may cause additional iatrogenic trauma. Computer-aided navigation based on 2D and 3D fluoroscopy is increasingly being applied for successful percutaneous screw fixation. Non-dislocated or minimally dislocated but unstable fractures are particularly suitable for navigation. The advantages of computer-assisted navigation are the improved accuracy of screw placement and reduced radiation exposure as well as protection of the soft tissue. Therefore, percutaneous navigated screw fixation is a promising alternative to conventional operative procedures in selected acetabular fractures considering the primary goals of anatomic reduction and rigid fixation allowing early exercises.     

透视导航下经皮螺钉固定治疗髋臼骨折

目的探讨导航技术在经皮螺钉固定治疗髋臼骨折中的临床应用。方法2005年5月至2007年8月，使用C臂透视导航设备对带34个髋臼损伤的33例患者行导航下髋臼骨折经皮螺钉固定术。骨折按照AO分型，A3型21个，B1型8个，B2型2个和c1型3个。受伤到手术的平均时间为5．6d（2—8d）。2例患者髋臼骨折需要小切口切开复位。结果共放置空心螺钉43枚，放置1枚空心螺钉平均费时24．6rain，平均X线透视28．4s。将导航下图像与实时C臂机摄片进行对照，放置螺钉后验证位置平均偏差为1．96mm，平均偏差角度为2．45。。术中出血少，其中1枚螺钉出现偏移。术后1例患者出现股神经损伤症状，2个月后恢复，该神经症状与髋臼骨折使用小切口复位有关，与螺钉固定无关。术后无感染及内固定失败。关节功能评分：优25例，良5例，一般3例，优良率91％。结论经皮螺钉固定可以有效早期治疗髋臼损伤，透视导航技术可使螺钉固定的安置更加准确和安全，既减少了手术和X线暴露时间，又有利于患者早期的康复治疗。     

Periazetabuläre Navigation

Following a period of conservative treatment of acetabular fractures in the past, the use of classifications and defined acetabular surgery indications was introduced because of an increasing number of extended surgical approaches for operative stabilization of acetabular fractures. This development has enabled minimally invasive procedures using three-dimensional (3D) visualization and navigation techniques in the operating room (OR), with the expectation of reduced intraoperative morbidity and optimized surgical precision. Most common in acetabular navigation is 3D C-arm-based navigation, which has enabled new techniques in combination with other modern OR systems. In special cases, techniques based on computed tomography and 2D C-arms are still used.     

Percutaneous screw fixation of acetabular fractures with 2D fluoroscopy-based computerized navigation

Introduction

The treatment of displaced acetabular fractures with formal open reduction and internal fixation has gained general acceptance. However, extensile exposure can lead to complications. Two-dimensional fluoroscopy-based computerized navigation for placement of percutaneous screw across non-displaced acetabular fractures has attracted interest by making use of stored patient-specific imaging data to provide real-time guidance in multiple image planes during implant placement. The purpose of the present study was to document early treatment results and complications associated with this new technique and evaluate its clinical application to displaced acetabular fractures amenable to closed or limited open reduction.

Materials and methods

Eighteen adult patients with 12 non-displaced and 8 displaced acetabular fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system. There were 14 men and four women with a mean age of 42.1 years (range 19–54 years). According to the AO and Orthopaedic Trauma Association Classification, there were nine 62-A3, five 62-B1, three 62-B2, and three 62-B3. The mean follow-up was 21 months (range 12–28 months). The mean time from injury to surgery was 4 days (range 2–7 days).

Results

A total of 30 acetabular screws were inserted, including 21 anterior column screws and 9 posterior column screws. The average operation time was 24.6 min (range 16–47 min) from the image acquisition to wound closure. The average fluoroscopic time was 28.4 s (range 11–58 s). Compared to the final position of the screw, the average deviated distance of wire tip was 2.5 mm (range 1.1–3.6 mm) and the average trajectory difference was 2.45° (range 1.5°–4.6°). Maximal gap displacement averaged 10 mm (range 2–22 mm) preoperatively and 3 mm (range 0–5 mm) postoperatively; while maximal step displacement averaged 4 mm (range 1–10 mm) preoperatively and 2 mm (range 0–4 mm) postoperatively. One patient sustained a transient femoral nerve palsy and resolved 2 months after the operation. No superficial or deep infection occurred. Using the rating system of D’Aubigne and Postel, 13 patients had excellent results, 4 patients had good results, and 1 patient had a fair result.

Conclusion

Percutaneous screw fixation of acetabular fractures with 2D fluoroscopy-based navigation could be applied not only to non-displaced fractures but also to displaced fractures amenable to closed or limited open reduction.     

Perkutane navigierte Ballonreposition einer dislozierten Acetabulumfraktur

Kyphoplasty is a well proven surgical procedure for osteoporotic fractures in spine surgery. Anatomic reconstruction of the joint is the primary aim in the treatment of acetabular fractures. To achieve this, extensive approaches with entry related morbidity are usually needed. Percutaneous stabilisations are still limited for non- or minimally displaced fractures.For displaced acetabular fractures, there are percutaneous procedures described with intraoperative CT control or by the use of a 3D C-arm. The case of an anterior column posterior hemitranverse fracture with an articular step in the weight bearing area is presented. In this case, a kyphoplasty balloon was placed by use of 3D C-arm navigation. After 2D C-arm controlled fracture reduction, the supra-acetabular screw was inserted percutaneously using the previous 3D navigation data set.With the combination of kyphoplasty technique, intraoperative 3D C-arm control and 3D C-arm based navigation, this displaced acetabular fracture could be reduced and fixed percutaneously. Anatomic reconstruction of the joint remains the primary aim.     

Image guidance in pelvic and acetabular surgery--expectations, success and limitations

During the last decade navigation techniques in pelvic and acetabular surgery have been described. Nowadays, available techniques include CT-based navigation, 2D C-arm navigation and 3D C-arm navigation. The main indication is the navigated percutaneous SI screw fixation, but acetabular screw fixations are also reported. In this article, based upon a literature review and our own clinical experiences, the indications for and limitations of navigated techniques in pelvic and acetabular surgery are described.     

Minimalinvasive Beckenchirurgie

The pelvis is the mechanical connection between the lower extremities and the spinal column. The aim of surgical treatment for pelvic and acetabular injuries is to compensate the strong mechanical forces needed here, without compromising wound healing and restricting muscle function due to additional soft tissue damage. In recent years, minimally invasive stabilizing techniques, which reduce surgical risks and recovery time as well as improving outcomes, have become increasingly established. The increased use of improved imaging modalities also plays a significant role here. Surgical errors can be avoided in the osteosynthesis of acetabular fractures by means of intraoperative visualization using 3D image converters. Navigated percutaneous pelvic sacroiliac screw fixation is the main procedure to be used for pelvic and acetabular navigation. New software enables a 2D representation of the hip area and a 3D calculation of instrument and implant positions, thereby reducing X-ray exposure and increasing intraoperative safety.     

BK 2112 Gonarthrose

This article presents an overview of the possibilities of navigated procedures in pelvic ring and acetabular fractures from our experimental and clinical experiences. First of all, various navigated procedures for sacroiliac (SI) screw fixation were assessed in cadaveric studies (n=80 screws) and compared with the conventional technique. Subsequently, clinical comparison was made of the 2D fluoroscopic navigated procedure (n=35) and the conventional technique (n=23) and by a retrospective survey all SI screw fixations from a 7-year period conducted in our hospital (n=139) were analyzed. Experimental studies in human cadaveric models (n=10 screws) for supra-acetabular percutaneous screw placement (parallel to the quadrilateral surface) via 3D-fluoroscopic navigated procedure were performed and compared with clinical case studies. Conclusion: we found a significant prolongation of the procedural time for navigated inserted iliosacral screws in comparison to those that were inserted by the conventional technique. In contrast, intraoperative fluoroscopic exposure time was decreased by approximately 50% by using the navigated technique. Furthermore, the failure rate in screw positioning was around four times higher using the conventional technique versus the navigated procedure. The failure rate increased significantly according to the practical experience of the surgeon. For acetabular surgery the 2D-fluoroscopic based navigation is a helpful tool, whereas the 3D-fluoroscopic navigation procedure reveals a high learning curve. While navigated iliosacral screw fixation is well-established, the use of navigation in acetabular surgery will remain limited, for the time being, to individual cases.