内置外固定架技术中辅助O-arm导航成像治疗不稳定骨盆骨折

目的: 探讨内置外固定架技术中辅助O-arm导航成像治疗不稳定骨盆骨折的疗效。方法: 2019年5月至2019年11月采用内置外固定架技术术中利用O-arm导航成像治疗15例不稳定骨盆骨折患者,其中男6例,女9例;年龄24~66岁;病程2~14 d。按照Tile分型:B1型1例,B2型8例,C1型3例,C2型3例。依据Young-Burgess分型:LC型8例,APC型1例,VS型4例,CM型2例。术前常规行骨盆正位、入口位、出口位X线片和骨盆CT三维重建检查,术中应用O-arm导航系统三维重建及三平面扫描成像评估术中复位效果,采用内置外固定架固定骨盆前环,骶髂螺钉、钢板螺钉或者腰髂固定后环。观察记录手术时间、术中出血量、置钉情况,采用Matta标准评价骨折复位质量,采用Majeed功能评分评估术后功能情况。结果: 所有患者术后伤口愈合佳,无血管、神经及局部刺激等相关并发症。15例均获得随访,时间10~16个月。按照骨折复位Matta评分,结果优9例,良5例,可1例;术后Majeed功能评分0~95分。结论: 内置外固定架术中辅助O-arm导航成像系统治疗不稳定骨盆骨折,术中提早评估复位效果,缩短手术时间,提高内固定物的准确性,且手术操作简便、安全,手术出血少,手术符合骨科微创医疗原则和精准医疗原则,有利于患者术后功能的恢复,实现快速康复。

Intraoperative assisted O-arm navigation imaging for unstable pelvic fractures in INFIX

Objective: To investigate the effect of internal external fixator assisted O-arm navigation imaging in the treatment of unstable pelvic fractures.Methods: From May 2019 to November 2019,15 patients with unstable pelvic fractures were treated by intraoperative O-arm navigation imaging using INFIX technology. There were 6 males and 9 females. The age ranged from 24 to 66 years old. The course of disease ranged from 2 to 14 days. According to Tile classification,there were 1 case of B1 type,8 cases of B2 type,3 cases of C1 type,and 3 cases of C2 type. According to Young-Burgess classification,there were 8 cases of LC,1 case of APC,4 cases of VS,2 cases of CM. Preoperative routine pelvic anteroposterior film,entrance position,exit position and pelvic CT three-dimensional reconstruction were performed. Intraoperative O-arm navigation system three-dimensional reconstruction and triplane scanning imaging were used to evaluate the effect of intraoperative reduction. The anterior pelvic ring was fixed with internal external fixator,and the posterior ring was fixed with sacroiliac screw,plate screw or lumbar iliac screw. The operation time,intraoperative bleeding and nail placement were observed and recorded. The quality of fracture reduction was evaluated by Matta standard,and the postoperative function was evaluated by Majeed function score.Results: Wound healing was good in all patients without vascular,nerve and local irritation complications. All the 15 patients were followed up for 10 to 16 months. The fracture reduction was evaluated according to the Matta scoring standard,9 cases were excellent results,5 cases were good,and 1 case was medium. The Majeed functional score was 0 to 95 points.Conclusion: The built-in external fixator assisted O-arm navigation imaging system in the treatment of unstable pelvic fractures. The reduction effect is evaluated in advance,the operation time is shortened,and the accuracy of internal fixation is improved. The operation is simple,safe and less bleeding. The operation is in line with the principles of minimally invasive medical treatment and precision medical treatment in orthopedics,which is conducive to the recovery of patients'' postoperative function and rapid recovery.