CT引导下微创导向器在经皮骶髂关节螺钉固定中的初步应用

 目的 探讨CT引导下微创导向器辅助经皮骶髂关节螺钉固定的准确性。方法 2011年 1月至 5月, 采用 CT引导下微创导向器辅助经皮骶髂关节螺钉固定治疗骶髂关节骨折脱位患者 8例, 男 5例, 女 3例;年龄 26~56岁, 平均 32岁;均为垂直不稳定骨盆骨折。术前对 6例骶髂关节移位超过 2 cm的患者行股骨髁上骨牵引, 牵引重量为体重的 1/8~1/7。在 CT操作台的计算机屏幕上进行定位、测量最佳进针轨道后, 在患侧臀部标记定位。根据 CT扫描确定的进针角度调节导向器角度, 沿导向器前 端套筒打入克氏针, 并顺克氏针拧入 7.3 mm的空心螺钉。结果 8例患者均一次操作成功。手术时间 10~20 min, 平均 14 min。术后即刻行 CT扫描, 确认所有螺钉均位于术前预计的位置并完全位于骨内无 穿出, 骶髂关节形态恢复满意并得到确切固定。所有患者术中均未诉患侧下肢麻木或放射样疼痛, 术后患肢无一例发生血管、神经并发症。结论 导向器可避免 CT引导下骶髂关节螺钉固定时术者仅凭感觉判断进针角度而造成的偏差, 提高了CT引导下骶髂关节螺钉置入的准确性、安全性和简便性。

The clinical application of minimally invasive guider with CT-gulded in percutaneous iliosacral screw fixation

Objective To investigate the accuracy of percutaneous iliosacral screw fixation in sacroiliac joint fracture-dislocation with minimally invasive guider with CT-guided.Methods From January 2011 to May 2011,8 patients with sacroiliac joint fracture-dislocation were treated using percutaneous iliosacral screw fixation assist with minimally invasive guider in CT-guided,which included 5 males and 3 females,with the average age of 32 years (ranged from 26 to 56 years).All patients suffered with vertically unstable pelvic fractures.Bone traction was used in femoral condyle for 6 cases which displaced more than 2cm in sacroiliac joints.Patients were prone position on the CT bed.First sacroiliac joint CT-scan was performed,then marked the needle position on affected side buttocks after measure the best position and track of needle that expected on CT computer screen.According to the data of CT-scan,the angle of the devices was adjusted,which could control 3D direction of the minimally invasive guider,then insert the Kirschner wire into sacroiliac joint guided with the front end of the sleeve of the minimally invasive guider,confirmed the track of needle was excellent with CT-scan (3D),then the guider was moved out and put the hollow screw (dia 7.3 mm Synthes) into the sacroiliac joint along the Kirschner wire.Results All 8 patients were successfully insert the Kirschner wire.The operation time was from 10 to 20 min (mean,14 min).All screws were in the position expected before surgery,no cut out of bone with the CT-scan immediately after operation,the shape of sacroiliac joint was restored satisfied and the fixation was stable.No numbness and radiation-like pain appeared among the operation in the lower limb for all patients,no case had vascular and neurological complications postoperative.Conclusion The minimally invasive guider can improve the accuracy,security and simplicity of the percutaneous iliosacral screw fixation with CT-guided,and also avoid the deviation of needle insertion angle that determined by operator himself.