2D导航辅助经皮骶髂螺钉治疗骨盆后环骨折经验分析

目的:观察C型臂透视2D导航引导下经皮骶髂螺钉治疗骨盆后环不稳定型骨折的手术安全性和临床效果。方法:2011年1月-2013年12月采用二维透视导航辅助经皮置入骶髂螺钉治疗C型(Tile分型)骨盆骨折患者22例,其中交通伤16例,坠落伤4例,重物砸伤2例。伤后就诊时间5 h~12d(平均20 h)。按照骨盆骨折Tile分型:B3.3型1例,C1.2型8例,C1.3型12例,C3.3型1例。其中伴有休克2例,腹部损伤3例,尿道损伤4例,脊柱损伤5例,骶神经损伤1例,胫骨骨折2例。结果:建立导航系统耗时13~30 min(平均18.50±6.20 min),每枚螺钉置入耗时15~25 min(平均17.50±7.20 min),置入每枚螺钉出血量约20 m L。所有患者螺钉置入位置均较满意,无穿透椎弓根或椎体骨皮质进入骶孔、骶管和前方的盆腔等现象出现,无伤口感染发生。采用Matta评分标准评价骨折复位情况:优15例,良5例,可2例。采用Majeed评分行功能评价:优13例,良6例,可3例。结论:采用导航下骶髂螺钉固定技术能够有效恢复骨盆后环稳定性,但需要手术者熟练掌握骨盆解剖结构及生物力学特点,有效增加手术准确性,避免副损伤。

Fluoro-navigation Screw Fixation for the Treatment of Posterior Pelvic Ring Injuries

Objective:To evaluate the application of fluoroscopy navigation-assisted percutaneous screw fixation of unstable posterior pelvic ring trauma.Methods:From January 2011 to December 2013, 22 patients with posterior pelvic ring injuries were included. All patients were treated with percutaneous screw fixation using an optoelectronic fluoroscopy navigation system. In all the 22 patients, 16 were injured by traffic accident, 4 were injured by high-altitude falling and 2was injured by crashing object. According to Tile classification, there were 1 cases ofB 3.3 type, 8 cases ofC 1.2 type, 12 cases of C 1.3 type, 1 cases ofC 3.3 type.Results:Mean operation time for each screw was 18.50± 6.20 min. The mean blood loss for each screw was 20 mL. The postoperative X ray and three dimensional CT showed that the fractures had good reduction and all the screws had good position. No screw misplacement and no wound infections was observed. Using the rating system of Matta, 15 patients had excellent results, 5 patients had good results, and 2 patients had a fair result. According to Majeed functional scoring, 13 patients had the excellent results, 6 patients had good results, and 3 patients had fair results.Conclusion:Our results showed that fluoroscopy-based navigation technique for the pelvic ring injuries could become a safe and effective method for the treatment of posterior pelvic ring injuries.