CAJ | 학술논문

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,B1型10例,根据术中透视导航方式不同将患者分为C型臂X线机透视组(A组,16例)和Iso-C三维导航组(B组,21例).记录并比较两组患者手术时间、每枚螺钉置入时间、术中透视时间、复位满意率、骨折愈合时间及术后功能优良率. 结果 37例患者中共置入空心螺钉49枚,两组平均手术时间[(78.4±2.4) min vs.(73.1±2.0) min],差异无统计学意义(t=1.751,P=0.088);而B组平均术中透视时间[(43.9±0.3)s vs.(63.2±2.9)s]和每枚螺钉平均置入时间 [(28.1±1.3)min vs.(376±1.8)min]均少于A组,差异有统计学意义(P＜0.05).术后根据Matta评分标准:优25例,良10例,可2例,优良率为94.6％.34例患者获得随访,时间6～18个月,平均12.4个月.末次随访X线片示骨折愈合,螺钉无松动及脱出.术后半年根据Majeed 疗效评价标准进行功能评估:优19例,良11例,中2例,差2例,优良率为88.2％.两组患者复位满意率(93 8％vs.95.2％)、骨折平均愈合时间[(12.1±0.5)周vs.(1.6±0.3)周]、功能满意率(86.7％ vs.89.5％)差异均无统计学意义(P＞0.05).两组患者骨折均愈合,无延迟愈合或不愈合.结论计算机导航辅助手术具有微创、精确的特点,患者和医护人员更加安全,是治疗无移位或移位经牵引能复位的髋臼骨折的一种有效的方法.
목적 비교Iso-C 삼유계산궤도항보조하여보통C형비X선궤투시하경피공심라정미창치료관구골절적효과.방법 회고성분석2005년6월지2010년12월채용경피공심라정미창치료적37례관구골절환자자료남23례,녀14례,년령18 ～56세,평균35.8세.소유환자균위폐합성관구골절,안조AO분형:A2형9례,A3형18례,B1형10례,근거술중투시도항방식불동장환자분위C형비X선궤투시조(A조,16례)화Iso-C삼유도항조(B조,21례).기록병비교량조환자수술시간、매매라정치입시간、술중투시시간、복위만의솔、골절유합시간급술후공능우량솔. 결과 37례환자중공치입공심라정49매,량조평균수술시간[(78.4±2.4) min vs.(73.1±2.0) min],차이무통계학의의(t=1.751,P=0.088);이B조평균술중투시시간[(43.9±0.3)s vs.(63.2±2.9)s]화매매라정평균치입시간 [(28.1±1.3)min vs.(376±1.8)min]균소우A조,차이유통계학의의(P＜0.05).술후근거Matta평분표준:우25례,량10례,가2례,우량솔위94.6％.34례환자획득수방,시간6～18개월,평균12.4개월.말차수방X선편시골절유합,라정무송동급탈출.술후반년근거Majeed 료효평개표준진행공능평고:우19례,량11례,중2례,차2례,우량솔위88.2％.량조환자복위만의솔(93 8％vs.95.2％)、골절평균유합시간[(12.1±0.5)주vs.(1.6±0.3)주]、공능만의솔(86.7％ vs.89.5％)차이균무통계학의의(P＞0.05).량조환자골절균유합,무연지유합혹불유합.결론 계산궤도항보조수술구유미창、정학적특점,환자화의호인원경가안전,시치료무이위혹이위경견인능복위적관구골절적일충유효적방법.
Objective To compare isocentric C-arm 3-dimensional (Iso-C 3D) navigation and conventional C-arm fluoroscopy in percutaneous screw fixation for acetabular fractures. Methods From June 2005 to December 2010,37 patients (23 males and 14 females) with acetabular fracture were treated through percutaneous screw fixattion technique.Their average age was 35.8 years (from 18 to 56 years).According to AO classification,9 cases were of A2 type,18 cases of A3 type, and 10 cases of B1 type.They were assigned into 2 groups.In Group A of 16 cases,the cannulated screws were inserted with assistance of C-arm fluoroscopy,while in Group B of 21 cases,the operations were assisted by Iso-C 3D navigation system.Average operation time,average radiation time,average screw fixation time,average bone union time,functional recovery and satisfactory reduction rate were recorded and compared between the 2 groups.Results Altogether 49 cannulated screws were inserted in 37 patients.No complication was noted in any patient postoperatively.By Matla evaluation sysem,the operations were rated as excellent in 25,good in 10and fair in 2,with a good to excellent rate of 94.6％.Thirty-four patients were followed up for 6 to 18 months (average,12.4 months).The average screw fixation time (28.1 ± 1.3 minutes vs.37.6 ± 1.8 minutes) and the average radiation time (43.9 ± 0.3 seconds vs.63.2 ± 2.9 seconds) were significantly shorter in Group B than in Group A ( P ＜ 0.05).There were no significant between-group differences in average operation time (78.4 ±2.4 minutes vs.73.1 ± 2.0 minutes),satisfactory reduction rate (93.8％ vs.95.2％ ),average bone union time (12.1 ± 0.5 weeks vs.11.6 ± 0.3 weeks) or satisfactory functional recovery rate (86.7％vs.89.5％ ) ( P ＞ 0.05).Functional recovery by Majeed evaluation system after 6 months showed 9 excellent cases,11 good cases,2 fair cases and 2 poor cases,with a good to excellent rate of 88.2％ and no between-group difference.All fractures were healed,and no delayed union or nonunion happened. Conclusions Percutaneous screw fixation under Iso-C 3D navigational system is not only minimally invasive and precise but also safer to the patient and medical staff.It is a reliable method of treating undisplaced or mildly displaced acetabular fractures.