CAJ | 학술논문

目的探讨术中三维图像导航下经皮骶髂关节螺钉固定术的使用技术.方法 16例骶骨骨折安装定位标记后三维C臂机扫描,获取骨盆三维图像,输出到导航设备后自动进行注册.根据导航探针的指示做皮肤小切口,运用导航电钻经皮钻孔后空心螺钉固定骶髂关节.术毕三维扫描r解内固定情况,术后CT扫描评价螺钉位置.结果所有16例手术20枚螺钉均顺利植入,无术中及术后并发症,所有螺钉均固定至骶1椎体.手术时间平均80 min,术中放射时间平均1.13 min.4例进行了双侧骶髂关节螺钉固定,所需手术时间及术中透视时间较长.术毕三维扫描及术后CT扫描显示所有骨折或脱位复位后位置满意,螺钉的位置均满意.结论术中三维图像导航下的骶髂关节螺钉固定术是可行的.虽然有术中图像质量相对CT较差、手术时间相对较长、需要导航设备等缺点,但相对于传统透视下的方法,它能减少手术中的放射量、提高手术的准确性,是一有效的临床新技术.
목적 탐토술중삼유도상도항하경피저가관절라정고정술적사용기술.방법 16례저골골절안장정위표기후삼유C비궤소묘,획취골분삼유도상,수출도도항설비후자동진행주책.근거도항탐침적지시주피부소절구,운용도항전찬경피찬공후공심라정고정저가관절.술필삼유소묘r해내고정정황,술후CT소묘평개라정위치.결과 소유16례수술20매라정균순리식입,무술중급술후병발증,소유라정균고정지저1추체.수술시간평균80 min,술중방사시간평균1.13 min.4례진행료쌍측저가관절라정고정,소수수술시간급술중투시시간교장.술필삼유소묘급술후CT소묘현시소유골절혹탈위복위후위치만의,라정적위치균만의.결론 술중삼유도상도항하적저가관절라정고정술시가행적.수연유술중도상질량상대CT교차、수술시간상대교장、수요도항설비등결점,단상대우전통투시하적방법,타능감소수술중적방사량、제고수술적준학성,시일유효적림상신기술.
Objective To investigate the effect of a new technique of navigated percutaneous placement of iliosacral screws using intra-operative three-dimensional (3D) imaging. Methods Sixteen patients with hip fracture were placed in supine position. After the reference marker was fixed on the iliac crest,a 3-D C-arm navigation system was used intra-operatively to obtain 3D images that were transferred to the navigation system by an automatic. Registration process to calculate the length of screw and direction to insert it. A navigated pointer defined the entry point,while navigated percutaneous drilling was done accordingly with a navigated drillbit in combination with a navigated drill sleeve under permanent dynamic control on the navigation screen without further intra-operative fluoroscopic imaging. A control intra-operative 3D scan was used to observe the position of the screws,while for didactic reasons another postoperative CT scan was done. Results Twenty screws were successfully inserted into the first sacral vertebral bodies of the 16 patients. No additional intra-operative and postoperative complications occurred. The average operation time was 80 minutes and the average intra-operative radiation time was 1.13 minutes. Four patients underwent bilateral iliosacral fixation with longer operation time (152 minutes) and radiation time (1.56 minutes). The post-operative 3D scanning showed good results. No screws penetrated into the sacral canal or foramen. The reduction of fracture or dislocation and the position of iliosacral screws were all judged satisfactory. Conclusion Compared with the conventional fluoroscopy method,navigated percutaneous placement of iliosacral screws under intra-operative 3D imaging reduces the radiation time and improves the accuracy. It is feasible and useful though there are some disadvantages such as the inferior image quality compared to CT scan,prolonged operation time and higher overall cost.