中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2009年
7期
603-608
,共6页
王军强%赵春鹏%苏永刚%朱仕文%曹奇勇%吴新宝%王满宜%吴伟坚%邓宁%梁国穗
王軍彊%趙春鵬%囌永剛%硃仕文%曹奇勇%吳新寶%王滿宜%吳偉堅%鄧寧%樑國穗
왕군강%조춘붕%소영강%주사문%조기용%오신보%왕만의%오위견%산저%량국수
骨盆%骨折%外科手术%计算机辅助%骨折固定术%内
骨盆%骨摺%外科手術%計算機輔助%骨摺固定術%內
골분%골절%외과수술%계산궤보조%골절고정술%내
Pelvis%Fractures%Surgery,computer-assisted%Fracture fixation,internal
目的 探讨透视导航下经皮螺钉内固定治疗不稳定骨盆骨折的适应证及方法 ,初步评估手术效果. 方法 2006年8月至2008年9月收治16例骨盆骨折患者,根据Tile分型:B2型2例,B3型3例;C2型8例(2例合并髋臼骨折),C3型3例(1例合并髋臼骨折).透视导航经皮骶髂螺钉内固定14例26枚螺钉,耻骨支螺钉9例15枚螺钉,耻骨联合螺钉4例4枚螺钉,髋臼前柱螺钉2例2枚螺钉.术后根据影像资料评估螺钉位置及骨折愈合情况,分别记录骶髂螺钉、耻骨支螺钉、耻骨联合螺钉、髋臼前柱螺钉的平均每枚螺钉置入时间、术中透视时间. 结果 11例患者术后获平均(119.6±2.3)d(63～527 d)随访.骨折愈合时间平均为(67.7±9.7)d.3例患者术后有轻微会阴区及下肢麻木症状,无其他螺钉置入的相关并发症发生.术后X线片及CT确认所有螺钉位置均满意.平均每枚骶髂螺钉、耻骨支螺钉、耻骨联合螺钉、髋臼前柱螺钉的置入时间和术中透视时间分别为(26.39±6.23)、(0.57±0.03)min,(18.20±1.59)、(0.61±0.13)min,(13.70±2.13)、(0.33±0.06)min,(19.40±0.79)、(0.63±0.02)min.结论 不稳定骨盆骨折中的骶髂关节脱位或者骶骨骨折、耻骨支骨折、耻骨联合分离是术中透视影像导航下经皮螺钉固定治疗的适应证,导航下经皮螺钉固定治疗不稳定骨盆骨折具有微创、精确、安全的优点.
目的 探討透視導航下經皮螺釘內固定治療不穩定骨盆骨摺的適應證及方法 ,初步評估手術效果. 方法 2006年8月至2008年9月收治16例骨盆骨摺患者,根據Tile分型:B2型2例,B3型3例;C2型8例(2例閤併髖臼骨摺),C3型3例(1例閤併髖臼骨摺).透視導航經皮骶髂螺釘內固定14例26枚螺釘,恥骨支螺釘9例15枚螺釘,恥骨聯閤螺釘4例4枚螺釘,髖臼前柱螺釘2例2枚螺釘.術後根據影像資料評估螺釘位置及骨摺愈閤情況,分彆記錄骶髂螺釘、恥骨支螺釘、恥骨聯閤螺釘、髖臼前柱螺釘的平均每枚螺釘置入時間、術中透視時間. 結果 11例患者術後穫平均(119.6±2.3)d(63～527 d)隨訪.骨摺愈閤時間平均為(67.7±9.7)d.3例患者術後有輕微會陰區及下肢痳木癥狀,無其他螺釘置入的相關併髮癥髮生.術後X線片及CT確認所有螺釘位置均滿意.平均每枚骶髂螺釘、恥骨支螺釘、恥骨聯閤螺釘、髖臼前柱螺釘的置入時間和術中透視時間分彆為(26.39±6.23)、(0.57±0.03)min,(18.20±1.59)、(0.61±0.13)min,(13.70±2.13)、(0.33±0.06)min,(19.40±0.79)、(0.63±0.02)min.結論 不穩定骨盆骨摺中的骶髂關節脫位或者骶骨骨摺、恥骨支骨摺、恥骨聯閤分離是術中透視影像導航下經皮螺釘固定治療的適應證,導航下經皮螺釘固定治療不穩定骨盆骨摺具有微創、精確、安全的優點.
목적 탐토투시도항하경피라정내고정치료불은정골분골절적괄응증급방법 ,초보평고수술효과. 방법 2006년8월지2008년9월수치16례골분골절환자,근거Tile분형:B2형2례,B3형3례;C2형8례(2례합병관구골절),C3형3례(1례합병관구골절).투시도항경피저가라정내고정14례26매라정,치골지라정9례15매라정,치골연합라정4례4매라정,관구전주라정2례2매라정.술후근거영상자료평고라정위치급골절유합정황,분별기록저가라정、치골지라정、치골연합라정、관구전주라정적평균매매라정치입시간、술중투시시간. 결과 11례환자술후획평균(119.6±2.3)d(63～527 d)수방.골절유합시간평균위(67.7±9.7)d.3례환자술후유경미회음구급하지마목증상,무기타라정치입적상관병발증발생.술후X선편급CT학인소유라정위치균만의.평균매매저가라정、치골지라정、치골연합라정、관구전주라정적치입시간화술중투시시간분별위(26.39±6.23)、(0.57±0.03)min,(18.20±1.59)、(0.61±0.13)min,(13.70±2.13)、(0.33±0.06)min,(19.40±0.79)、(0.63±0.02)min.결론 불은정골분골절중적저가관절탈위혹자저골골절、치골지골절、치골연합분리시술중투시영상도항하경피라정고정치료적괄응증,도항하경피라정고정치료불은정골분골절구유미창、정학、안전적우점.
Objective To discuss operative indications and clinical outcomes of the fluo-roscopy-based computerized navigational system for unstable pelvic fractures. Methods From August 2006 to September 2008, 16 patients with unstable pelvic fractures were treated with pereutaneous screwing under a fluoroscopy-based computer navigation system. According to Tile classification, 2 cases were type B2,3 type B3, 8 type C2, and 3 type C3. Navigated pereutaneons screwing included 26 sacroiliac screws in 14 eases, 15 superior ramus medullary screws in 9 cases, 4 pubic symphysis screws in 4 cases, and 2 anterior column screws in 2 cases. Accuracy of screw placement was verified by radiography and CT scan. Mean time of percutaneous screw implantation and intra-operative fluoroscopic time were recorded for each type to evaluate the procedure. Results Eleven patients were followed up for 119.6 ± 2.3 d. The mean time of bone healing was 67.7 ± 9.7 d. All screws were placed accurately without perforating the cortex. Expect a little numbness in the lower extremities in 3 patients, no eomplication was noted postoperatively. The mean time of navigated screw implantation was 26. 39 ± 6. 23 min for sacroiliac screw, 18.20 ± 1.59 min for superior ramus medullary screw, 13.70 ± 2.13 min for pubic symphysis screw implantation, and 19.40 ± 0.79 min for an-terior column screw. The mean time of intra-operative fluoroscopy was 0. 57 ± 0. 03 min for sacroiliac screw,0.61±0.13 min for superior ramus medullary screw, 0.33±0.06 min for pubic symphysis screw, and 0.63 ± 0.02 min for anterior column screw. Conclusions Percutaneous sacroiliac screwing, superior ramus medullary screwing, pubic symphysis screwing can be performed with assistance of fluoroscopy-based computerized navigation for the treatment of unstable peivie fractures. Though the indications for this procedure are limited, we think it should be applied due to its advantages of less radiation, higher accuracy and greater reliability.
