CAJ | 학술논문

目的探讨术中使用三维“C”型臂透视导航下髋臼骨折微创治疗的安全性及临床疗效.方法2008年8月至2010年12月,对20例无明显移位的髋臼骨折患者采用三维“C”型臂透视导航下经皮微创螺钉内固定治疗,男9例,女11例；年龄26～54岁,平均(37.1±1.2)岁.致伤原因:交通伤15例,高处坠落伤5例.骨折按AO分型:A1.1型2例,A2.2型3例,A2.3型4例,A3.2型2例,A3.3型2例,B1.1型2例,B2.2型2例,B3.1型1例,C2.1型1例,C2.3型1例.结果伤后至入院时间为2～46 h,平均(8.6±0.2)h.入院后行骨牵引3～14 d后手术.术中共置入空心钉46枚,平均每枚置入时间为(22.6±1.2) min.除1枚空心钉因术中采集图像时出现较大偏差需重新置入外,其余均一次性准确置入,成功率为97.8％.置入后术中使用三维“C”型臂进行透视成像验证所有螺钉均未进入关节间隙,与术后CT扫描验证结果一致,符合率100％.术后切口均一期愈合,无内固定失败.20例患者均获得随访,随访时间12～28个月,平均(22.8±1.7)个月.末次随访X线片示骨折愈合,螺钉置入位置满意.结论术中三维透视成像导航下对无明显移位髋臼骨折进行经皮微创内固定,可有效重建髋臼关节面的平整性,提高螺钉置入的精确度,减少切口长度与出血量,降低手术对患者的损害,减少术后并发症的发生,有利于患者功能康复.
목적 탐토술중사용삼유“C”형비투시도항하관구골절미창치료적안전성급림상료효.방법2008년8월지2010년12월,대20례무명현이위적관구골절환자채용삼유“C”형비투시도항하경피미창라정내고정치료,남9례,녀11례；년령26～54세,평균(37.1±1.2)세.치상원인:교통상15례,고처추락상5례.골절안AO분형:A1.1형2례,A2.2형3례,A2.3형4례,A3.2형2례,A3.3형2례,B1.1형2례,B2.2형2례,B3.1형1례,C2.1형1례,C2.3형1례.결과 상후지입원시간위2～46 h,평균(8.6±0.2)h.입원후행골견인3～14 d후수술.술중공치입공심정46매,평균매매치입시간위(22.6±1.2) min.제1매공심정인술중채집도상시출현교대편차수중신치입외,기여균일차성준학치입,성공솔위97.8％.치입후술중사용삼유“C”형비진행투시성상험증소유라정균미진입관절간극,여술후CT소묘험증결과일치,부합솔100％.술후절구균일기유합,무내고정실패.20례환자균획득수방,수방시간12～28개월,평균(22.8±1.7)개월.말차수방X선편시골절유합,라정치입위치만의.결론 술중삼유투시성상도항하대무명현이위관구골절진행경피미창내고정,가유효중건관구관절면적평정성,제고라정치입적정학도,감소절구장도여출혈량,강저수술대환자적손해,감소술후병발증적발생,유리우환자공능강복.
Objective To evaluate the security and effectiveness of minimal invasive fixation with 3D fluoro-images navigation in the management of acetabular fractures.Methods From August 2008 to December 2010,20 patients with acetabular fractures were treated with percutaneous screw fixation under the guidance of 3D fluoro-images based on navigation system after closed reduction.There were 9 males and 11 females,aged 26-54 years old (mean,37.1±1.2 years).Fractures were caused by traffic accident in 15cases,and falling from height in 5 cases.According to AO classification,there were 2 cases of A1.1 type,3 cases of A2.2 type,4 cases of A2.3 type,2 cases of A3.2 type,2 cases of A3.3 type,2 cases of B1.1 type,2 cases of B2.2 type,1 case of B3.1 type,1 case of C2.1 type,1 case of C2.3 type.The interval from injury to hospitalization was 2-46 h (mean,8.6±0.2 h).After 3-14 days of skeletal traction through tibial tubercle,the operation was performed.Results Totally 46 screws were fixed.The average time for surgery was (22.6 ±1.2) min per screw.Forty-five screws were placed correctly with a successful rate of 97.8％,only one screw was reinserted for deviation.All the screws were checked by the 3D fluoro-images that they were not in the joint space after fixation.The result was same with CT scan.No incision problem and implant failure occurred.All 20 patients were followed up 12 to 28 months with an average of (22.8±1.7) months.At last follow-up,fracture union was achieved in all patients with satisfactory screw fixation.Conclusion The minimal invasive fixation with 3D fluoro-images navigation makes the surgery for the nondisplaced acetabular fracture more precise and time-saving,minimize the surgery injury,and improves clinical results without an increasing rate of complications.