CAJ | 학술논문

背景:移位的髋臼骨折常需要切开复位内固定手术治疗.广泛的手术暴露可以产生许多并发症.经皮螺钉置入内固定髋臼骨折可以减少这些并发症.计算机辅助透视导航技术可以提高螺钉固定的精确度以及减少X射线透视的时间.目的:评估在透视导航指引下经皮螺钉置入内固定髋臼骨折的临床应用结果.方法:使用C臂透视导航设备对伴有20个髋臼损伤的18例患者行导航下髋臼骨折经皮螺钉置入内固定.采集图像后在导航下按照损伤部位分为髋臼前柱骨折和髋臼后柱骨折,分别采用不同的空心螺钉固定.置入后第2天开始进行静力性肌肉收缩以及限制性主动和被动关节活动,4周后开始部分负重锻炼.观察螺钉置入时间,验证螺钉位置偏差,观察螺钉生物相容性及置入后不良反应,随访时进行d'Aubigne and Postel评分.结果与结论:放置空心螺钉30枚.置入中每枚空心螺钉放置平均时间为24.1 min,X射线图像采集平均27.6 s.将导航下图像与真实C臂机射片进行对照,螺钉置入后验证位置平均偏差为1.5 mm,平均偏差角度为2.25°.置入后1例患者出现股神经损伤症状,2个月后恢复,该神经症状与髋臼骨折使用有限切开复位有关,与螺钉置入固定无关.置入后无感染及内固定失败.d'Aubigne and Postel评分优13例,良4例,一般1例,优良率94%.结果证实,对于无移位或移位后能够闭合复位或有限切开复位的髋臼骨折透视导航下经皮螺钉置入内固定技术能够成为一种安全有效的骨折固定方法.
배경:이위적관구골절상수요절개복위내고정수술치료.엄범적수술폭로가이산생허다병발증.경피라정치입내고정관구골절가이감소저사병발증.계산궤보조투시도항기술가이제고라정고정적정학도이급감소X사선투시적시간.목적:평고재투시도항지인하경피라정치입내고정관구골절적림상응용결과.방법:사용C비투시도항설비대반유20개관구손상적18례환자행도항하관구골절경피라정치입내고정.채집도상후재도항하안조손상부위분위관구전주골절화관구후주골절,분별채용불동적공심라정고정.치입후제2천개시진행정력성기육수축이급한제성주동화피동관절활동,4주후개시부분부중단련.관찰라정치입시간,험증라정위치편차,관찰라정생물상용성급치입후불량반응,수방시진행d'Aubigne and Postel평분.결과여결론:방치공심라정30매.치입중매매공심라정방치평균시간위24.1 min,X사선도상채집평균27.6 s.장도항하도상여진실C비궤사편진행대조,라정치입후험증위치평균편차위1.5 mm,평균편차각도위2.25°.치입후1례환자출현고신경손상증상,2개월후회복,해신경증상여관구골절사용유한절개복위유관,여라정치입고정무관.치입후무감염급내고정실패.d'Aubigne and Postel평분우13례,량4례,일반1례,우량솔94%.결과증실,대우무이위혹이위후능구폐합복위혹유한절개복위적관구골절투시도항하경피라정치입내고정기술능구성위일충안전유효적골절고정방법.
BACKGROUND:The treatment of displaced acetabular fractures consists of formal open reduction and internal fixation.However,extensile exposure can lead to a lot of complications Percutaneous screw fixation for acetabukar fractures can decrease these complications Recently developed fluoroscopic-based computerized navigation technology not only allows the surgeon to achieve maximum accuracy of screw fixation but also significantly reduce radiation exposure time.OBJECTIVE:To evaluate the clinical application of the fluoroscopic-based computerized navigation system for percutaneous screwing for acetabular fractures.METHODS:A total of 18 adult patients with 20 non-displaced and displaced acetabular fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system.All acetabular fractures were acetabular anterior column fractures and posterior column fractures,which were fixed by varied hollow screws Static muscle contraction and limited active and passive motion were performed at 2 days,and weight-bearing exercise was performed at 4 weeks after operation.The time of screw implantation,screw position deviation,screw biocompatibility,as well as adverse effect after screw implantation was observed.In addition.d'Aubigne and Postel scoring was used in follow-up.RESULTS AND CONCLUSION:A total of 30 acetabular screws were inserted.The average operation time for per screw was24.1 minutes from the image acquisition to wound closure.The average fluoroscopic time for per screw was 27.6 seconds.Compared to the final position of the screw,the average wire tip error was 1.5 mm and the average trajectory difference was2.25°.One patient sustained a transient femoral nerve palsy which was attribute to reduction clamp inserting from the use of the limited open reduction method rather than screw fixation itself and resolved 2 months after the operation.No evidence was noted of secondary displacement of the fragment or screw failure Using the rating system of d'Aubigne and Postel,13 patients had excellent results,4 patients had good results,and 1 patient had a fair result.The excellent to good rate was 94%All results demonstrated that percutaneous screw fixation of acetabular fractures with fluoroscopy-based navigation can produce excellent results in selected patients with non-displaced and displaced fracture amenable to closed or limited open reduction,which becomes a safe and effective alternative to traditional open reduction and internal fixation for the treatment of certain acetabular fractures.