CAJ | 학술논문

目的探讨CT引导下微创导向器辅助经皮骶髂关节螺钉固定的准确性.方法 2011年1月至5月,采用CT引导下微创导向器辅助经皮骶髂关节螺钉固定治疗骶髂关节骨折脱位患者8例,男5例,女3例；年龄26～56岁,平均32岁；均为垂直不稳定骨盆骨折.术前对6例骶髂关节移位超过2 cm的患者行股骨髁上骨牵引,牵引重量为体重的1/8～1/7.在CT操作台的计算机屏幕上进行定位、测量最佳进针轨道后,在患侧臀部标记定位.根据CT扫描确定的进针角度调节导向器角度,沿导向器前端套筒打入克氏针,并顺克氏针拧入7.3 mm的空心螺钉.结果 8例患者均一次操作成功.手术时间10～20 min,平均14 min.术后即刻行CT扫描,确认所有螺钉均位于术前预计的位置并完全位于骨内无穿出,骶髂关节形态恢复满意并得到确切固定.所有患者术中均未诉患侧下肢麻木或放射样疼痛,术后患肢无一例发生血管、神经并发症.结论导向器可避免CT引导下骶髂关节螺钉固定时术者仅凭感觉判断进针角度而造成的偏差,提高了CT引导下骶髂关节螺钉置入的准确性、安全性和简便性.
목적 탐토CT인도하미창도향기보조경피저가관절라정고정적준학성.방법 2011년1월지5월,채용CT인도하미창도향기보조경피저가관절라정고정치료저가관절골절탈위환자8례,남5례,녀3례；년령26～56세,평균32세；균위수직불은정골분골절.술전대6례저가관절이위초과2 cm적환자행고골과상골견인,견인중량위체중적1/8～1/7.재CT조작태적계산궤병막상진행정위、측량최가진침궤도후,재환측둔부표기정위.근거CT소묘학정적진침각도조절도향기각도,연도향기전단투통타입극씨침,병순극씨침녕입7.3 mm적공심라정.결과 8례환자균일차조작성공.수술시간10～20 min,평균14 min.술후즉각행CT소묘,학인소유라정균위우술전예계적위치병완전위우골내무천출,저가관절형태회복만의병득도학절고정.소유환자술중균미소환측하지마목혹방사양동통,술후환지무일례발생혈관、신경병발증.결론 도향기가피면CT인도하저가관절라정고정시술자부빙감각판단진침각도이조성적편차,제고료CT인도하저가관절라정치입적준학성、안전성화간편성.
Objective To investigate the accuracy of percutaneous iliosacral screw fixation in sacroiliac joint fracture-dislocation with minimally invasive guider with CT-guided.Methods From January 2011 to May 2011,8 patients with sacroiliac joint fracture-dislocation were treated using percutaneous iliosacral screw fixation assist with minimally invasive guider in CT-guided,which included 5 males and 3 females,with the average age of 32 years (ranged from 26 to 56 years).All patients suffered with vertically unstable pelvic fractures.Bone traction was used in femoral condyle for 6 cases which displaced more than 2cm in sacroiliac joints.Patients were prone position on the CT bed.First sacroiliac joint CT-scan was performed,then marked the needle position on affected side buttocks after measure the best position and track of needle that expected on CT computer screen.According to the data of CT-scan,the angle of the devices was adjusted,which could control 3D direction of the minimally invasive guider,then insert the Kirschner wire into sacroiliac joint guided with the front end of the sleeve of the minimally invasive guider,confirmed the track of needle was excellent with CT-scan (3D),then the guider was moved out and put the hollow screw (dia 7.3 mm Synthes) into the sacroiliac joint along the Kirschner wire.Results All 8 patients were successfully insert the Kirschner wire.The operation time was from 10 to 20 min (mean,14 min).All screws were in the position expected before surgery,no cut out of bone with the CT-scan immediately after operation,the shape of sacroiliac joint was restored satisfied and the fixation was stable.No numbness and radiation-like pain appeared among the operation in the lower limb for all patients,no case had vascular and neurological complications postoperative.Conclusion The minimally invasive guider can improve the accuracy,security and simplicity of the percutaneous iliosacral screw fixation with CT-guided,and also avoid the deviation of needle insertion angle that determined by operator himself.