CAJ | 학술논문

目的探讨计算机辅助骨科手术导航系统(CAOS)在芦山地震骨盆骨折治疗中的应用.方法回顾性分析2013年4月20日至5月3日芦山地震中应用CAOS引导下手术治疗的6例骨盆骨折患者资料,男3例,女3例；年龄20 ～54岁,平均39.7岁.骨折按Tile分类:B型2例,C型4例.合并伤:双侧胫骨开放性骨折1例,肋骨骨折2例,股骨骨折3例,腰椎骨折2例,髌骨、肱骨骨折各1例,皮肤挫裂伤5例.6例患者于伤后3～10d(平均6d)均在CAOS引导下行手术治疗.术后复查骨盆X线片,并根据Matta标准评定疗效. 结果 6例患者共置入空心钉11枚,其中骶髂螺钉6枚(S15枚,S2l枚),耻骨支螺钉5枚(顺行2枚,逆行3枚).所有患者手术均顺利,术中无明显神经及血管损伤,术中置入每枚螺钉的平均出血量约为20 mL,术中平均总出血量为110 mL,术中平均置入每枚螺钉的透视时间为10 s,平均手术时间为110 min,术后复查骨盆X线片示骨折均复位满意,根据Matta标准评定疗效:优4例,良2例.手术切口均一期愈合,无切口感染、深静脉血栓形成、多器官功能障碍综合征等并发症发生. 结论 CAOS引导下手术由于其微创、术中出血量少、手术准确度高、术中透视时间短、手术时间相对较短等特点,可有效进行严重骨盆损伤、多发伤患者的损伤控制,可早期固定骨折,是治疗地震伤骨盆骨折的一种可行、安全、有效的方法.
목적 탐토계산궤보조골과수술도항계통(CAOS)재호산지진골분골절치료중적응용.방법 회고성분석2013년4월20일지5월3일호산지진중응용CAOS인도하수술치료적6례골분골절환자자료,남3례,녀3례；년령20 ～54세,평균39.7세.골절안Tile분류:B형2례,C형4례.합병상:쌍측경골개방성골절1례,륵골골절2례,고골골절3례,요추골절2례,빈골、굉골골절각1례,피부좌렬상5례.6례환자우상후3～10d(평균6d)균재CAOS인도하행수술치료.술후복사골분X선편,병근거Matta표준평정료효. 결과 6례환자공치입공심정11매,기중저가라정6매(S15매,S2l매),치골지라정5매(순행2매,역행3매).소유환자수술균순리,술중무명현신경급혈관손상,술중치입매매라정적평균출혈량약위20 mL,술중평균총출혈량위110 mL,술중평균치입매매라정적투시시간위10 s,평균수술시간위110 min,술후복사골분X선편시골절균복위만의,근거Matta표준평정료효:우4례,량2례.수술절구균일기유합,무절구감염、심정맥혈전형성、다기관공능장애종합정등병발증발생. 결론 CAOS인도하수술유우기미창、술중출혈량소、수술준학도고、술중투시시간단、수술시간상대교단등특점,가유효진행엄중골분손상、다발상환자적손상공제,가조기고정골절,시치료지진상골분골절적일충가행、안전、유효적방법.
Objective To report our clinical experience of using computer-aided orthopedic surgery (CAOS) in the treatment of patients with pelvic fracture who had been injured in the earthquake at Yaan,Lushan,Sichuan,China.Methods From 20 April to 3 May,2013 we treated 6 patients with pelvic fracture using CAOS in the Lushan earthquake rescue.They were 3 men and 3 women,aged from 20 to 54years (average,39.7 years).By the Tile classification,there were 2 cases of type B and 4 cases of type C.One case was complicated with open fractures of bilateral tibias,2 with costal fracture,3 with femoral fracture,2 with lumbar fracture,one with patellar fracture,one with humeral fracture,and 5 with skin contusion.The 6 patients received surgery under computer-aided navigation system 3 to 10 days after injury (average,6days).X-ray follow-ups of the pelvis were conducted post-surgery and the therapeutic effects were assessed by the Matta criteria.Results Altogether 11 cannulated screws were implanted,including 6 sacroiliac screws (5 S1 ones and one S2) and 5 pubic ramus screws (2 antegrade ones and 3 retrograde ones).All the surgeries went on uneventfully with no neurovascular injury.The average amount of bleeding for each cannulated screw was 20 mL.The total intraoperative bleeding ranged from 60 to 200 mL,averaging 110 mL.The time of radiation exposure for each screw averaged 10 seconds and the operative time 110 minutes.Postoperative review of the pelvic X-ray films showed satisfactory fracture reduction.Four cases were rated as excellent and 2 as good.All the surgical wounds healed primarily with no wound infection,deep vein thrombosis,multiple organ dysfunction syndrome or other complications.Conclusion CAOS is a feasible,safe and effective method for treatment of pelvic fractures in an earthquake rescue not only because it has common advantages of minimal invasion,high accuracy,less radiation exposure,shorter operative time and early stabilization but also because it can provide damage control for the patients who have been severely injured in the earthquake.