CAJ | 학술논문

目的：探讨计算机辅助三维(threedimensional，3D)导航引导下经皮骶髂螺钉固定骨盆后环损伤的安全性和治疗效果。方法2009年3月至2012年12月，采取3D透视导航经皮置入骶髂螺钉治疗骨盆后环损伤患者18例：其中男13例，女5例，年龄23～61岁(平均40.2岁)；交通伤12例，坠落伤5例，房屋倒塌砸伤1例。伤后就诊时间3 h至5天(平均25 h )。按照AO损伤分型：B 1.2型3例，B 2.2型2例， C1.2型7例，C1.3型5例，C2.3型1例。结果术中置入共计40枚骶髂螺钉，每枚螺钉置入耗时20～38(29.12±3.00) min，每枚螺钉术中透视时间3.5～5.2(4.55±0.80) min，每枚螺钉出血量约10～20 ml。所有患者螺钉置入位置均较为满意，无穿透骨质进入关节腔及骶管现象出现，无伤口感染发生，术后均未出现明显神经系统并发症。采用Matta评分标准评价损伤复位情况：优12例，良5例，可1例，总体优良率94%。采用Majeed骨盆损伤量化评估体系进行功能评价：优11例，良7例，总体优良率100%。结论计算机辅助3D导航下经皮骶髂螺钉置入提供了一种治疗骨盆后环损伤安全有效的技术选择。
목적：탐토계산궤보조삼유(threedimensional，3D)도항인도하경피저가라정고정골분후배손상적안전성화치료효과。방법2009년3월지2012년12월，채취3D투시도항경피치입저가라정치료골분후배손상환자18례：기중남13례，녀5례，년령23～61세(평균40.2세)；교통상12례，추락상5례，방옥도탑잡상1례。상후취진시간3 h지5천(평균25 h )。안조AO손상분형：B 1.2형3례，B 2.2형2례， C1.2형7례，C1.3형5례，C2.3형1례。결과술중치입공계40매저가라정，매매라정치입모시20～38(29.12±3.00) min，매매라정술중투시시간3.5～5.2(4.55±0.80) min，매매라정출혈량약10～20 ml。소유환자라정치입위치균교위만의，무천투골질진입관절강급저관현상출현，무상구감염발생，술후균미출현명현신경계통병발증。채용Matta평분표준평개손상복위정황：우12례，량5례，가1례，총체우량솔94%。채용Majeed골분손상양화평고체계진행공능평개：우11례，량7례，총체우량솔100%。결론계산궤보조3D도항하경피저가라정치입제공료일충치료골분후배손상안전유효적기술선택。
Objective To explore the safety and treatment outcomes of the application of three-dimensional ( 3D ) lfuoroscopic navigation in percutaneous iliosacral screw ifxation for posterior pelvic ring injuries.Methods From March 2009 to December 2012, 18 patients with posterior pelvic ring injuries underwent percutaneous iliosacral screw ifxation using an optoelectronic 3D lfuoroscopic based navigation system. There were 13 males and 5 females, whose average age was 40.2 years old ( range: 23-61 years ). Fractures were caused by trafifc accidents in 12 cases, high falling injuries in 5 cases and collapsed building in 1 case. The interval from injury to hospitalization was 25 hours on average ( range: 3 hours-5 days ). According to AO classiifcation, there were 3 cases of type B 1.2, 2 cases of type B 2.2, 7 cases of type C 1.2, 5 cases of type C 1.3 and 1 case of type C 2.3.Results A total of 40 iliosacral screws were inserted during the operation, which took a mean period of ( 29.12±3.00 ) min per screw ( range: 20-38 min ). The mean lfuoroscopy time was ( 4.55±0.80 ) min per screw ( 3.5-5.2 min ), and the blood loss ranged from 10 ml to 20 ml per screw. The screw position was satisfactory in all the patients, without breaking into the sclerotin or entering the articular cavity or the sacral canal. No wound infections or obvious neurological complications were found. Based on the Matta scoring system, excellent results were seen in 12 patients, good results in 5 patients and a fair result in 1 patient, and the overall excellent and good rate was 94%. According to the Majeed functional scoring, the results were excellent in 11 cases and good in 7 cases, with the overall excellent and good rate of 100%.Conclusions The technique of 3D lfuoroscopic navigation is safe and effective in percutaneous iliosacral screw ifxation for posterior pelvic ring injuries.