局麻下CT导引骶髂螺钉固定治疗DenisⅡ型骶骨骨折疗效分析

Iliosacral screw fixation of Dennis type II sacral fractures using local anaesthesia and computerized tomography

目的探讨局麻下CT导引骶髂螺钉固定治疗DenisⅡ型骶骨骨折的疗效。方法 11例DenisⅡ型骶骨骨折接受局麻下CT导引经皮骶髂螺钉固定。记录患者手术时间、辐射剂量、静脉镇静剂和局麻药的用量,评估在患者清醒状态下对腰骶神经丛的监测能力。结果 11例患者中共置入17枚骶髂螺钉,所有螺钉位置满意。在先期的3例患者中,使用传统的CT扫描参数设定经皮骶髂螺钉固定,每枚螺钉置入接受辐射剂量(DLP)平均为825.75mGY.cm。随后的8例使用CT低剂量扫描方式,每枚螺钉置入DLP平均为105.86mGY.cm。平均每枚螺钉置入手术时间为(30.20±12.51)min,术中疼痛VAS评分平均为6.52±1.80。在患者清醒状态下能有效避免腰骶神经丛损伤。结论局麻下CT导引骶髂螺钉固定治疗DenisⅡ型骶骨骨折,手术操作简单、可行,提高了骶髂螺钉固定的安全性。

Objective To evaluate the technique of percutaneous iliosacral screw fixation of Dennis type Ⅱ sacral fractures using local anaesthesia and computerized tomography. Methods Eleven patients with Dennis type Ⅱ sacral fractures were treated with percutaneous iliosacral screw fixation using local anaesthesia and the CT-guided technique. Time for the procedure, total radiation dosage, amount of local anesthesia and intravenous sedation used were recorded and analyzed. Results A total of seventeen iliosacral screws were well placed in eleven patients. The mean dose-length-product of the procedure in the fist three cases was 825.75 mGY.cm and the others had lower DLP （105.86 mGY.cm）. The mean time for the procedure was （30.20±12.51） mins. The mean pain scale was 6.52±1.80. Conclusions CT-guided iliosacral screw placement is a reliable, safe and feasible technique for Dennis type Ⅱ sacral fracture.