透视导航下微创手术治疗骨盆前环骨折

Minimally invasive surgery under fluoro-navigation for fractures of anterior pelvic ring

目的探讨导航技术在手术治疗骨盆前环骨折中的初步临床应用结果。方法2005年1-10月，采用C型臂透视导航设备行导航下骨盆前环骨折内固定术18例，包括27处骨折。对导航下行骨盆前环骨折手术患者的相关资料进行统计。结果术中共置人27枚空心钉，其中每枚空心钉的平均置人时间为23．1min，X线透视时间平均为18．9s。将导航下图像与真实C型臂机摄片进行对照，放置空心钉后验证位置平均偏差距离为（3．38±1．04）mm，平均偏差角度为2．86。±1．78。。术中出血量极少（〈22．1mL／枚），术中1枚（3．7％）螺钉出现偏移。术后无感染及内固定失败等并发症发生。术后平均随访时间为16．6个月（12—18个月）。术后1年对所有患者进行短期骨骼肌肉功能调查问卷：功能评分平均为64．26分，烦恼指数评分平均为65．83分。结论使用透视导航技术手术治疗骨盆前环骨折，手术更精确、安全，可以减少手术时间和X线暴露时间；但若要在创伤骨科手术中更好地应用透视导航技术，则需制定标准化操作程序，完善术前培训。

Objective To investigate the clinical results of fluoro-navigated surgery for anterior pelvic ring fractures. Methods From January to October in 2005, a fluoro-navigation system was used to guide the placement of the screws for the fixation of anterior pelvic ring fractures. There were totally 18 patients, 11 males and 7 females. Totally 27 screws were inserted, involving pubic rami and anterior acetabular columns. Results The average time for operation was 23.1 minutes/per screw, and the average time of X-ray exposure was 18.9 seconds/per screw. The images of fluoro-navigation were compared with the real X-rays during and after surgery. The mean deviated distance was 3.38 ± 1.04 mm and the mean deviated angle was 2. 86± 1.78 degrees in the postoperative verification. The blood loss during the operation was minimal（ 〈 22. 1 mL/per screw）. One （3.7%） screw deviated out of the fracture during the operation. No complication was recorded after surgery. Conclusions Fluoro-navigation makes the surgery for the anterior pelvic ring fractures more precise, safe and time-saving, and reduces X-ray exposure at the same time. Standardization of operative procedures and preoperative training are mandatory for success.