三维透视断层成像导航下微创治疗髋臼骨折初步报道

MINIMAL INVASIVE FIXATION FOR ACETABULAR FRACTURE WITH THREE DIMENSIONAL FLUORO-IMAGES BASED ON NAVIGATION

目的探讨术中三维透视断层成像导航下髋臼骨折微创治疗的安全性及临床疗效。方法 2008年8月-2010年1月,对12例无明显移位的髋臼骨折患者采取三维透视断层成像导航下经皮微创螺钉内固定治疗。其中男7例,女5例;年龄28～57岁,平均38.1岁。致伤原因:交通事故伤9例,高处坠落伤3例。骨折按AO分型:A2.2型1例,A2.3型3例,A3.2型2例,A3.3型2例,B2.2型1例,B3.2型1例,C2.1型1例,C2.3型1例。伤后至入院时间为4 h～3 d,平均1.2 d。结果术中共植入空心螺钉28枚,平均每枚植入时间为24.8 min。除1枚空心螺钉因术中采集图像时出现较大偏差,需重新植入,余均一次性准确植入,成功率为96.4%。术中三维透视断层成像验证所有螺钉均未突入关节间隙,与术后CT扫描结果一致。术后切口均Ⅰ期愈合,无内固定失败。12例均获随访,随访时间7～24个月,平均16.8个月。末次随访X线片示骨折均愈合,螺钉植入位置满意。结论术中三维透视断层成像导航下对无明显移位的髋臼骨折进行经皮微创螺钉内固定,可有效重建髋臼关节面的平整性,提高螺钉植入的精确度,减少切口长度及出血量,降低手术对患者的损伤,减少术后并发症,有利于患者功能康复。

Objective To evaluate the security and effectiveness of minimal invasive fixation with three dimensional（3D） fluoro-images based on navigation system in the management of acetabular fractures.Methods Between August 2008 and January 2010,12 patients with acetabular fractures were treated with percutaneous screw fixation under the guidance of 3D fluoro-images based on navigation system after closed reduction.There were 7 males and 5 females,aged 28-57 years（mean,38.1 years）.Fractures were caused by traffic accident in 9 cases,and falling from height in 3 cases.According to AO classification,there were 1 case of A2.2 type,3 cases of A2.3 type,2 cases of A3.2 type,2 cases of A3.3 type,1 case of B2.2 type,1 case of B3.2 type,1 case of C2.1 type,and 1 case of C2.3 type.The interval from injury to hospitalization was 4 hours to 3 days（mean,1.2 days）.Results Totally 28 screws were implanted.The average time to implant 1 screw was 24.8 minutes.Twenty-seven screws were placed correctly with a successful rate of 96.4%,only 1 screw was reinserted for deviation.All the screws were checked by the 3D fluoro-images,which showed they were not in the joint space after fixation.The results were the same as that by CT scanning.Incisions healed by first intention,and no implant failure occurred.All 12 patients were followed up 7 to 24 months with an average of 16.8 months.At last follow-up,fracture union was achieved in all patients with satisfactory screw fixation.Conclusion The minimal invasive fixation with 3D fluoro-images based on navigation system makes the surgery for the nondisplaced acetabular fracture more precise and time-saving,minimizes the surgery injury,and improves the clinical results with less complications.