三维导航与普通透视下微创治疗髋臼骨折的比较研究

Iso-C 3D navigation versus conventional C-arm fluoroscopy in minimally invasive treatment of acetabular fractures

目的比较Iso-C三维计算机导航辅助下与普通C型臂X线机透视下经皮空心螺钉微创治疗髋臼骨折的效果。方法回顾性分析2005年6月至2010年12月采用经皮空心螺钉微创治疗的37例髋臼骨折患者资料，男23例，女14例；年龄18-56岁，平均35．8岁。所有患者均为闭合性髋臼骨折，按照AO分型：A2型9例，A3型18例，B1型10例，根据术中透视导航方式不同将患者分为C型臂X线机透视组（A组，16例）和Iso-C三维导航组（B组，21例）。记录并比较两组患者手术时间、每枚螺钉置入时间、术中透视时间、复位满意率、骨折愈合时间及术后功能优良率。结果37例患者中共置入空心螺钉49枚，两组平均手术时间[（78．4±2．4）min vs．（73．1±2．0）min]，差异无统计学意义（t=1．751，P=0．088）；而B组平均术中透视时间[（43．9±0．3）s vs．（63．2±2．9）s]和每枚螺钉平均置入时间[（28．1±1．3）min vs．（37．6±1．8）min]均少于A组，差异有统计学意义（P〈0．05）。术后根据Matta评分标准：优25例，良10例，可2例，优良率为94．6％。34例患者获得随访，时间6-18个月，平均12．4个月。末次随访X线片示骨折愈合，螺钉无松动及脱出。术后半年根据Majeed疗效评价标准进行功能评估：优19例，良11例，中2例，差2例，优良率为88．2％。两组患者复位满意率（93．8％vs.95．2％）、骨折平均愈合时间[（12．1±0．5）周vs.（11．6±0．3）周]、功能满意率（86．7％vs.89．5％）差异均无统计学意义（P〉0．05）。两组患者骨折均愈合，尤延迟愈合或不愈合。结论计算机导航辅助手术具有微创、精确的特点，患者和医护人员更加安全，是治疗无移位或移位经牵引能复位的髋臼骨折的一种有效的方法。

Objective To compare isocentric C-arm 3-dimensional （Iso-C 3D） navigation and conventional C-arm fluoroscopy in percutaneous screw fixation for acetabular fractures. Methods From June 2005 to December 2010, 37 patients （23 males and 14 females） with aeetabular fracture were treated through percutaneous screw fixation technique. Their average age was 35.8 years （from 18 to 56 years） . According to AO classification, 9 cases were of A2 type, 18 cases of A3 type, and 10 cases of B1 type. They were assigned into 2 groups. In Group A of 16 cases, the cannulated screws were inserted with assistance of C-arm fluoroscopy, while in Group B of 21 cases, the operations were assisted by Iso-C 3D navigation system. Average operation time, average radiation time, average screw fixation time, average bone union time, functional recovery and satisfactory reduction rate were recorded and compared between the 2 groups. Results Altogether 49 cannulated screws were inserted in 37 patients. No complication was noted in any patient postoperatively. By Matta evaluation system, the operations were rated as excellent in 25, good in 10 and fair in 2, with a good to excellent rate of 94.6%. Thirty-four patients were followed up for 6 to 18 months （average, 12.4 months）. The average screw fixation time （28. 1 ± 1.3 minutes vs. 37.6 ± 1.8 minutes） and the average radiation time （43.9 ± 0. 3 seconds vs. 63.2 ± 2.9 seconds） were significantly shorter in Group B than in Group A （ P 〈 0. 05）. There were no significant between-group differences in average operation time （78.4 ± 2.4 minutes vs. 73. 1 ± 2.0 minutes）, satisfactory reduction rate （93.8% vs. 95.2% ）, average bone union time （12. 1 ± 0. 5 weeks vs. 11.6 ± 0. 3 weeks） or satisfactory functional recovery rate （86.7% vs. 89.5% ） （ P 〉 0.05） . Functional recovery by Majeed evaluation system after 6 months showed 19 excellent cases, 11 good cases, 2 fair cases and 2 poor cases, with a good to excellent rate of 88.2% and no between-group difference. All fractures were healed, and no delayed union or nonunion happened. Conclusions Percutaneous screw fixation under Iso-C 3D navigational system is not only minimally invasive and precise bat also safer to the patient and medical staff. It is a reliable method of treating undisplaced or mildly displaced acetabular fractures.