数字技术与CT引导的经皮骶髂螺钉固定骶髂复合体损伤

Percutaneous sacroiliac screw fixation for injured sacroiliac complex with computer-aided orthopaedics techniques and CT guidance

目的评价数字技术与CT引导的经皮骶髂螺钉固定骶髂复合体损伤的疗效与安全性。方法采用经皮骶髂螺钉固定骶髂复合体损伤14例,包括骶骨骨折8例,其中DenisⅠ型骶骨骨折5例,DenisⅡ型骶骨骨折3例;骶髂关节脱位5例,骶髂关节骨折脱位1例。术前行螺旋CT扫描、三维重建,在计算机中模拟手术,确定个性化的进钉点和进钉方向。在CT引导下进行手术。结果手术时间为20～43min,平均28min。1例于术中钻入导针时出现一过性腹部疼痛,扫描发现导针钻入过长,退出后疼痛消失,术后复查大小便常规正常。未发生伤口和深部感染。未发现螺钉松动断裂、双下肢不等长和骨盆畸形等。术后均获随访。14例均恢复工作。术后X线及/或CT扫描显示螺钉位置良好。术后3～4个月均获骨性愈合。根据Matta评分标准评定,优11例,良3例。Majeed功能评分,优12例,良2例。结论数字技术和CT引导的经皮骶髂螺钉技术是一种微创、安全、可靠的骶髂复合体损伤的固定方法。

【Objective】 To evaluate the effectiveness of percutaneous sacroiliac screw fixation with computer-aided orthopaedics techniques and CT guidance in the treatment of injured sacroiliac complex.【Methods】 14 patients with injured sacroiliac complex were treated with percutaneous sacroiliac screws fixation with computer-aided orthopaedics techniques and CT guidance.Of 14 patients,8 had sacral fractures（5 type I and 3 type II sacral fractures according to Denis classification）,5 had dislocation of sacroiliac joint,and 1 had fracture-dislocation of sacroiliac joint.Before operation,CT scan and 3D reconstruction were taken.Simulating operation was performed to determine the individualized nail inserting point and nail inserting orientation with computer.Then the real operation was performed with CT guidance.【Results】 The average operating time was 28 minutes（20～43 minutes）.Abdominal pain occurred in 1 case in the operation and alleviated after adjusting the guide pin.No postoperative infection,screw loosening and breakage,leg length discrepancy,or pelvic deformity were found.All patients were followed up.All patients returned to their occupation.Postoperative X-ray and/or CT scan revealed excellent screw position.Bone union was obtained in all patients in 3～4 postoperative months.According to Matta criterion for fracture reduction,the results were excellent in 11 cases and good in 3 cases.According to Majeed functional scoring,the results were excellent in 12 cases and good in 2 cases.【Conclusion】 Percutaneous sacroiliac screw fixation with computer aidedorthopaedics techniques and CT guidance is a less invasive,safe,and reliable method in treatment of injured sacroiliac complex.