C型臂透视导航下微创经皮螺钉治疗骶髂关节复合体损伤

C-arm fluoroscopy- navigated minimally invasive percutaneous screw in treatment of sacroiliac joint complex injury

目的探讨C型臂透视导航下微创经皮螺钉内固定治疗骶髂关节复合体损伤的方法及疗效。方法 2009年10月-2011年8月本院收治骶髂关节复合体损伤患者12例,男9例,女3例。年龄19~67岁,平均39岁。骨折按Tile分型：B2型3例、B3型2例;C1型5例、C2型2例。应用C型臂透视导航下行微创经皮螺钉治疗骶髂关节复合体损伤。术后X线片用Mears复位标准评价,术后功能用Majeed功能评分标准评价。结果 12例共置入16枚螺钉;手术时间42（29~97）min,平均出血量8（1~20）ml,术中透视时间3.3（1.4~6.1）min。12例均获得随访,时间13（11~25）个月。术后X线及CT示骶髂关节复合体损伤均复位,螺钉固定位置好,均无医源性神经、血管损伤。术后2例下地活动后出现骶髂部轻度疼痛不适,给予药物治疗疼痛症状缓解;1例遗留轻度移位,无血管神经损伤等并发症;9例已重返社区。按Mears复位标准,解剖复位8例,满意复位4例,无复位不满意病例。Majeed功能评价,优8例,良3例,可1例,优良率91.7%。结论 C型臂透视导航下微创经皮螺钉治疗骶髂关节复合体损伤可提高螺钉的精准度,降低术后并发症的发生率,利于患者早期功能康复。

Objective To study the C-arm fluoroscopy-navigated minimally invasive percutaneous screw in treatment of sacroiliac joint complex injury.Methods Twelve sacroiliac joint complex injury patients（9 males and 3 females） aged 19-67 years（mean 39 years） admitted to our hospital from October 2009 to August 2011 were included in this study.Of these patients,3 were diagnosed as B2,2 as B3,5 as Cl and 2 as C2 according to the Tile classification system.The patients underwent C-arm fluoroscopy-navigated minimally invasive percutaneous screw.Their postoperative X-ray films were evaluated according to the Mears reduction standard and their postoperative function was scored following the Majeed criteria.Results A total of 16 screws were inserted in 12 patients.The average operation time was 42 min（ranging 29-97 min）.The average blood loss was 8 ml（range 1-20 ml）.The average fluoroscopy time was 3.3 min（range 1.4-6.1 min）.The patients were followed up for 11-25 months.The postoperative pelvic X-ray and CT scan showed that the sacroiliac joint complex injury had a good reduction and all the screws were exactly positioned except for mild shift in 1 patient.No complications occurred,such as iatrogenic nerve and vascular injury.Postoperative mild sacroiliac pain and discomfort occurred in 2 patients when they leaved their sickbed and were relieved after drug treatment.Nine patients returned to their community.Anatomy reduction was achieved in 8 patients according to the Mears reduction standard.Of the 12 patients,8 had an excellent outcome,3 a good outcome,and 1 a fair outcome according to the Majeed function evaluation standards,with an excellent and good rate of 91.7%.Conclusion C-arm fluoroscopy-navigated minimally invasive percutaneous screw can increase the reduction accuracy of sacroiliac joint complex injury and reduce the incidence of postoperative complications,thus contributing to the early function recovery of patients.