二维导航与三维导航在经皮骶髂空心钉内固定手术的应用对比

Comparison of two-dimensional and three-dimensional fluoroscopy-based navigation in percutaneous sacroiliac screw internal fixation

目的 比较二维导航与三维导航系统在经皮骶髂空心钉内固定手术中应用的优缺点,并结合两种导航系统优点找到一种更简便、安全的手术方式.方法 分析自2008年6月至2012年10月共41例行经皮骶髂空心钉固定的病例,根据手术方式分为A、B、C3组,A组在二维导航系统辅助下完成手术固定；B组在三维导航系统辅助下完成手术固定；C组在二维导航系统辅助下打入空心钉导针,术中进行3D C臂机扫描验证后行空心钉固定.比较3组手术每枚空心钉置入时间、曝光次数、突破S1椎弓皮质次数.结果 41例患者共置入空心螺钉44枚,平均螺钉置入时间：A组（51.2±5.6）min；B组（67.7±10.7）min；C组（55.3±4.0）min.平均透视次数：A组（74.7±5.6）次；B组（144.1±2.1）次；C组（104.3±1.0）次.除A组1枚螺钉突破S1骨皮质外,其余各组均无螺钉突破S1皮质.结论 结合二维及三维透视导航的优缺点,用二维透视导航系统辅助下打入空心钉导针再行3D C臂机透视扫描验证后行空心钉固定的方法,较三维透视导航手术的手术时间及透视时间短,且与三维透视导航同样具有较高的螺钉置入准确率.

ObJective To compare the advantages and disadvantages oI using lntraoperatlve 2 O1- mensional （2D）-fluoroscopy-based navigation technique and 3D technique used in percutaneous sacroiliac screw internal fixation, and to find a simple and safe operative method by combined the advantages of the two navigation techniques. Methods From June 2008 to October 2012, we retrospective analyzed 41 cases subject to percutancous sacroiliac screw fixation. The cases were divided into three groups of A, B, and C according to the operation method： group A, 2D-navigation technique; group B, 3D-navigation technique; group C： insertion of a guiding pin first with 2D navigation, verification with 3D fluoroscopy and then fixa- tion with cannulated screw. The time of screw insertion, the time of fluoroscopy, and the times of penetrat- ing the vertebrae cortex were compared. Methods We totally used 44 nails, and the mean time of screw insertion in groups A, B and C was （51.2±5.6） , （67.7 ± 10. 7） and （55.3 ±4. 0） min respectively. The mean fluoroscopy times in groups A, B and C were （74. 7 ± 5.6 ）, （ 144. 1 ±2. 1 ） and （ 104. 3± 1. 0）. One screw in the group A penetrated the S1 vertebrae cortex, and the rest two groups had no pene- tration of nails across the S1 vertebrae cortex. Conclusion Combining the advantages and disadvantages of 2D and 3D navigation, the method of inserting a guiding pin with 2D navigation, and using 3D fluoroscopy to verify it, would not only take less time of operation and fluoroscopy, but also has the same screw accura- cy rate as using the 3D navigation technique.