3D影像导航辅助经皮骶髂螺钉置入治疗骨盆后环损伤

Accessorial effect of 3D-fluoroscopic navigated percutaneous screw fixation in the treatment of posterior pelvic ring injuries

【目的】评价3D影像导航辅助经皮骶髂螺钉置入治疗骨盆后环损伤的安全性和治疗效果。【方法】回顾我院骨科2009年3月-2012年12月采取3D影像导航辅助经皮置入骶髂螺钉治疗骨盆后环损伤患者18例,平均年龄40.2岁（23～61岁）;交通伤12例,坠落伤5例,房屋倒塌砸伤1例。根据AO骨折分型：B 1.2型3例,B 2.2 2例,C1.2型7例,C1.3型5例,C 2.3 1例。【结果】术中共计置入骶髂螺钉40枚,每枚螺钉置入平均耗时（29.12±3.00）min,每枚螺钉术中平均透视（4.55±0.80）min。所有螺钉置入位置均较为满意,无伤口感染发生,所有患者术后均未出现明显神经系统并发症。采用Matta标准评价骨折复位情况：优12例,良5例,可1例。采用Maieed评估体系进行术后功能评价：优11例,良7例。【结论】研究显示3D影像导航辅助经皮骶髂螺钉置入技术是一种治疗骨盆后环损伤的有效方法。

【Objective】To evaluate the security and effect of 3D-fluoroscopic navigated percutaneous screw fixation in the treatment of posterior pelvic ring injuries.【MGthods】 18 patients（from March 2009 to December 2012） with posterior pelvic ring injuries were treated with 3D-fluoroscopic navigation.There were 13 males and 5 females with an average age of 40.2 years（ranged from 23 to 61years）.12 cases were caused by traffic accidents,5 cases by high fall,and1 case by collapsed building.Based on AO classification,there were 3 cases of B 1.2 type,2 cases of B2.2 type,7 cases of C1.2 type,5 cases of CL3 type,and 1 cases of C2.3 type.The perioperative data and radiographic outcomes of the patients were collected and analyzed.【 Results】 A total of 40 iliosacral screws were inserted.The mine time of navigated sacroiliac screw was（29.12 ± 3.00） min.The mine time of intra-operative fluoroscopy was（4.55 ± 0.80） min.No screw misplacement was observed in intraoperative fluoroscopic control images.No wound infection or iatrogenic neurovascular damage was observed.The following results were obtained with respect to the Matta score：12 X excellent,5 × good results,1 × fair result.According to Majeed functional scoring,the results were excellent in 11 cases and good in 7 cases.【Conclusion 】 Our results showed that 3D-fluoroscopic navigation technique for the pelvic ring injuries could become a safe and effective alterative method for the treatment of pelvic ring injuries.