计算机辅助导航髋关节周围骨折及骨盆前后环骨折微创固定

MINIMALLY INVASIVE FIXATION UNDER COMPUTER-ASSISTED NAVIGATION FOR TREATMENT OF PERIACETABUL AR FRACTURES,ANTERIOR AND POSTERIOR PELVIC RING FRACTURES

目的探讨计算机辅助导航技术在髋关节周围骨折及骨盆前后环骨折微创固定中的应用及技术要点。方法回顾分析2010年5月-2011年5月采用闭合复位、计算机辅助导航微创固定治疗髋关节周围骨折及骨盆前后环骨折,且随访达2年以上的39例患者临床资料。其中男21例,女18例;年龄15-64岁,平均36岁;交通事故伤23例,重物压伤6例,高处坠落伤10例。髋臼骨折6例,股骨颈骨折6例,骶髂关节骨折脱位18例,耻骨联合分离及耻骨支骨折15例。均采用闭合复位或小切口撬拔复位,计算机辅助导航下空心钉内固定。结果术中共植入空心螺钉89枚,其中髋臼8枚,股骨颈18枚,骶髂关节33枚,耻骨联合及耻骨支30枚。每枚螺钉植入时间11-38 min,平均20 min;术中出血10-50 mL,平均20 mL。术后骨盆X线片及三维CT示骨折均获良好复位,螺钉无错误植入。术后切口均I期愈合,无感染及内固定失败发生,无神经、血管及其他脏器损伤等并发症发生。39例患者均获随访,随访时间27-33个月,平均29.6个月。患者于术后6-12周,平均8周开始完全负重行走;末次随访时患者平地步行、单足站立、下蹲等功能恢复良好,均回归正常生活及工作。结论计算机辅助导航微创固定治疗髋关节周围骨折及骨盆前后环骨折具有创伤小、术中失血少、并发症发生率低、术后无需输血、无需使用抗生素、患者恢复快等优点,是治疗髋关节周围骨折及骨盆前后环骨折的一种较好方法。

Objective To investigate the application and technical essentials of computer-assisted navigation in the surgical management of periacetabular fractures and pelvic fractures. Methods Between May 2010 and May 2011,39 patients with periacetabular or anterior and posterior pelvic ring fractures were treated by minimally invasive fixation under computer-assisted navigation and were followed up more than 2 years,and the clinical data were analyzed retrospectively. There were 21 males and 18 females,aged 15-64 years（mean,36 years）. Fractures were caused by traffic accident in 23 cases,crush injury in 6 cases,and falling from height in 10 cases. Of them,6 cases had acetabular fractures; 6 cases had femoral neck fractures; 18 cases had dislocation of sacroiliac joint; and 15 cases had anterior pelvic ring injuries. All patients were treated with closed or limited open reduction and screw fixations assisted with navigation. Results Eighty-nine screws were inserted during operation,including 8 in the acetabulum,18 in the neck of the femur,33 in the sacroiliac joint,and 30 in the symphysis pubis and pubic rami. The mean time of screw implanted was 20 minutes（range,11-38 minutes）,and the average blood loss volume was 20 mL（range,10-50 mL）. The postoperative pelvic X-ray and three dimensional CT scan showed good reduction of fractures and good position of the screws. No incision infection,neurovascular injury,or implant failure occurred. All patients were followed up 27-33 months with an average of 29.6 months. The patients could walk with full weight loading at 6-12 weeks after operation（mean,8 weeks）; at last follow-up,the patients could walk on the flat ground,stand with one leg,and squat down,and they recovered well enough to do their job and to live a normal life. Conclusion Minimally invasive fixation under computer-assisted navigation may be an excellent method to treat some specific types of periacetabular and anterior and posterior pelvic ring fractures because it has the advantages of less trauma and blood loss,lower complication incidence,and faster recovery.