三维数字规划结合导航与单纯导航下经皮髋臼前柱螺钉内固定术的对比研究

Comparative study on digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation for percutaneous screw fixation of acetabulum anterior column fractures

目的对比分析三维数字规划结合导航下经皮髋臼前柱螺钉内固定技术与单纯导航下经皮髋臼前柱螺钉内固定技术的临床疗效。方法采用回顾性病例对照研究分析2015年1月-2016年3月收治的19例采用导航下经皮髋臼前柱螺钉内固定治疗的累及前柱髋臼骨折患者，其中男12例，女7例；年龄21—66岁，平均39．3岁。骨折按AO分型：A3型17例，B1型2例。根据术前是否应用三维数字规划分为三维数字规划结合导航组（A组，9例）和单纯导航组（B组，10例）。A组常规行术前X线片、CT平扫以及三维重建等检查，并应用Mimics计算机外科辅助软件在健侧髋臼模拟手术置入前柱螺钉；B组行常规术前检查，不进行术前模拟规划。比较两组前柱螺钉置入时间、出血量、透视次数、骨折复位质量、末次随访时Majeed骨盆骨折评分等。结果19例患者均获随访3—12个月，平均8．4个月。A、B组出血量分别为（14．1±3．0）ml、（15．1±2．2）ml，骨折复位优良率分别为89％（8／9）、80％（8／10），末次随访时M6eed骨盆骨折功能评分优良率分别为89％（8／9）、80％（8／10），差异均无统计学意义（P〉0．05）。A组每枚前柱螺钉置入时间为（22．4±3．4）min，少于B组的（29．4±4．5）min（P〈0．05）。A组前柱螺钉置入透视次数为（24．9±3．8）次，少于B组的（30．5±5．8）次（P〈0．05）。结论三维数字规划结合导航可减少导航下经皮髋臼前柱螺钉内固定术的螺钉置入时间、术中透视次数，是一种有效的导航下经皮髋臼前柱螺钉内固定术的辅助手段。

Objective To compare the clinical effect of digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation for percutaneous screw fixation of aeetabulum anterior column fractures. Methods A retrospeetiveease-control analysis was made on 19 cases undergone percutaneous screw fixation of acetabular anterior column fractures under image-based computer navigation from January 2015 to 2016 March. There were 12 males and 7 females, aged from 21 to 66 years （ mean, 39. 3 years ）. AO fracture classification was A3 type in 17 cases and B1 type in 2. Based on the application of three-dimensional digital programming, the cases were assigned to two groups： group A （n = 9 ）, virtual three-dimensional model was reconstructed and the virtual screw were inserted to uninjured side by software Mimics and group B （n = 10 ）, patients were only prepared for routine preoperative preparation. Time of anterior column screw insertion, intraoperative bleeding, intraoperative fluoroscopy frequency, fracture reduction and Majeed score were compared between the two groups. Results All cases were followed up for mean 8.4 months （range, 3-12 months）. There were no significant differences between groups A and group B in intraoperative bleeding [ （ 14. 1 ±3.0） ml, （ 15. 1 ±2.2） ml], good to excellent rate of reduction （89% , 80% ） , good to excellent rate of Majeed score （ 89% , 80% ） （ P 〉 0.05 ）. Time of anterior column screw insertion [ （ 22.4 ±3.4 ） min] and intraoperative fluoroscopy frequency [ （ 24.9 ±3.8 ） times] in group A were significantly less than those [ （ 29.4 ±4.5 ） min, （ 30.5 ±5.8 ） times ] in group B （ P 〈 0.05 ）. Conclusion Digital orthopedic three-dimensional visualization technology is associated with shortened time of anterior column screw insertion and reduced intraoperative fluoroscopy frequency, indicating an effective adjuvant technique for percutaneous screw fixation of acetabulum anterior column under navigation.